Deep Brain Stimulation for Parkinson’s Disease

PARKINSON’S DISEASE (PD) is a chronic and degenerative brain disorder that results in motor impairment. After 4 to 6 years of treatment, medication-induced complications can develop. As the disease advances, symptoms become more severe and other problems related to the patient’s gait, cognition and musculoskeletal system develop.
In Singapore, PD is the second most common neurological disorder. Local studies have shown that the disease occurs in three out of every 1,000 people aged 50 and above. It is estimated that there are between 4,000 to 5,000 PD patients in Singapore [1].

Oral medication is the standard of care in early PD; however, as the disease progresses and medication-induced complications develop, patients may become refractory to this treatment option.

Deep Brain Stimulation (DBS) is the most common surgical treatment performed on people with PD, when medications alone are no longer able to adequately control their motor symptoms. It is also required when medication-related problems, particularly levodopa-induced dyskinesia (involuntary movements) and motor fluctuations, significantly affect the quality of life of the patient.

DBS therapy is an adjustable and reversible surgical treatment and more than 140,000 patients worldwide have been treated with DBS. In Singapore, more than 100 patients have benefited from DBS therapy. DBS has been approved for the following indications:

  • Essential tremor
  • Parkinson’s disease
  • Primary dystonia
  • Obsessive-compulsive disorder
  • Epilepsy

PD is clinically defined by the presence of bradykinesia (slowness in movement), with at least one cardinal motor feature (rigidity or rest tremor).

In addition to the cardinal motor features, patients with PD also have non-motor symptoms involving a multitude of functions, such as disorders of the sleep–wake cycle regulation, cognitive impairment, disorders of mood and affect, autonomic dysfunction (mainly orthostatic hypotension, urogenital dysfunction, constipation and hyperhidrosis), as well as sensory symptoms (most prominently hyposmia) and pain.

Deep Brain Stimulation for Parkinson’s Disease Deep Brain Stimulation for Parkinson’s Disease