What is the Deep Brain Stimulation Success rate for Parkinson’s?

Deep Brain Stimulation Success rate for Parkinson’s disease is excellent.

According to Medtronic’s data, 85-90% of patients have significant improvement after DBS.

DBS does not reduce all symptoms equally. It reduces some symptoms more than others.

In most cases:

  • DBS reduces the major symptoms of shaking, stiffness and slowness.
  • Patients walk faster. However, DBS does not reduce imbalance.
  • DBS reduces many non-motor symptoms of Parkinson’s disease. But it may worsen thinking problems & depression.

So, we should discuss Deep Brain Stimulation Success rate under different headings.

Please note that this is the average improvement after DBS. A few patients may not benefit. The reasons for DBS failure are also described below.

Let us begin.

Deep Brain Stimulation Success rate for Shaking, slowness and stiffness

Shaking (Tremor) responds very well to DBS. In most cases, the severity of tremor decreases by more than half (>50%).

In the future, customized DBS may reduce tremor by almost 90%. Customized DBS includes putting the wire into other targets (such as the zona inserta). Currently, we can use this data during programming to stimulate these areas as well.

Tremor e1573658344750
DBS is very successful in reducing uncontrolled shaking (Tremor).

Tremor is the most noticeable symptom of Parkinson’s. But, most patients complain that stiffness and slowness are most disabling.

DBS works great in reducing these symptoms as well. Both are reduced by more than half (>50%). Again, future customized DBS may be even more successful.

 

Deep Brain Stimulation Success rate for Walking and imbalance

As expected, patients with Parkinson’s walk slowly. They may also have episodes when they feel “stuck” to the ground. This is called “Freezing”.

After DBS, patients walk much faster. Also, “Freezing” is reduced.

walking
DBS enables patients to walk faster. Also, they get fewer episodes of feeling “stuck” to the ground (Freezing).

What is the problem?

DBS does not improve balance. In about 1/3rd of patients, it may worsen balance.

So are falls more common after DBS?

No. Most studies indicate that falls decrease after DBS. For example, Dr. Karachi reported that falls reduced in 1/3rd of patients after DBS.

You see, one of the major cause of falls is “Freezing” of gait. Reduction in “freezing” leads to a reduction in falls.

Again, this is an average. If you are falling due to instability rather than freezing, you may fall more often after DBS (see box).

If I fall often, should I get DBS?
You should discuss 3 questions with your doctor:

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.

Falling e1574089012814
If you are falling down often, you should find out the reason why you are falling BEFORE you get DBS surgery.

Deep Brain Stimulation Success rate for Non-Motor symptoms

Patients with Parkinson’s disease have non-movement problems as well. These include sleep problems, constipation, pain and many others. You can find articles on these problems on the site.

Thankfully, DBS decreases many of these non-motor problems. For example, sleep improves after DBS. I, along with my colleagues at Kings college, published a research paper on improvement in sleep after DBS in 2018.

people 2537324 1920
DBS improves sleep and many other non-motor symptoms of Parkinson’s.

The effect of DBS on some non-motor symptoms is unknown. For example, we don’t know if DBS reduces excessive sweating and urinary problems.

Unfortunately, DBS may worsen a few non-motor symptoms.

  • If you already have thinking/memory problems, DBS may worsen them.
  • If you already have severe depression, DBS may worsen it.

This possible worsening is important to consider. Please read these two articles to know more: [Good DBS surgical candidate] [DBS risks].

 

Deep Brain Stimulation Success rate for Motor fluctuations

Before going on, let us look at the simple terms “OFF” and “ON”.

  • OFF is how a Parkinson’s patient is without symptoms – he/she has very severe symptoms.
  • ON is how a patient is when his treatment is working well – he has few symptoms.

In late Parkinson’s disease, medications effect becomes inconsistent. This causes “Motor fluctuations”.

Parkinsons Fluctuations
In late Parkinson’s disease, your day may seem like a roller coaster ride. You are ON during some hours, and OFF during other hours. These ups and downs are called “Motor Fluctuations”.

Let us look at the 2 most common motor fluctuations:

  • Some patients report that their medications stop working after a few hours. They become “OFF”. This is called “Predictable wearing-OFF”.
  • Some patients complain that their body shakes a lot after taking medications. This is called “Dyskinesia”.

