Neurostimulator For Parkinson’s Disease

Benefits Of Medtronic Dbs

HELPS CONTROL MOTOR FUNCTION AND IMPROVES QUALITY OF LIFE

• Improves motor function and reduce medication for patients with recent or longer-standing motor complications1,2
• Improves quality of life and activities of daily living for Parkinsons patients with recent or longer-standing onset of motor complications.1,2
• Reduces medication and improves drug-related complications1
• Offers the first safe* access to MRI anywhere on the body for diagnosing health conditions in patients with deep brain stimulation
• Allows therapy to be turned off or reversed, preserving options for future therapies and treatments

How Deep Brain Stimulation Works

Exactly how DBS works is not completely understood, but many experts believe it regulates abnormal electrical signaling patterns in the brain. To control normal movement and other functions, brain cells communicate with each other using electrical signals. In Parkinson’s disease, these signals become irregular and uncoordinated, which leads to motor symptoms. DBS may interrupt the irregular signaling patterns so cells can communicate more smoothly and symptoms lessen.

How Does Deep Brain Stimulation Work

Movement-related symptoms of Parkinsons disease and other neurological conditions are caused by disorganized electrical signals in the areas of the brain that control movement. When successful, DBS interrupts the irregular signals that cause tremors and other movement symptoms.

After a series of tests that determines the optimal placement, neurosurgeons implant one or more wires, called leads, inside the brain. The leads are connected with an insulated wire extension to a very small neurostimulator implanted under the persons collarbone, similar to a heart pacemaker. Continuous pulses of electric current from the neurostimulator pass through the leads and into the brain.

A few weeks after the neurostimulator has been in place, the doctor programs it to deliver an electrical signal. This programming process may take more than one visit over a period of weeks or months to ensure the current is properly adjusted and providing effective results. In adjusting the device, the doctor seeks an optimal balance between improving symptom control and limiting side effects.

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Precision Of Temporal Interference Stimulation

One important requirement of DBS is high spatial precision . Stimulating brain regions unrelated to the disease might reduce the effectiveness of treatment or cause undesired side effects. In their study, the authors both built computer models to simulate the stimulation effects and demonstrated their spatial precision via two sets of experiments in anaesthetised mice.

In the first set of experiments, the researchers selectively targeted a small region found deep in the brain called the hippocampus, and they proved that stimulation of this area does not affect an overlaying brain region called the cortex. The stimulation effect was validated with two laboratory techniques. The first method was an electrical recording technique called in vivo whole cell patch clamp, which uses a glass tube called a patch pipette to acquire signals from neurons in the brains of live animals. This method requires open-skull surgery on mice to place the patch pipette deep into the stimulated brain region, and it demonstrated the stimulation effect with single-cell precision. The second method was a technique called c-fos labeling, which can reveal neurons that have recently been stimulated. After the noninvasive stimulation experiment, the authors dissected the mouses brain and found that the only neurons that had been activated resided in the hippocampus region and not in the overlaying cortex region.

Are There Any Alternative Treatments

Some research suggests that a supplement called coenzyme Q10 may help in the early stages of Parkinsons when taken for 16 months or longer. For mild to moderate Parkinsons, the practice of tai chi may help improve balance more than resistance training or stretching.

Other complementary therapies may include:

• massage or meditation for relaxation
• acupuncture for pain reduction
• yoga to improve flexibility and balance

Some dietary or herbal supplements can react with medications, so talk to your doctor before starting any supplements.

The neurostimulator runs on batteries that last three to five years. They can be replaced in an outpatient procedure.

Your doctor will provide you with specific instructions on life with DBS, such as:

• Other screening devices and theft detectors in stores and other public venues can cause your neurostimulator to turn off or on. This may cause a mild, uncomfortable sensation. Show your ID card and ask for assistance in bypassing these devices, if possible.

• Places to avoid include those with large magnetic fields, such as power generators and automobile junkyards. You should also avoid high-voltage or radar machinery, including television and radio transmitters, high-tension wires, electric arc welders, radar installations, and smelting furnaces.
• Its safe to use cellphones,home appliances, and computers, as they wont cause interference.

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Stereotactic Dbs Vs Interventional Image

Stereotactic DBS surgery requires the patient to be off their medication. During the procedure, a frame stabilizes the head and provides coordinates to help the surgeons guide the lead to the correct location in the brain. The patient gets local anesthesia to keep them comfortable throughout each step along with a mild sedative to help them relax.

During image-guided DBS surgery, such as with interventional MRI or CT scan, the patient is often asleep under general anesthesia while the surgeon uses images of the brain to guide the lead to its target.

Some advanced centers offer both the stereotactic and iMRI-guided options for DBS surgery. In this case, the doctor and patient will discuss which procedure is better based on a number of factors.

For instance, the doctor may recommend an image-guided procedure for children, patients who have extreme symptoms, those who are especially anxious or fearful or those whose leads are going into certain parts of the brain.

Generally, DBS surgery follows this process:

Why A Doctor May Choose Deep Brain Stimulation

According to the National Parkinson Foundation, the ideal Parkinsons disease candidate for DBS surgery has:

• PD symptoms that interfere with activities of daily living.

