Through close collaboration between neurologists and neurosurgeons, Duke Health is expanding its expertise in Deep Brain Stimulation (DBS) to treat advanced Parkinson’s disease (PD). DBS is being used to successfully treat patients with PD, dystonia, or essential tremor who are not responding well to medication therapies or experiencing adverse effects.

“DBS is a great treatment for many conditions. We often see dramatic changes in patients’ symptoms, which continue long term. Our multidisciplinary team works closely to thoroughly evaluate patients for DBS, identifying those who are most likely to achieve the highest success rates, and most patients experience very positive outcomes,” says Kyle Mitchell, MD, neurologist and movement disorders specialist.

Duke neurosurgeons and neurologists have developed innovative clinical and surgical approaches for DBS and a coordinated process for patient referrals, evaluations, and treatment. 

Mitchell explains the team has refined the process for patients being evaluated for DBS to see both the neurologist and neurosurgeon during a single day. “We have a designated navigator who supports patients with scheduling the evaluation process to make sure it is comprehensive yet convenient and efficient,” he says. 

The assessment for DBS requires extensive testing, including an off-medication/on-medication evaluation, imaging, and neuropsychiatric testing. After testing, the multidisciplinary team convenes to review results and collectively determine if the patient is a good candidate for DBS.

DBS has been FDA-approved to treat movement disorders for over 25 years and continues to evolve with new technologies and techniques. “We’ve employed the latest methods to accurately place the device, with surgical precision and perform long term personalized adjustments to the therapy,” says Mitchell. 

Duke has a team of four highly respected neurosurgeons performing advanced DBS surgeries, all with the collaboration of neurologists during the device implantation surgery. Many cases are performed under light anesthesia with sedation to allow for patient-awake confirmation of the device, while others are done under general anesthesia. “In cases where partially awake surgery is not an option, we use interventional MRI-guided placement of the device to ensure accuracy,” adds Mitchell. 

Neurologists are also very involved in the surgical planning and during the procedure to record brain activity and test the device. “We’re having conversations back and forth in the operating room,” says Mitchell. “It’s highly collaborative.” This partnership continues postoperatively to closely monitor the patient’s symptoms and adjust the device as necessary.

DBS is evolving with new devices and technologies to improve the level of care for patients. “We have some of the best biomedical engineers in the country at Duke working to improve our devices and targets,” says Mitchell. Duke also has open clinical trials focused on optimizing DBS devices. Mitchell continues, “Many of our patients are offered participation in trials as a continuation of their care. We’re also one of the first programs to offer a new FDA-approved DBS device that auto-adjusts to symptoms. If brain waves signal slowness or stiffness, the device automatically turns up to control them.”

If patients are still experiencing motor dysfunction after medication therapy, early referral for evaluation is key. Mitchell says, “We’re here to support our community neurologists by offering second opinions or solutions with advanced approaches that can relieve symptoms and improve quality of life.”