DBS Relieves Parkinson's and Essential Tremor Symptoms

North Kansas City Hospital is the only hospital in the Northland to offer deep brain stimulation for patients with Parkinson’s disease and essential tremor. A surgical treatment, DBS uses electrical impulses to reduce tremors


and block involuntary movements. Although DBS is not curative, most patients experience an improved quality of life.

“We strive for a 100% reduction in symptoms, but realistically we usually see at least an 80%-90% change,” said Larry C. Hollenbeck, MD, FAAN, a neurologist with Meritas Health Neurology. “It’s amazing how DBS improves symptoms, quality of life and life expectancy. It’s very effective and gives patients a new lease on life.”

Candidates

Dr. Hollenbeck first examines patients in his clinic to determine whether they will benefit from DBS. People with Parkinson’s disease and essential tremor have different requirements:

• Parkinson’s disease: If their medications are less effective at controlling tremors and if they still respond to levodopa
• Essential tremor: If the two major classes of medications no longer alleviate symptoms

“Age is also a factor for all patients,” Dr. Hollenbeck added. “We usually do not recommend DBS for people over 80 because of the risk of cognitive impairment afterward.”

After confirming candidacy for DBS, Michael J. Kinsman, MD, a neurosurgeon with Kansas University Neurological Surgery, meets with the patient in his NKCH clinic, located in the Hospital Services Pavilion, to go over the procedure.

“For people with Parkinson’s disease whose symptoms fluctuate between medication doses, DBS will prevent those fluctuations,” Dr. Kinsman said. “For people with essential tremor, DBS also makes a huge difference because it allows them to be more functional and less embarrassed about being in public.”

Surgery

DBS requires two surgeries. During the first procedure, Dr. Kinsman uses imaging technology to implant electrodes in areas of the brain responsible for movement, and extension wires that ultimately will lead to a neurostimulation device.

DBS involves one surgery to implant electrodes


and leads and a second to place a battery-powered


neurostimulator. Illustration: Medtronic

During the two-hour surgery, the patient is sedated. The patient remains in the hospital overnight in an ICU. One week later, Dr. Kinsman performs a 45-minute outpatient procedure during which he places the battery-powered neurostimulation device, which is like a pacemaker, under the collarbone and connects it to the previously placed leads.

Dr. Kinsman concurs with Dr. Hollenbeck regarding patient feedback. “The vast majority of patients usually have a very significant improvement in their symptoms and quality of life, so they are quite happy with the results,” Dr. Kinsman said.

DBS Programming

A few weeks after both surgeries, Dr. Hollenbeck meets with the patient to program the neurotransmitter, tweaking frequency, voltage and pulse width on four different contacts within each of the two leads.

The patient receives a controller that turns the device on and off. The battery lasts between five to seven years, depending on the patient’s stimulation settings.

Larry C. Hollenbeck, MD, FAAN

Dr. Hollenbeck earned his medical degree from the University of Kansas School of Medicine. He completed his internal medicine internship at Saint Luke’s Hospital and neurology residency at the University of Kansas School of Medicine.

Michael J. Kinsman, MD

Dr. Kinsman holds a medical degree from the Indiana University School of Medicine. He completed his residency in neurosurgery at the University of Louisville School of Medicine and a fellowship in stereotactic and functional neurosurgery at Oregon Health Sciences University.