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Parkinson's, Dementia & Mental Health

Deep Brain Stimulation Appears to Help Parkinson's Disease Patients for 10 Years

What is Deep Brain Stimulation - see below news report

Aug. 8, 2011 - One decade after receiving implants that stimulate areas of their brains, patients with Parkinson's disease (PD) appear to sustain improvement in motor function, although part of the initial benefit wore off mainly because of progressive loss of benefit in other functions, according to a report published Online First by Archives of Neurology, one of the JAMA/Archives journals.

Previous clinical studies have shown deep brain stimulation of the subthalamic nucleus (STN-DBS) for PD to be effective and safe. They show that the technique, which stimulates a part of the brain involved in motor function, may have advantages compared with other medical treatments in terms of controlling motor complications and improving quality of life.

 

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This is the first study, however, to look at the success ten years after the surgery.

"The motor improvement induced by STN stimulation has been reported to be sustained for up to five to eight years after surgery, although part of the initial benefit progressively deteriorates, mainly because of worsening axial signs," write the authors.

A study of 18 patients with advanced PD who had received DBS implants for PD between 1996 and 2000, was carried out by Anna Castrioto, M.D., from the Università degli Studi di Perugia, Perugia, Italy, and colleagues.

Motor assessments were conducted before implantation and at one, five and 10 years. All motor assessments were videotaped. Patients were assessed without medication, without stimulation, without either, and with both. At each assessment, the researchers recorded every patient's medications and dosages.

At 10 years, the combination of medication and STN-DBS was associated with significantly better motor, resting and action tremor, bradykinesia (slowed movement) and rigidity scores.

Compared with baseline, reductions were also seen in the scores in the medication and no medication conditions, the dyskinesia (difficulty controlling movement) and motor fluctuation scores and the levadopa-equivalent daily dose.

Axial signs (such as posture, gait and balance), however, showed the most progressive decline in stimulation and medication response.

"Our findings further support the long-term response to STN stimulation in patients with advanced PD, showing a prolonged motor improvement up to 10 years," conclude the authors.


About Deep Brain Stimulation

What is Deep Brain Stimulation for Parkinson's Disease?

Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, a common neurological movement disorder. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.

DBS uses a surgically implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.

Before the procedure, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. Some surgeons may use microelectrode recording - which involves a small wire that monitors the activity of nerve cells in the target area - to more specifically identify the precise brain target that will be stimulated. Generally, these targets are the thalamus, subthalamic nucleus, and globus pallidus.

The DBS system consists of three components: the lead, the extension, and the neurostimulator. The lead (also called an electrode) - a thin, insulated wire - is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the targeted brain area.

The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connectng the lead to the neurostimulator. The neurostimulator (the "battery pack") is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.

Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with and block the electrical signals that cause PD symptoms.

>> More at National Institute of Neurological Disorders and Stroke

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