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Deep Brain Stimulation for Movement Disorders

  • Education and Training
  • Efficacy
  • Products and Procedures
  • Reimbursement and Practice Management
  • Indications, Safety, and Warnings
  • Patient Selection

    These resources can help identify patients who may be candidates for deep brain stimulation.

    Parkinson's Disease

    Candidates

    Consider deep brain stimulation when a patient has:

    • Symptoms of levodopa-responsive Parkinson's disease of at least 4 years' duration that are not adequately controlled with medication.
    • And motor complications of recent onset (from 4 months to 3 years) or motor complications of longer-standing duration.

    A patient must also be a suitable candidate for stereotactic neurosurgery.

    In 2002, the FDA initially approved Medtronic DBS Therapy for use in patients with advanced Parkinson’s disease. Medtronic DBS of the STN improved quality of life and motor function as shown in a Level I evidence clinical study of patients of at least 4 years disease duration and recent onset of motor complications.1 Based on the clinical evidence, in 2015 the FDA approved Medtronic DBS Therapy for use in people with Parkinson’s disease starting with those who have recent onset of motor complications. This means clinicians no longer have to delay consideration of Medtronic DBS Therapy until the disease has become debilitating.

    Medtronic DBS Therapy is also appropriate for patients with longer-standing motor complications, and there is no upper age limit restriction, as shown in a post-approval Level 1 evidence clinical trial.2

    The safety and effectiveness of deep brain stimulation therapy for Parkinson's disease have not been established for patients who:

    • Have a neurological disease other than idiopathic Parkinson's disease
    • Had a surgical ablation procedure
    • Are pregnant
    • Are under the age of 18
    • Have dementia
    • Have coagulopathies
    • Have moderate to severe depression

    Assessment Tools

    Assess DBS PD is an online tool to help identify those Parkinson's patients with longer-standing motor complications who may be appropriate referral candidates for deep brain stimulation. Available as an app or software, Assess DBS PD calculates a level of recommendation based on 6 absolute screening criteria and 7 relevant clinical variables. The recommendations reflect the opinions of a panel of leading neurologists who specialize in movement disorders and deep brain stimulation.

    Download Assess DBS PD

    An app and web-based tool to help identify Parkinson's disease patients who may be appropriate referral candidates for DBS Therapy.


    Referral for Evaluation

    Clinicians may refer candidates to a DBS multidisciplinary center for a comprehensive evaluation for possible Medtronic DBS Therapy.

    The evaluation usually includes: 

    • Medical history
    • Neurological exam of movements, both on and off medications
    • MRI of the brain to check whether there are any issues that would pose a risk during the surgery
    • Lab tests, such as a blood test to make sure blood clots properly
    • Neuropsychological tests

    Window of Opportunity

    Deep brain stimulation for Parkinson's disease has a window of opportunity when it may be most effective.

    The window opens when a patient has Parkinson's disease of at least 4 years' duration that is not adequately controlled by medication, including motor complications for at least 4 months or motor complications of longer-standing duration. You may observe one or more of the following:

    • "On" time characterized by disabling dyskinesias (or other nonmotor side effects)
    • "Off" time characterized by disabling tremor, rigidity, or akinesia/bradykinesia
    • Unpredicable "on/off" motor fluctuations
    • Medication-resistant tremor

    The window closes when:

    • Symptoms no longer respond to dopaminergic medication.
    • The patient is severely disabled even in the best "on" state.
    • Medical conditions prevent surgery.
    • The patient has dementia.

    Introducing patients to DBS as a future option early in the disease progression can help prepare them to start therapy in time to take advantage of their window of opportunity.

    References
    1. Schuepbach WMM, Rau J, Knudsen K, et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med. February 14, 2013; 368:610-622.
    2. Medtronic DBS Therapy for Parkinsons’ Disease and Essential Tremor Clinical Summary, 2015.

    Essential Tremor

    Deep brain stimulation should be considered when a patient with essential tremor has disabling symptoms and medications are ineffective or have intolerable side effects.

    Candidates

    Patients with essential tremor may be candidates for deep brain stimulation if:

    • They have a disabling tremor of an upper extremity due to essential tremor or parkinsonian tremor.
    • The tremor causes a significant functional disability.
    • The tremor is refractory to pharmacological therapies.
    • They are suitable candidates for stereotactic neurosurgery.
    • The tremor is of physiologic origin.

    The safety and effectiveness of deep brain stimulation therapy for essential tremor has not been established for:

    • Bilateral VIM stimulation
    • Patients with neurological disease origins other than essential tremor or Parkinson’s disease
    • Patients with a previous thalamotomy or surgical ablation procedure
    • Patients who are pregnant
    • Patients under the age of 18 years
    • Patients over the age of 80 years

    Assessment

    The patient should be evaluated to determine the impact of essential tremor on daily life. Deep brain stimulation may be appropriate if:

    • The tremors interfere with activities of daily living such as eating, dressing, or writing.
    • Tremors prevent the patient from working.
    • Medications are ineffective or cause troublesome side effects such as sleepiness, dizziness, or thinking problems.

    Assess DBS ET an online tool to help identify essential tremor patients who may be appropriate referral candidates for deep brain stimulation. The recommendations reflect the opinions of a panel of movement disorder neurologists, all with experience in the field of deep brain stimulation for the management of essential tremor. The tool is available as both an app and website.

    Download Assess DBS ET

    An app and web-based tool to help identify essential tremor patients who may be appropriate referral candidates for DBS Therapy.

     

    Dystonia

    Deep brain stimulation should be considered when a patient with chronic, primary dystonia cannot successfully manage symptoms with medication.

    Candidates

    Deep brain stimulation may be appropriate if the patient:

    • Has chronic, primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia (torticollis)
    • Cannot successfully manage symptoms with medication
    • Is 7 years of age or older
    • Is a suitable candidate for stereotactic neurosurgery

     

    Humanitarian Device: The effectiveness of this device for the treatment of dystonia has not been demonstrated. Learn more about HDE.

    Tools and Resources

    Use these tools and resources to help identify candidates for deep brain stimulation for movement disorders.

    Parkinson’s Disease

    Assess DBS PD

    An app and web-based tool to help identify Parkinson's disease patients who may be appropriate referral candidates for DBS Therapy.

    My Parkinson's Checkup

    Free online patient questionnaire designed to save time and improve communication during a consultation. At home, the patient answers 20 questions about symptoms, side effects, and everyday challenges, then prints a report as a starting point for your further questions and evaluation.

    Symptom Tracker Diary

    The diary explains the importance of keeping an “on” time diary and includes instructions for completing it. 

    Essential Tremor

    Assess DBS ET

    An app and web-based tool to help identify essential tremor patients who may be appropriate referral candidates for deep brain stimulation.

     

    United States