Jake Morris

Deep Brain Stimulation For

parkinson’s disease

Parkinson’s Disease Neurodegenerative disorder

caused by the death of dopamine-generating cells in the substantia nigra

Prevalence 1.5-2.0% of people age 60 or

olderSymptoms

Tremors, impaired gait, loss of balance, bradykinesia

Background

Persistent Tremors

Shuffling gait, taking small steps

Repetitive “pill rolling” movement

Levodopa

Dopamine Agonists

Surgery (Deep Brain Stimulation)

Modern Treatments

Brief history

Mechanism High frequency pulses sent to

specific areas of the brainComponents

Lead, implantable pulse generate, electrode

Uses Parkinson’s Disease Tourette’s Syndrome Chronic Pain Major Depression

What is deep brain stimulation?

Generators

Electrode Brain Implant

Different dbs insertions

• Reduces all of the major motor manifestions of PD, painful cramps and sensory symptoms, and dopa-induced dyskinesias

• Reduces motor symptoms, improves gait, tremor, and bradykinesia

• Reduces limb tremor

Pros Reduces time a patient spends in the

‘off’ state when medication benefits diminish Off state leaves patients slow,

shaky, stiff, and unable to rise from a chair

Permits reduction of medications and their adverse side effects

Cons Simple cognitive tasks may be

improved but difficult tasks may be impaired Emotional awareness/identification

May induce manic responses, hallucinations, and decreased mood or act as an antidepressant

Selective candidacy DBS may exacerbate cognitive

impairments i.e. disorientation or memory deficits

Advantages and disadvantages of dbs

Short duration of benefit from individual doses of levodopa

Substantial motor benefit from oral medication

Limited by dopa-induced side effects

Candidacy requirements

Exact mechanism still unknown for DBS

Only alleviates symptoms, does not act as a cure

Surgical complications, risk of infection

Not beneficial to all patients suffering from PD

Limitations

Personalized medicine in which clinicians choose targets and approaches for specific symptoms in an individual patient.

Smaller hardwarePlacement of pulse generator in chest to disappearMore leads and targets per patientLeads coated to reduce chance for infectionRemotely monitor and control devicesPatients given access to their electrical settings, ability to

“tune” themselves

Future

Breit, Sorin, JöRg B. Schulz, and Alim-Louis Benabid. "Deep Brain Stimulation." Cell and Tissue Research 318.1 (2004): 275-88. Web. 27 Sept. 2014.

"Deep Brain Stimulation for Parkinson's Disease Patients." WebMD. WebMD. Web. 28 Sept. 2014.

"Deep Brain Stimulation." National Parkinson Foundation -. Web. 27 Sept. 2014.

"Deep-Brain Stimulation for Parkinson's Disease." New England Journal of Medicine 368.5 (2013): 482-84. Web. 27 Sept. 2014.

"Parkinson's Disease." Wikipedia. Wikimedia Foundation, 26 Sept. 2014. Web. 28 Sept. 2014.

Perlmutter, Joel S., and Jonathan W. Mink. "Deep Brain Stimulation." Annual Review of Neuroscience 29.1 (2006): 229-57. Web. 26 Sept. 2014.

Works cited