Movement Disorders Center
Deep Brain Stimulation: History of DBS Surgery
When did deep brain stimulation become popular? What was used to treat movement disorders before DBS surgery? Read below for a full history of the evolution of deep brain stimulation to treat Parkinson’s disease and other movement disorders.
Early 1900s: Surgical Treatments
DBS surgery began In the early 1900s, before the advent of modern anti-Parkinsonian drugs. Surgeons used a variety of operations aimed at destroying certain areas of the brain in order to relieve severe tremor and rigidity.
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Mid-1900s: Pallidotomy Successfully Introduced
In 1947, special stereotactic techniques were introduced, allowing for safer, more precise surgical treatment. Doctors were able to target many deep brain structures within the basal ganglia with varied degrees of success. Pallidotomy was introduced in 1952 by Dr. Lars Leksell and was successful in relieving many Parkinsonian symptoms in patients. During a pallidotomy procedure, the surgeon destroys a part of the globus pallidus (part of the brain), which helps relieve tremor and stiffness.
Thalamotomy Replaces Pallidotomy
At the same time, many surgeons were performing surgery on the thalamus. Thalamotomy is destroying a selected portion of the thalamus, part of the brain that is involved with controlling movement. Thalamotomy replaced pallidotomy as the surgical treatment of choice for Parkinson's disease. Thalamotomy, which has an excellent effect on the tremor, was not as effective at reducing rigidity, bradykinesia (slowness of movement) or hypokinesia (decreased motor function). In fact, bradykinesia could actually be aggravated by the procedure.
1980s: Pallidotomy Reexamined
In 1985, Dr. Lauri Laitinen, who had worked with Dr. Leksell in Sweden, reintroduced the pallidotomy as a treatment for patients who had previously undergone thalamotomy but remained symptomatic. Many of his patients suffered from severe bradykinesia, rigidity, tremor and other unusual involuntary movements. These patients had long-standing, severe PD that had been treated with medications for many years. He reported his first pallidotomy series of 38 patients in January of 1992 and found that 80—90 percent of patients experienced long-lasting relief of symptoms. The rate of control of tremor was somewhat lower, but the chance of eliminating dyskinesias was even higher. This encouraging experience prompted other specialists to reexamine the role of pallidotomy in PD. Today, there are several centers in the United States that perform the Laitinen pallidotomy procedure.
Pallidotomy Used To Treat Dystonia
Pallidotomy has also been found to be effective for some patients with a handful of other movement disorders known collectively as dystonias. The "mildest" forms of dystonia are writer’s cramp and spasmodic torticollis. More severe is idiopathic hemidystonia. Familial dystonias are usually the most disabling forms of dystonia. All have been observed to respond to either DBS or pallidotomy.
1997: Deep Brain Stimulation (DBS Surgery) is Introduced
In 1997 the most important procedure to treat the tremor of Parkinson's disease and essential tremor received approval from the U.S. Food and Drug Administration (FDA): the stereotactic insertion of a deep brain stimulator into the thalamus, and DBS surgery was born. In January 2002, the FDA approved bilateral subthalamic nucleus and globus pallidus deep brain stimulators to treat other movement symptoms of Parkinson's disease including rigidity, bradykinesia, tremor and freezing with DBS surgery.