Aug. 30, 2006 -- Brain surgery might make the ordeal of Parkinson's disease a little easier for some patients, according to a study published in this week's issue of the New England Journal of Medicine.
While several medications can help control the symptoms of this degenerative disease, they can produce side effects, including uncontrollable body movements that can be almost as disturbing as the shaking and tremors of the disease itself.
Parkinson's affects 1.5 million Americans. It can take away a person's ability to move by causing tremors, stiffness, shuffled walk, muffled speech. The new study confirms that a surgery to provide deep-brain stimulation, or DBS, might help when medications have failed.
"For patients and their families, this is a landmark study because it focuses on what is really important to them: quality of life. And it shows, very clearly, that DBS improves quality of life," said Dr. Jaimie Henderson, director of stereotactic and functional neurosurgery at Stanford University Medical Center.
The study followed 156 patients with severe Parkinson's disease, all under the age of 75. Half of the patients took medications to manage their disease, while the others received DBS.
During the procedure, a battery-operated neurostimulator is surgically implanted into the brain. That stimulator can improve motor symptoms in some Parkinson's patients by blocking the abnormal nerve signals that cause tremors and other symptoms.
According to the study, patients treated with this surgery had better mobility, quality of life and emotional well-being than the patients who received standard medications.
Promising Results, Yet Caution Advised
Most doctors already know that deep-brain stimulation helps Parkinson's patients, but this study is the first to prove that the surgery brings greater overall benefits.
"This may be the first published article to demonstrate … that surgery is better than the best medical therapy," said Dr. Gordon Baltuch, director of the Center for Functional and Restorative Neurosurgery at the University of Pennsylvania.
The study is also important because it shows that DBS can help make life better for those with Parkinson's, given how patients feel after the surgery.
Some doctors suggest this study will have an impact on the treatment of patients, as the surgery might become more widely used.
Dr. Daniel Tarsy, director of the Parkinson's Disease and Movement Disorders Center at Boston's Beth Israel Deaconess Medical Center, said, "At present, DBS is often regarded as somewhat of a last-ditch effort to improve function in patients with advanced PD. … The findings of this study should lead to greater use of surgery for treatment of this group of patients."
"Hopefully, this study will provide enough evidence to convince these physicians of what functional neurosurgeons have known for years: DBS is the best treatment for Parkinson's disease when medicine begins to fail," Henderson said.
The surgery is not fail-safe. While medications generally bring more side effects than the surgery, serious side effects were more common among patients who received the neurostimulator. One study patient actually died during the brain surgery.
One doctor voiced concern about the enthusiasm this study might generate. "It is important to stress that DBS is not a cure," said Dr. William J. Weiner, director of the Maryland Parkinson's Disease and Movement Disorders Center.
He said the study also does not help doctors understand if the surgery is best for patients early in their diagnosis, or for those with more advanced cases of the disease.
"This study will not help us decide this issue, and there may be an over reaction to the results of the study," Weiner said. "It may also push patients and neurologists into performing DBS before it is required."
Brain surgery might not be the best option for all patients. But for some, this neurostimulator could be life changing.