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