• Fluctuations in mobility due to PD medications with or without dyskinesia .

• Continued good response to PD medications, even if the medication effects may wear off sooner than they have in the past.

• A history of several different combinations of PD medications while under the supervision of a neurologist specializing in movement disorders.

These factors* may make a person a less than ideal candidate for DBS surgery:

• Difficulty with balance, walking, or freezing as the main disabling symptom.

• A primary symptom of speech difficulty.

• Continuous confusion and problems with memory and thinking.

• A psychiatric condition such as depression or anxiety that has not improved or stabilized with other treatment.

• Another condition that increases the risk for surgery complications.

*Some of these factors may be treatable. Having one or more does not disqualify a person for future DBS surgery, but the doctor may recommend more aggressive therapy focused on these issues before surgery takes place.

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Who Is A Candidate For Deep Brain Stimulation

DBS is more than just a surgical procedure. It involves a series of evaluations, procedures, and consultations before and after the actual operation, so people interested in being treated with DBS should be prepared to commit time to the process.

For example, those who do not live close to a medical center that offers DBS surgery may need to spend significant time traveling back and forth to appointments.

The procedure, as well as the pre-operative evaluation and post-operative follow-up, can be expensive depending on the persons insurance coverage. DBS surgery is an FDA-approved treatment for Parkinsons disease, and Medicare and most private insurers cover the procedure, but the extent of coverage will depend on each persons individual policy.

Prospective patients should have realistic expectations about DBS results. Although DBS can improve movement symptoms of Parkinsons disease and greatly improve quality of life in properly selected patients, it is not likely to return anyone to perfect health.

Can I Use Electrical Devices

While you should be able to use most electronic devices, you should be aware that:

• Some devices, such as theft detectors and screening devices, like those found in airports, department stores, and public libraries, can cause your neurotransmitter to switch on or off. Usually, this only causes an uncomfortable sensation. However, your symptoms could get worse suddenly. Always carry the identification card given to you. With this, you may request assistance to bypass those devices.
• You will be able to use home appliances, computers, and cell phones. They do not usually interfere with your implanted stimulator.
• You will be provided with a magnet to activate and deactivate your stimulator. This magnet may damage televisions, credit cards, and computer discs. Always keep it at least 1 foot away from these items.

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What Is The Prognosis

Although most patients still need to take medication after undergoing DBS, many patients experience considerable reduction of their PD symptoms and are able to greatly reduce their medications. The amount of reduction varies from patient to patient but can be considerably reduced in most patients. The reduction in dose of medication leads to a significant improvement in side effects such as dyskinesias . In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication.

What Happens During Dbs

Implantation of a DBS lead generally requires a hospital stay of a day or longer. Procedures may vary depending on your condition and your healthcare providers practices. The lead and neurostimulator may be implanted at the same time, or the neurostimulator may be implanted in a separate procedure after the lead is implanted. Talk with your healthcare provider about what you will experience during your procedure.

Generally, surgery for DBS follows this process:

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Innovative Deep Brain Stimulation Device Reads Brain Signals Allowing For Individualized Treatment For Parkinsons Patients

Pacific Neuroscience Institute at Providence Saint Johns Health Center among first treatment sites

SANTA MONICA Pacific Neuroscience Institute is the first provider in the Providence health system to treat a patient with an innovative surgically implanted Deep Brain Stimulation device.

Used for the management of symptoms of movement disorders such as Parkinsons disease, Percept PC Neurostimulator with BrainSense technology has been developed by Medtronic as a next-generation Deep Brain Stimulation system. The Food and Drug Administration-approved device is the first and only DBS system in the U.S. with ground-breaking BrainSense technology that allows clinicians to capture a patients brain signals, enabling more data-driven, personalized treatment for patients with neurologic disorders, such as Parkinsons disease, essential tremor and epilepsy.

Many patients with PD may be good candidates for deep brain stimulation surgery, said neurologist Melita Petrossian, MD, medical director at Pacific Movement Disorders Center, Pacific Neuroscience Institute. It is a way to reduce off time, increase the amount of time the medication is working on time, reduce tremor and reduce dyskinesias, which are the involuntary movements related to treatment.

M

Will I Be Asleep During The Entire Procedure

You will be sedated or receive local anesthesia for part of the procedure, may or may not be awake for lead and electrode placement, and will be asleep when the impulse generator is implanted. To provide more details:

• A local anesthetic is applied to areas of the head where pins or screws are used to secure the head frame and sedation is given.
• You will be sedated during the beginning of the procedure, while the surgical team is opening the skin and drilling the opening in the skull for placement of the lead.
• Most patients will be awake for lead and electrode placement. This part of the procedure is not painful, as the brain does not feel pain. Being awake allows the surgical team to interact with you when testing the effects of the stimulation. However, some patients who cannot tolerate the procedure while awake can have the electrode and lead placed under general anesthesia. The lead placement is guided in real time by magnetic resonance imaging. The procedure is performed in a special MR-equipped operation room.
• Implantation of the pulse generator in the chest and connection of the leads from the device to the lead in the brain is usually done under general anesthesia.

