07/18/2017

How Deep Brain Stimulation is improving the quality of life for Parkinson’s, tremor patients

Dr. Jill Trumble simply asked her patient to write her name, and when the patient did, she was met with tears. 

Dr. Jill Trumble, neurologist, St. Joseph's/Candler
Dr. Jill Trumble, neurologist and medical director of the St. Joseph’s/Candler Movement Disorders Program

Those tears came because the patient, who struggles with essential tremor, clearly wrote her name for the first time in 15 years.

Essential tremor is a neurological disorder that causes the hands, head, trunk, voice and/or legs to shake rhythmically. What allowed her to write her name legibly after 15 years was a procedure called Deep Brain Stimulation (DBS).

DBS is a surgical treatment for certain movement disorders, particularly Parkinson’s disease, essential tremor and dystonia, says Trumble, neurologist and medical director of the St. Joseph’s/Candler Movement Disorders Program. The procedure is performed in three stages. Trumble is responsible for making sure patients are the right candidate for the procedure and then programing the stimulator, which in the case above, allowed the patient to legibly write her name.

DBS is not a cure, but for the right candidate, can improve the quality of life, Trumble says.

“Patients are able to get off their medications, or at least decrease their medications, and they are able to do what they need to do to take care of themselves,” says Trumble.

Trumble works with neurosurgeons Dr. Nicolas Arredondo and Dr. Randolph Bishop for a multi-disciplinary approach to treating movement disorders through Deep Brain Stimulation. Trumble first meets with a patient to determine if he or she is a good candidate. Then, over the course of three procedures, three components are put in place. The components include:

  • The lead (also called an electrode) – a thin, insulated wire that is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the targeted brain area.
  • The extension – an insulated wire that is passed under the skin of the head, neck and shoulder and connects the lead to the neurostimulator.
  • The neurostimulator (the battery pack) – may be implanted under the skin near the collarbone, lower in the chest or under the skin over the abdomen.

About two to three weeks following the final procedure, the patient will meet with Trumble to program the stimulator. She is able to adjust and change settings to improve symptoms or decrease side effects. Adjustments can be made to the stimulator throughout the patient’s life as the disease progresses. 

Deep Brain Stimulation Illustration

“The disease, for example Parkinson’s, continues to progress over time so their settings will have to be adjusted, but that’s why Deep Brain Stimulation is so much more beneficial than some of these other surgical procedures such as ultrasounds or radiation because those are lesions in the brain, but as the disease progresses, there’s no changing or altering it,” Trumble says. “With this, because there’s still that stimulator there, I can adjust that overtime to help with their symptoms.”

For essential tremor, Trumble says DBS can improve extremity tremor in the hands or legs and it may or may not improve midline tremor (voice and head). Potential side effects of DBS for essential tremor are worsening balance and speech. 

For Parkinson’s patients, DBS is going to improve their symptoms to the amount their Carbidopa/Levodopa (generic medication to treat Parkinson’s symptoms) does without causing the side effects of dyskinesia – the extra movement that Carbidopa/Levodpa causes, Trumble says. It also can improve tremor. Potential side effects of DBS for Parkinson’s patients are cognitive issues, balance issues, choking and slurred speech.

Trumble adds that if you are the right candidate for DBS, the side effects are typically minimal.

Another success story that Trumble recalls is a Parkinson’s patient who had to take a pill every three hours. Following the DBS procedure, the patient is completely off that medication and is doing great, Trumble says.

DBS is not for every movement disorders patient. Trumble emphasizes the importance of having the right candidate for the procedure. Careful patient selection is the first and perhaps the most important step for successful DBS, and one that Trumble takes seriously. There are no standardized criteria for selecting DBS candidates and cases vary from patient to patient; however, some of the areas considered include age, level of cognitive function, clear diagnosis, degree of disability and understanding and willingness to participate in the multi-stage procedure.

Trumble recommends talking to your doctor and/or scheduling an appointment with a neurologist to find out if you are the right candidate.

Trumble is reminded of an essential tremor patient she recently met with who had the DBS procedure at another facility. He was experiencing complications from the surgery. Trumble learned he had never been put on any medication for his tremor. Now, the patient is successfully treating his tremor with one pill a day and is not using the stimulator, but is still dealing with issues related to the surgery.

“Deep Brain Stimulation is great. It really is beneficial, but realistically it’s great and beneficial for the right patient,” Trumble says. “Don’t just go out and get Deep Brain Stimulation because a friend of yours had it or you saw this video on YouTube and that person did great. You really want to make sure you are a good candidate for it because that’s the only way it’s going to be as beneficial as you see.”

If you’d like to learn more about Deep Brain Stimulation or want to find out if you are a candidate for the procedure, talk to your doctor or request an appointment with the St. Joseph’s/Candler Medical Group – Neurology at 912-819-4949 or online

  • St. Joseph's Hospital Campus: 11705 Mercy Blvd., Savannah, GA 31419, (p) 912-819-4100
  • Candler Hospital Campus: 5353 Reynolds St., Savannah, GA 31405, (p) 912-819-6000
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St.Joseph's Hospital Campus: 912-819-4100

Candler Hospital Campus: 912-819-6000