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Deep Brain Stimulation For parkinson ’ s disease

Deep Brain Stimulation For parkinson ’ s disease. Jake Morris. Background. 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 older Symptoms

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Deep Brain Stimulation For parkinson ’ s disease

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  1. Deep Brain Stimulation For parkinson’s disease Jake Morris

  2. Background • 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 older • Symptoms • Tremors, impaired gait, loss of balance, bradykinesia Repetitive “pill rolling” movement Persistent Tremors Shuffling gait, taking small steps

  3. Modern Treatments • Levodopa • Dopamine Agonists • Surgery (Deep Brain Stimulation)

  4. Brief history

  5. What is deep brain stimulation? • Mechanism • High frequency pulses sent to specific areas of the brain • Components • Lead, implantable pulse generate, electrode • Uses • Parkinson’s Disease • Tourette’s Syndrome • Chronic Pain • Major Depression Electrode Brain Implant Generators

  6. Different dbs insertions • Reduces motor symptoms, improves gait, tremor, and bradykinesia • Reduces all of the major motor manifestions of PD, painful cramps and sensory symptoms, and dopa-induced dyskinesias • Reduces limb tremor

  7. Advantages and disadvantages of dbs Pros 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 • 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

  8. Candidacy requirements • Short duration of benefit from individual doses of levodopa • Substantial motor benefit from oral medication • Limited by dopa-induced side effects

  9. Limitations • 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

  10. Future • Personalized medicine in which clinicians choose targets and approaches for specific symptoms in an individual patient. • Smaller hardware • Placement of pulse generator in chest to disappear • More leads and targets per patient • Leads coated to reduce chance for infection • Remotely monitor and control devices • Patients given access to their electrical settings, ability to “tune” themselves

  11. Works cited • 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.

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