The Parkinson's Appeal for Deep Brain Stimulation

WHAT IS DEEP BRAIN STIMULATION (DBS)

Deep Brain Stimulation is now widely used to alleviate tremor, rigidity and dyskinesia associated with a variety of movement disorders. The technique employs chronic, high-frequency electrical stimulation of specific brain targets through implanted electrodes. Different types of movement disorder are treated by stimulation of specific brain structures. The majority of DBS operations are carried out in patients with Parkinson's Disease (PD). Most of successful effects have been achieved using DBS in the vicinity of the subthalamic nucleus (STN), a small but integral part of the basal ganglia, which collectively control complex movements. DBS has proved an extremely effective approach towards movement disorders: it can return the patient to a normal quality of life and allow them to play their full part in the family and in society. It is a reversible approach (the electrodes can be removed), and is therefore preferable to lesions (such as pallidotomy or thalamotomy).

Who can benefit from Deep Brain Stimulation
Patients with Parkinson's Disease, essential tremor, dystonia, epilepsy or tremor due to multiple sclerosis, with movement related symptoms that cannot be controlled by medications can be evaluated as possible candidates for deep brain stimulation only In addition, patients who experience intolerable side effects from medication may also be candidates. It should be noted that not everyone is eligible for DBS, patient's mental state and general condition is taken into consideration. It is important to note that these issues should be discussed with a movement disorders expert or specially trained neurologist.

How does DBS work?
Although it is known that DBS suppresses activity in the overactive STN of Parkinson's patients, and Globus Pallidus Interna (GPi) in Dystonia patients much more research is needed to understand the action of DBS. It may block conduction in local circuits, generate inhibitory activity or act by desynchronizing pathological brain rhythms. The potential of treating other sites for treatment is largely unexplored.

What are the advantages of DBS?
Deep brain stimulation offers a number advantages. The electrical stimulation is adjustable, whereas surgical destruction is not. The electrode has four metal contacts that can be used in many different combinations. Even if one electrode contact is not in the exact location, it is likely that one of the others or some combination of electrical contacts will be closer to the proper target. As the patient's response to surgery changes over time, the stimulation can be adjusted without the necessity of repeat operation.

Another significant advantage of deep brain stimulation relates to future treatments. Destructive surgery, such as thalamotomy or pallidotomy, may reduce the patient's potential to benefit from future therapies.

 

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