DBS part 3

Several people have asked if DBS is a cure for Parkinson's (it is not) or if it will freeze the progression (it will not).  DBS is a treatment, akin to medication.  Each treats symptoms of the disease, but not the disease itself.  Neither can slow the progression of PD.  Medications are a pharmaceutical treatment, and DBS is a surgical treatment.

An analogy that might help understand what DBS will do for most patients who undergo the procedure is a house which has a leaky pipe in the basement.  For my purposes here, the basement is the brain, the leaky pipe is PD, and flooding in the basement represents symptoms of the disease--typically reduced functionality (slow movement, tremor, freezing etc., but the symptoms vary from person to person).

In the beginning the leak is small, and it goes unnoticed.  You have PD, but there are no noticeable symptoms, and it remains undiagnosed.  Over time the leak grows larger--PD progresses--until the water accumulates fast enough that the basement begins to flood.  At this point we have noticed the disease, and we seek treatment.  Prescribed medication is the customary first treatment.  Taking meds is akin to turning on a variable-speed bilge pump to get rid of the water.  You can increase the speed of the pump by taking more medications, but there is an upper limit. You're good to go for a while, but as PD progresses, the rate of water coming in from the leak exceeds the capacity of the pump even running at full speed, and again we have flooding.  In spite of the meds, the PD intrudes increasingly, making life more difficult.

Undergoing DBS is like adding a second pump, fixed-speed but more powerful than the first one.  The greater incoming flood water from the leak can be handled, often with the first pump running at a lower speed, or perhaps not running at all; fewer pills are needed.  However, PD still continues to progress, and the leak continues to get worse.  Eventually both pumps are needed, and ultimately even the combined effects of both running at full speed will not be enough to keep the flooding under control.  Even with medication and DBS, PD's progression is relentless.  Sadly, the only thing that can stop it is death.  Assuming one lives long enough, the years prior to death are marked not only by uncontrollable physical symptoms, but also by a nasty collection of non-movement related symptoms.  These can include sleep disorders, impulse control disorders, delusions, hallucinations, and dementia.

That is where exercise comes in.  Exercise is the only ting that is proven to slow the progression of Parkinson's.  We cannot stop it, so slowing it down is the best available option.  Start early, and exercise.  Hard.  A LOT.