Jake Morris

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Deep Brain Stimulation For parkinsons disease

• Jake Morris

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Background

• Parkinsons 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
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Modern Treatments

• Levodopa
• Dopamine Agonists
• Surgery (Deep Brain Stimulation)

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Brief history
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What is deep brain stimulation?

• Mechanism
• High frequency pulses sent to specific areas of
  the brain
• Components
• Lead, implantable pulse generate, electrode
• Uses
• Parkinsons Disease
• Tourettes Syndrome
• Chronic Pain
• Major Depression

Electrode Brain Implant
Generators
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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

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Advantages and disadvantages of dbs

• Pros

• Cons

• 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

• 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

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Candidacy requirements

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

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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

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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

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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.