Surgery for Parkinsons Disease Focus on Deep Brain
Surgery for Parkinson’s Disease: Focus on Deep Brain Stimulation Ramón L Rodríguez, MD Director of Clinical Services University of Florida Movement Disorders Center ramon. rodriguez@neurology. ufl. edu
Parkinson’s Disease Progressive neurodegenerative disease n Affects the substantia nigra, which produces dopamine n As a result, the patient develops the four cardinal symptoms of PD: n n Resting tremor, slowness, stiffness and balance problems
Parkinson’s Disease Shows a good response to levodopa (Sinemet) n Medications help improves the cardinal symptoms of the disease n Patients derive great benefit from the medication for a period of 5 -7 years n
Parkinson’s Disease With time, patients may develop motor fluctuations or side effects induced by levodopa n This motor fluctuations may become the most disabling aspect of the disease n
Parkinson’s Disease Wearing off n Unpredictable off n Sudden off n Dose failures n On-Off fluctuations n
Parkinson’s Disease n Levodopa induced Dyskinesias n n n Diphasic Dyskinesias Peak dose Dyskinesias Levodopa induced Dystonia
Parkinson’s disease Development of this symptoms may take the disease from a non disabling to a disabling state n At this stage, medical management may be difficult and accompanied by undesirable side effects n
Parkinson’s Disease n What can be done at this stage?
Surgery for Parkinson’s Disease Pallidotomy n Thalamotomy n Subthalamotomy n Deep Brain Stimualtion [DBS] n
Terapia Activa
What is DBS? n Deep Brain Stimulation n Device similar to a pacemaker Provides an electrical discharge to specific brain area This stimulation modulates the brain signals that causes the symptoms of Parkinson’s disease
Deep Brain Stimulation Not a cure for PD n Does not replaces medications for PD n Does not alter the mechanism of action of medications n
Deep Brain Stimulation Improves the cardinal symptoms of Parkinson’s disease n Smooth out motor fluctuations n Increase “on” time n Prevents disabling “off” periods n
Deep Brain Stimulation Reversible procedure n Side effect profile much more benign than lesioning procedures n Can be done bilaterally n As the disease advances, it can be modified n
Deep Brain Stimulation
Deep Brain Stimulation
Deep Brain Stimulation
Deep Brain Stimulation
Deep Brain Stimulation
Microelectrode Recording Border 10 sec 80 ms STN 10 sec 80 ms Border/SN 10 sec 80 ms Sagittal Section Through the Thalamus
Microelectrode Mapping Intraoperative somatosensory evoked responses
Deep Brain Stimulation
Deep Brain Stimulation Requires patient commitment for programming n 64, 000 different combinations n Patience from both patient and programmer n
Deep Brain Stimulation Battery needs to be replaces every 3 -6 years n Potential Complications n n n Infection Lead fracture Lead Migration Skin erosion Mood and Behavioral changes
Deep Brain Stimulation DBS is not for every patient n Proper patient selection is critical for success n Proper placement of the device is required for success n
Who is the best candidate? Disabling motor fluctuations n Significant proportion of day spent in disabling “off” state n Symptoms improve with levodopa n Patients suffering from disabling dyskinesias n
Not ideal candidate Poor response to levodopa n Cognitive deficits or dementia n Hallucinations not related to medications n Patients diagnosed with Parkinson’s plus syndromes (MSA, Lewy Body Disease, Corticobasal Degeneration, Progressive Supranuclear Palsy) n
Thank You!!!
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