Help for Drivers with Parkinson's

Parkinson disease patients with brain stimulating implant had enhanced coordination while driving

(RxWiki News) Amid the trembling, shaking and other changes that come with Parkinson's disease, many with Parkinson's still try to drive. One device might improve their driving ability.

A new study has found that a pacemaker type device that stimulates the brain may improve the driving ability of people with Parkinson's.

"Ask your doctor about the safety of driving with Parkinson's."

Carsten Buhmann, MD, of University Medical Center Hamburg-Eppendorf in Hamburg, Germany, was this study's main author.

Dr. Buhmann and his research team used an off-road driving simulator whose dashboard and controls resemble those in an actual vehicle to test the driving skills of 65 people. These participants averaged 61 to 63 years of age and had driven a real vehicle for at least 30 minutes per week during a three-year period.

Of the 65 people, 23 were Parkinson's patients who had undergone deep brain stimulation (DBS), which is done for those whose uncontrollable tremors are not eased with medication. A pacemaker-like device is implanted in the brain during that surgery. The battery-operated device is about the size of a stopwatch and be can be switched on and off.

In addition to the 23 patients with those implanted neurotransmitters, the study enrolled 21 Parkinson’s patients who had not undergone that surgery and 21 people who did not have Parkinson’s disease.

The 23 DBS patients were tested once while their deep brain stimulator was on and once while it was off. For a third test, the 23 were taken off the stimulator and given levodopa, which is prescribed to treat Parkinson's symptoms. Those symptoms include shaking, even when the body is at rest; slowed movement; lack of facial expression; loss of balance; and stiff limbs that are no longer flexible.

Based on standard driving practices, the simulated driving performance of Parkinson's patients with the surgically implanted deep brain stimulators was not "significantly worse" in any category than the performance of the 21 people who did not have Parkinson's, the researchers found.

Also, the DBS participants performed better using the brain stimulator than when they relied only on levopoda. Those with the brain stimulator had a total of 11 errors on the simulated driving test. That compared to 13 errors made by those taking only levodopa and 14 among those who neither took levodopa nor were on the brain stimulator.

In addition, Parkinson's patients with brain stimulators performed better than people without Parkinson's in a category researchers defined as slight errors. On average, those using stimulators made 3.8 slight driving errors. That compared to an average of 7.5 slight errors for patients without Parkinson's disease and 11.4 slight errors for those with Parkinson’s disease who did not have stimulators.

Parkinson’s patients without stimulators performed worse than the 21 people who did not have Parkinson's in every category except one that researchers labeled as moderate errors. A certified driving instructor evaluated the errors.

"Based on our data, we suggest handling driving permission for DBS-treated patients with [Parkinson's disease] not more restrictively than permissions for patients with [Parkinson's disease] in general," the researchers wrote.

These researchers also noted that improved physical coordination through use of the brain stimulator does not necessarily mean driving is risk-free for Parkinson's patients. Their thinking skills and reflexes often are harmed or slowed by the disease.

Deep brain stimulation "… might enhance driving ability by improving the motor problems which occur with Parkinson’s disease, but on the other hand, it might hamper driving because it potentially causes a decline in executive cognitive skills,” Dr. Burhmann said.

The value of deep brain surgery itself has been debated. Some researchers have concluded that the motor skills of some Parkinson's patients actually declines following surgery.

This study was published online December 18 in Neurology.

The Georg & Jürgen Rickertsen Foundation in Hamburg, Germany funded the study.

Several of the nine researchers for this study have received speaking fees and research grants from pharmaceutical companies and medical device makers.

Review Date: 
December 18, 2013
Last Updated:
December 30, 2013