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Movement Disorders

Deep Brain Stimulation for the treatment of Movement Disorders

Parkinson’s Disease is a progressive, neurological disabling disease caused by a degeneration of the dopaminergic neurons. The cardinal symptoms of PD are:

* Resting tremor – shaking of the limbs when realized
* Bradykinesia – slowness of movement
* Rigidity – stiffness of the limb to passive movement when the limb is relaxed
* Postural instability – poor balance

The last three being the most disabling. Since first described in 1817 tremendous advances have been made in understanding the underlying pathology and in the development of effective treatments. Research into new medical and surgical treatments continuous at a high pace. Most patients initially do very well on medication for 4 to 6 years. Between five and 8 years most patients develop medication related disorders.

Therefore Deep Brain Stimulation has become an alternative for many patients that were successfully treated with levodopa therapy for some years and present therapy related side effects. Deep Brain Stimulation involves the implantation of a lead with multiple electrodes in predetermined functional sites such as the GP or STN. The lead is then connected to a pulse generator implanted in the chest wall. When the stimulator is activated it modifies the function of the target site. The main advantage of Deep Brain Stimulation is that it is reversible and offers a certain degree of therapy control. Among others: Deep Brain Stimulation increases ON time by 7+ hours per day, decreases OFF time, improves quality of life restoring dignity to patients and families controlling the cardinal symptoms of Parkinson’s disease effectively including rigidity, bradykinesia dyskinesia dystonia and tremor, reduces symptoms by a median of 89% and severity of dyskinesia by 80%, has a favourable safety and side effect profile particularly in comparison with ablative surgery, is effective in long term control even in severe disabled patients with reduction in OFF time UPDRS and ADL scores persisting for at least 2 years.

Deep Brain Stimulation also enables a significant reduction in drug demand. Not all patients with Parkinson’s disease are appropriate candidates for Deep Brain Stimulation. The careful selection of patients is required to ensure good results: in addition to the Parkinson’s disease diagnosis a good candidate for deep brain stimulation should :

* Respond to levodopa
* Have been examined and assessed by a neurologist with expertise in movement disorders
* Suffer significant disability from the disease despite maximum medical therapy or suffer from drug induced dyskinesias and motor fluctuations
* Experience either reduced effectiveness or intolerable side effects from antiparkisonian medication
* Be appropriate candidate for stereotactic neurosurgery.

If you are in interested in the use of Deep Brain Stimulation for the Treatment of Movement Disorders and would like to participate in our training programs please select contact us