DBS reduces these fluctuations. On average, patients get 4-5 hours of extra ON-time after DBS. This is the major success of DBS. Also:

  • Even when patients are OFF, their symptoms are less severe.
  • Dyskinesias improve. On average, Dyskinesias are reduced by more than 80%.

Deep Brain Stimulation Success rate for Quality of life

The goal of reducing your symptoms is to improve your quality of life.

So, the ultimate measure of Deep Brain Stimulation Success rate is an improvement in Quality of Life (QOL).

The distinction is crucial. For example, if your slowness decreases by 60-70%, your doctor would be happy. But are you satisfied? Has that enabled you to have a better life?

elegant 3885946 1920
DBS helps you become independent in your ADLs (Activities of Daily Living such as bathing, dressing, eating, etc.).

Does a high Deep Brain Stimulation Success rate enable you to have a better life?

Yes.

The evidence behind this is quite robust. In multiple studies, patients have reported improved quality of life after DBS.

For example, ADL means activities of daily living – bathing, dressing etc. Many patients can perform ADLs better after DBS.

For all these symptoms, the progression of underlying Parkinson’s itself may worsen QOL and ADL in some patients.

Improvement in movement (especially slowness) improves your quality of life. But, if your quality of life is low due to other symptoms such as depression, DBS may not improve it. These other factors need to be separately treated.

In how many patients does DBS fail completely?

About 10-15 %.

It is difficult to confirm that there is no improvement in ANY of the symptoms mentioned above. Medtronic reports this data on its website [here].

DBS Success rate
A few patients may not respond to DBS.

But that is not the end of the story. Some of these initial DBS failures can be converted into successes.

A recent study looked at 14 patients who initially did not respond to DBS. [Study available here]

This study was conducted by the University of Florida & Harvard University. A majority of these patients had been diagnosed with Parkinson’s disease before DBS.

The most common reasons for failure were:

  • Misdiagnosis. (the patient did not have Parkinson’s disease) [read more]
  • Incorrectly placed electrode. (the wire was not inside the DBS target) [read more]
  • Incorrect programming. (the DBS settings were not correct)
  • Incorrect medications (After DBS, the medications were not properly adjusted)

After they rectified these errors, 21 patients (slightly more than half) improved.

So, with careful post-operative care, the Deep Brain Stimulation Success rate may be higher.

Bottom line: How many patients are happy they had DBS

Here are the most critical questions. Are people who had the DBS happy with their decision? Would they recommend it to others?

This is an excellent way of measuring the Deep Brain Stimulation Success rate for Parkinson’s disease.

The results are very encouraging.

For example, in 2019, doctors from the University of Pennsylvania asked these questions to 320 patients who had DBS for Parkinson’s disease.

  • 92.5% of patients were happy with DBS.
  • 95% would recommend DBS to another patient with Parkinson’s.
  • 75% reported that it still controlled their symptoms.
startup 3373320 1920
More than 90% of people who have DBS surgery for Parkinson’s disease are happy with it. Most of them would recommend it to others.
Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & 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.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.7 57 reviews

  • Avatar JAIKUMAR MANI ★★★★★ in the last week
    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
  • Avatar Rohit shetye ★★★★★ 3 weeks ago
    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
  • Avatar Ashish Patil ★★★★★ 4 weeks ago
    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
  • Avatar Bianca D'silva ★★★★★ in the last week
    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
  • Avatar Neelam Satghare ★★★★★ 4 weeks ago
    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
  • Avatar Nitin Ghotge ★★★★★ 4 weeks ago
    Dr.Sidharth Kharkar is one of the best neurologist i came across ....He is really genuine and focused .....We really satisfied after consultancy...
  • Avatar Krishna kumari Radhakrishnan ★★★★★ 2 months ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
  • Avatar a kumar ★★★★★ 4 weeks ago
    Dr kharkar is very nice doctor, sir explained each and every thing very nicely, and i am thankful for Dr kharkar for his treatment .
  • Avatar Nidhi Sonawane ★★★★★ 3 months ago
    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ 4 weeks ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ 4 months ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
  • Avatar Govind Patel ★★★★★ 2 months ago
    Doctor explained very Good nice person give length time to check body
  • Avatar Sharmila Kumawat ★★★★★ 6 months ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

Leave a Comment

India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai