DBS surgery risks & Deep Brain Stimulation side effects

DBS surgery risks & Deep Brain Stimulation side effects are relatively low.

It is very easy to think only about the risks of the surgery itself. But the DBS surgery risk is relatively minor, and described below.

A few weeks after the DBS surgery, the DBS electrical current is switched on. The current decreases Parkinson’s Disease symptoms. But sometimes, Deep Brain Stimulation side effects are seen.

Stimulation can increase certain symptoms such as depression, thinking problems and rarely, falling.

There is a small risk of DBS failure as well (10-15%). Although not a DBS risk as such, it is worthwhile to discuss it here.

Let us learn more.

What are the DBS surgery risks (risk of the actual DBS surgery)?

Although this is surgery on the brain, as compared to other surgeries, it is relatively minor. Therefore the DBS surgery risks are low. But they are not non-existent.

The DBS surgery takes a few hours but is quite safe.

Let us look at one of the largest studies on this topic, to know the DBS surgery risk.

A group of German researchers studied 1,183 patients who had Deep Brain Stimulation (DBS) surgery. This series included patients with Parkinson’s disease as well as with other diseases. These were their findings.

  1. The risk of death was less than 1%. 
  2. About 2% of patients had bleeding inside their head that caused weakness on one side of the body. In many patients, this weakness resolved by itself within 30 days.
  3. A few patients (0.6%) had uncommon problems such as infection.
  4. A few patients (0.6%) had somewhat unrelated problems such as pneumonia.

In short:

  • More than 95% of patients did not have any complications.
  • The risk of death or permanent problems was minimal (about 1%).

Overall, as previously mentioned DBS surgery risks are modest. They are on the lower side of those expected from a major surgery.

Perhaps more important is to consider the long-term side effects of the electrical stimulation itself.

[Click here for the entire study]

What is the risk of long-term Deep Brain Stimulation Side-effects?

A few weeks after the surgery is done, the DBS current (stimulation) is switched on. Most people have marked relief from their Parkinson’s symptoms at this time.

Many people do not have any Deep Brain Stimulation side effects.

But sometimes, the stimulation can cause some characteristic problems.

A few weeks after surgery, the DBS device is switched on. This may cause worsening of some side effects.

Deep Brain Stimulation side effects include possible worsening of 3 symptoms of Parkinson’s disease:

  • It can worsen Depression, if you already have uncontrollable depression.
  • It can worsen Thinking & Memory problems, especially if you already have them.
  • It can worsen falling, if your falling is caused mostly due to instability.

Depression and Memory:

The first two problems usually happen only if you have these problems before DBS as well. This risks can be reduced by making sure you are a good DBS candidate. [Read “Am I a good DBS candidate?”]

If you have uncontrolled deprssion or thinking/memory problems, these need to be controlled before you can have DBS. Also your doctor may recommend DBS of a different brain part called GPi. [Read about DBS targets].

If you have uncontrolled depression, it needs to be treated before you have DBS.

Instability and rarely, falling

Let us think about two things that can cause you to fall if you have Parkinson’s:

  • Imbalance – increases in 1/3rd of patients after DBS.
  • Freezing – decrease in most patients after DBS.

Overall, the beneficial effects outweigh the increased imbalance. So, usually patients fall less often after DBS. 

But if the most important reason for you falling is that you are unstable, you should pause.

And think.

You should ask your doctor these 3 questions, BEFORE DBS.

  1. Why am I falling? Is it because of Freezing or Instability?
  2. Do I have a “Parkinson’s Plus Syndrome”?
  3. Is another problem (for example, B12 deficiency) causing my falls?

If instability is the cause of your falls, proceed only after understanding the pros & cons.

If you have a Parkinson’s plus syndrome, consider not getting DBS.

If you are falling very often, you need to stop and think BEFORE you have DBS.
In summary
DBS improves most symptoms of Parkinson’s disease. But it may worsen three symptoms:

1. Falling: If you are falling because of instability.

2. Thinking/memory: If you already have these problems.

3. Depression: If you already have uncontrollable depression.

No one is perfect. Most patients with Parkinson’s have these symptoms, in greater or lesser severity. This does not mean nobody can get DBS. 

But if you have very severe/uncontrollable problems with any of these three symptoms, you should discuss the pros/cons of DBS in detail with your doctor before proceeding.

What is the risk of DBS failure?

10-15%

Few patients do not get any benefit after DBS. Proper selection of the DBS candidate helps to reduce this risk.

But, even if you don’t improve initially after DBS surgery, there is still hope. A initial DBS failure can be converted into a success.

For example, the University of Florida & Harvard university studied patients who had not improved after DBS.

This study included both Parkinson’s patients and some patients with other diseases.

The most common reasons for failure were:

  • Misdiagnosis. [read more]
  • Incorrectly placed electrode. [read more]
  • Incorrect DBS programming. (the DBS settings needed to be changed)
  • Improper medication adjustment

With optimized care such as changing medication doses and reprogramming the DBS, more than half these patients improved. 

Therefore the DBS risk of failure can be lowered.

You can click here for the entire study.

 

In summary, DBS surgery risks are low. Deep Brain Stimulation side effects are uncommon, provided the evaluation is done carefully, BEFORE DBS.

Ont the other hand, the chances of DBS success are very high. They are described in another article.


Caution:
This information is for educational purposes. It is not a substitute for professional medical diagnosis & treatment. Do not change your medications, supplements or other treatments without your doctor's permission.

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Dr. Siddharth Kharkar

Dr. Siddharth Kharkar is a board certified (American Board of Psychiatry & Neurology certified) Neurologist. He is a Epilepsy specialist & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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