Does Deep Brain Stimulation for Tardive Dyskinesia Work?

When traditional treatments are ineffective for severe tardive dyskinesia, deep brain stimulation (DBS) may be useful.

Involuntary movements of the tongue, neck, face, trunk of the body, or limbs are a symptom of tardive dyskinesia (TD). Long-term usage of some drugs is typically the cause of the illness. A person's quality of life can be significantly impacted by severe TD symptoms.

One new therapy for TD is deep brain stimulation (DBS). There is a considerable amount of research supporting the use of DBS for other illnesses like epilepsy and Parkinson's disease, but not much for TD. The therapy exhibits potential and may provide a secure and practical choice for those whose TD is not adequately controlled by standard therapies like medicine.

What is deep brain stimulation?

With deep brain stimulation (DBS), a tiny wire is inserted inside the brain using a minimally invasive procedure.

The precise region of the brain generating the symptoms is where the wire's tip is positioned. An implanted pulse generator (IPG), which is positioned beneath the skin at the collarbone, chest, or belly, is connected to the wire. The IPG modifies the electrical activity of the brain where symptoms first appear by sending pulses via the wire.

Following device implantation, DBS patients are required to see a neurologist multiple times. This is done in part to determine how best to program the pulses on the gadget so that they function optimally for a particular user.

How does deep brain stimulation help tardive dyskinesia?

DBS affects brain regions deemed hyperactive during tardive dyskinesia-related involuntary movements.

Long-term usage of several drugs, particularly dopamine receptor agonists, can result in tardive dyskinesia. Scientists have a few theories as to why tardive dyskinesia can result from long-term usage of this medication.

According to one notion, persistent blockade of dopamine receptors may result in modifications to the brain's information-transmission pathways. There is potential for increased activity in brain regions linked to involuntary movements.

DBS may lessen the release of a neurotransmitter in these hyperactive brain regions, which would minimise tardive dyskinesia symptoms.

Who might benefit?

The use of DBS in treating tardive dyskinesia patients is still being researched. Currently, it is only a possibility in cases of chronic, severe tardive dyskinesia in which other treatments have failed. Deutatrabenazine (Austedo) and valbenazine (Ingrezza) are two first-line therapies for tardive dyskinesia.

Research on deep brain stimulation in individuals with tardive disorders has corroborated the notion that this therapy modality has potential. A 2018 analysis of research revealed that 117 patients receiving DBS for tardive disorders saw an improvement in their symptoms. Just four of the 117 individuals had tardive dyskinesia, and 113 had tardive dystonia.

Although more clinical trials are required to determine whether DBS is beneficial for tardive dyskinesia, some researchers have concluded that the surgery may be safe.

The following conditions make a person a candidate for deep brain stimulation, per the American Association of Neurological Surgeons (AANS):

• symptoms significantly lower life quality
• Even when taking medication, symptoms don't go away.
• The existing drugs' adverse effects are unbearable.

Before deep brain stimulation is advised, a thorough medical evaluation is conducted on the persons in question.

Potential candidates for DBS with tardive dyskinesia include those who have:

• symptoms that are severely hindering and have persisted for a minimum of a year
• not responding well to clozapine or tetrabenazine for four weeks at the maximum dose that is tolerated

Even in these situations, if a patient has unstable mental status, major cognitive impairment, depressive symptoms, or other medical issues, a medical expert might not advise DBS.

What are the risks?

Deep brain stimulation is a well-established treatment for tardive dyskinesia, despite its recent development. According to a 2019 report, the surgery has been performed on over 160,000 patients. It can be used to treat a variety of illnesses, such as Parkinson's disease and epilepsy. The IPG can be removed by doctors, making the operation reversible.

Deep brain stimulation indeed has hazards. The dangers could appear during stimulation or during the surgical procedure for implanting the device. It's also possible that the stimulation device's parts deteriorate over time and need to be surgically replaced.

Surgical risks include the following:

• brain haemorrhage
• infection in the brain
• headache
• seizures
• Brain tissue edoema and haemorrhage
• issue with the IPG gadget
• decline in emotional or mental health
• little discomfort after the surgery

Among the risks during stimulation are:

• face or limb tingling
• loss of balance
• feeling as though your muscles are pulling
• issues with speech or vision

In a tiny clinical experiment conducted in 2018, 10 out of 25 participants who got either DBS or sham therapy experienced adverse effects, according to one author. Dysarthria, difficulty speaking, skin erosion, pulmonary embolism, and gait abnormalities were among those occurrences.

FAQs

How successful is deep brain stimulation?

According to the findings, 75% of participants thought the process had improved their ability to control their symptoms. Deep brain stimulation is generally effective in controlling Parkinson's symptoms, according to a study.

How do neurologists treat tardive dyskinesia?

The doctor measures movement during these visits to make sure TD isn't progressing. The doctor may reduce the dosage of the drug or switch to an alternative antipsychotic if these measurements start to fluctuate.

The takeaway

An emerging treatment for tardive dyskinesia is deep brain stimulation.

Small-scale clinical trials have been conducted, but the technique appears promising in symptom reduction for those with severe, refractory TD who do not respond to treatment. DBS is a recognised treatment for several different ailments, such as Parkinson's disease and epilepsy.