It is almost impossible to cure Parkinson’s disease. The best treatment option is to slow the disease progression and help patients carry on daily lives as much as possible.

Recently, deep brain stimulation (DBS) has drawn attention as a treatment for Parkinson’s disease.

DBS is known to reduce drug exhaustion from standard care and improve symptoms, including dyskinesia. If so, which patients should receive DBS, and are there any side effects or concerns?

To get the answers, Korea Biomedical Review met with Professor Kim Moo-seong of the Neurosurgery Department at Inje University Busan Paik Hospital, one of the eminent scholars in the field of Parkinson’s disease. Kim has performed over 750 DBS surgeries since the treatment was introduced in the early 2000s.

Question: In Parkinson’s treatment, which patients can receive DBS?

Answer: Patients with Parkinson’s disease receive dopamine-based therapy as the main treatment, with exercise and diet as adjuvant therapy. However, five to 10 years after the medication, 10 to 15 percent of the patients experience adverse drug reactions such as dyskinesia, a movement disorder where limbs contract involuntarily. In some cases, the effect of dopamine-based drugs decreases after a certain period. Some patients experience motor fluctuations in which the patient has to take the medication eight to 10 times a day, instead of once or twice a day, and even during sleep. DBS is an effective surgery for these patients.

Q: What is the benefit of DBS?

A: To perform DBS, a physician inserts electrodes into abnormal brain areas and gives electrical stimulation. This way, we can control abnormal neural circuits and improve movement disorder symptoms. It can benefit patients suffering from abnormal movements or shorter drug effects after long-term drug use. After DBS, 80 to 90 percent of patients experience improved symptoms.

Q: What other diseases can DBS help?

A: DBS can help some patients with pain, obsessive-compulsive disorder, mental illness, epilepsy, and dementia. It can also be used for ultra-obese patients with a BMI of 150 or higher or hypoxic brain injury (in a vegetative state).

Q: We heard that you revived a person in a vegetative state with DBS. Is it true?

A: If a patient with a hypoxic brain injury does not improve for more than six months, we can run a neurological test to see if we can perform DBS. About half of DBS-treated patients recover consciousness. So far, I have performed DBS for around 10 patients, and four have regained consciousness. The most memorable patient was a young man who suffered brain damage from brutal acts in the military. Fortunately, the patient returned to consciousness after receiving DBS.

Q: DBS is performed most for Parkinson’s disease, though. What is the best advantage of DBS?

A: As I mentioned earlier, when patients with Parkinson's disease take drugs for a long time, drug reactions decline, or they experience abnormal movements and intractable tremors. In these cases, DBS can be effective. As the surgery slows the degeneration of the brain and reduces the decline of drug reactions. So, DBS helps patients maintain the present status until a better treatment becomes available.

Q: Is it true that DBS could cause electrode damage in rare cases?

A: Among Parkinson’s patients, body twisting of those with dystonia could damage the electrode wire or the power generator's connection part. But this case is extremely rare. Even if the wire gets damaged, we can replace it with a new one.

Q: What is the latest technology for DBS, and how is it different from existing ones?

A: Conventional DBS products were inconvenient because they consisted of wires, chargers, and IPG’s alignment. To overcome this, companies are releasing new devices. For example, there is a product that can be charged wirelessly and has a long battery life (Vercise Gevia). This product is known to have 25 years of battery life. If the battery life is long, it can reduce second surgeries required because of battery discharge.

Q: When DBS was first introduced, the surgery cost was very high. But DBS can be covered by insurance now, which greatly relieved the financial burden for patients. What’s your opinion on this?

A: In the early 2000s, when DBS was introduced, the treatment expense amounted to over 30 million won ($27,384). Fortunately, the health insurance reimbursement recently reduced the financial burden on patients. As the government changed DBS's criteria from five years of the medication to three years, patients’ access to DBS improved.

Q: How is the outlook for DBS treatment?

A: The number of Parkinson’s patients will increase in Korea in the future. This is because the number of patients with neurodegenerative diseases is rising rapidly due to the aging population. Government statistics showed that the number of people aged 65 or more surpassed 8 million. With more patients, there will be more demand for DBS. People will make an environment with more hospitals where patients can get the best care. Many patients living in provincial areas visit a large hospital in the Seoul metropolitan area. But people should know that they will be able to get the best treatment for Parkinson’s disease in their neighborhood, too.