Trembling, slowness and stiffness are annoying symptoms of Parkinson’s disease. Small electrical impulses in the brain, so-called deep brain stimulation (DBS), can help. To do this, a neurosurgeon places two electrodes in a deep part of the brain through holes in the skull. The electrodes give electrical impulses via a pacemaker, which can greatly reduce the complaints. In the Netherlands, this involves three hundred procedures per year.
Coffee bean
In the classic surgical method, the patient is largely awake. “This method is thirty years old,” says neurosurgeon Saman Vinke. “The surgeon uses small currents to find the right place for the electrodes. Thanks to the awake state, the surgeon can immediately check whether the symptoms are improving.” But there are drawbacks to this classical method. For example, the operation takes almost an entire working day, most of which the patient is awake with the head fixed. In addition, the patient has to temporarily stop taking medication, which makes the complaints worse.
Vinke investigated whether the measurements and tests during the operation, for which a patient must be awake and without medication, contribute to determining the best position for the DBS electrode. “Such an electrode is the size of a spaghetti strap. We place it in a core in the brain the size of a coffee bean, the so-called subthalamic nucleus,” explains Vinke. “We use a custom-made MRI scan, which allows us to properly detect the coffee bean. Our study shows that the measurements and tests do not contribute to determining the correct place to place the spaghetti string when we use this MRI .”
More women
Thanks to the MRI scan, doctors can perform the operation under anesthesia, which offers great advantages. Vinke: “The procedure is much shorter. We can now operate on two patients in one day instead of one. In addition, patients continue to take their medication, so that the symptoms remain stable before the operation.”
Another striking advantage that Vinke describes in his dissertation is that women in particular opt much more often for DBS surgery if it can be performed under anesthesia. “Parkinson’s disease occurs in 40 percent of cases in women. But in our study, only 17 percent of patients with the classic surgical method were women,” explains Vinke. “Since we started operating under anesthesia, that percentage has risen to over forty percent, as the disease is also distributed in the population.” Vinke could not figure out why women opt less for an awake operation. This will be further investigated in follow-up research.
By: National Care Guide