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How Effective Is Deep Brain Stimulation For Parkinsons Disease

Deep brain stimulation provides excellent relief for most patients symptoms including tremor, stiffness , slowed movement , freezing of gait and dyskinesias. Long-term studies have shown continued improvement in tremor, bradykinesia, and dyskinesia. Many patients are able to reduce their medications and maintain their level of function including independent participation in activities of daily living required to care for oneself. One of the distinct advantages, is that after DBS, patients on average improve their daily on timewhen they are at their best, without troublesome dyskinesiaby half a day.

Loss Of Dopamine Movement Problems

He was far from alone Parkinsons disease is the second most common neurodegenerative disease. A report in 2017 estimated that it affects over 6 million people worldwide. The main symptoms include stiffness , slowness of movement , problems with gait , instability which may lead to falls, and tremor. Patients often report periods of severe symptoms in between periods of relief when movements are more normal .

Parkinsons is caused by progressive loss of brain cells in a small area of the brain known as the substantia nigra. These cells produce a chemical called dopamine which is important to the normal functioning of brain circuits that control movement. Depletion of dopamine disrupts normal function of these circuits, resulting in the symptoms described above. Dopamine replacement, in the form of a medication called levodopa, is the main medical therapy for Parkinsons.

Initially the symptoms respond well to medication, but after several years of treatment patients often develop more frequent and unpredictable ‘off’ periods, and unwanted and troublesome movements called dyskinesias may appear during ‘on’ periods. It becomes progressively harder to find a good level of medication that is enough to prevent the patient being ‘off’ but without causing dyskinesias.

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Brigham And Womens Hospital Neurosurgical Team

The neurosurgical team at BWH features internationally recognized surgeons who are all faculty at Harvard Medical School. Together they continue to build on our long and distinguished history by offering innovative, compassionate, and patient-centered care, and pioneering groundbreaking advances in the treatment of all neurosurgical conditions. Meet our neurosurgical team.

Deep Brain Stimulation: A Paradigm Shifting Approach To Treat Parkinson’s Disease

• Department of Neurology, Duke University Medical Center, Durham, NC, USA

Parkinson disease is a chronic and progressive movement disorder classically characterized by slowed voluntary movements, resting tremor, muscle rigidity, and impaired gait and balance. Medical treatment is highly successful early on, though the majority of people experience significant complications in later stages. In advanced PD, when medications no longer adequately control motor symptoms, deep brain stimulation offers a powerful therapeutic alternative. DBS involves the surgical implantation of one or more electrodes into specific areas of the brain, which modulate or disrupt abnormal patterns of neural signaling within the targeted region. Outcomes are often dramatic following DBS, with improvements in motor function and reductions motor complications having been repeatedly demonstrated. Given such robust responses, emerging indications for DBS are being investigated. In parallel with expansions of therapeutic scope, advancements within the areas of neurosurgical technique and the precision of stimulation delivery have recently broadened as well. This review focuses on the revolutionary addition of DBS to the therapeutic armamentarium for PD, and summarizes the technological advancements in the areas of neuroimaging and biomedical engineering intended to improve targeting, programming, and overall management.

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Living With A Stimulator

Once the DBS has been programmed, you are sent home with instructions for adjusting your own stimulation. The handheld controller allows you turn the stimulator on and off, select programs, and adjust the strength of the stimulation. Most patients keep their DBS system turned on 24 hours day and night. Some patients with essential tremor can use it during the day and turn off the system before bedtime. Your doctor may alter the settings on follow-up visits if necessary.

If your DBS has a rechargeable battery, you will need to use a charging unit. On average charging time is 1 to 2 hours per week. You will have a choice of either a primary cell battery or a rechargeable unit and you should discuss this with you surgeon prior to surgery.

Just like a cardiac pacemaker, other devices such as cellular phones, pagers, microwaves, security doors, and anti theft sensors will not affect your stimulator. Be sure to carry your Implanted Device Identification card when flying, since the device is detected at airport security gates.

Testing Before Deep Brain Stimulation

For patients with Parkinsons disease, the doctor must confirm that the PD is levodopa-responsive and determine which symptoms are most likely to respond to DBS and discuss these with the patient.

To accomplish these two objectives, the movement disorders neurologist will examine the patient in the absence of his or her PD medications, then again after having taken them. Seeing the effect of PD medications on the movement and non-motor symptoms helps the physician and patient identify good target symptoms for DBS.

A cognitive assessment can help determine a persons ability to participate in the procedure, which involves providing feedback to the doctor during surgery and throughout the neurostimulator adjustment process. This assessment also informs the team of the risk of having worsened confusion or cognitive problems following the procedure.

Some hospitals also perform an occupational therapy review or speech, language and swallowing assessment. A psychiatrist may examine the person to determine if a condition such as depression or anxiety requires treatment before the DBS procedure.

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What Are The Results

Successful DBS is related to 1) appropriate patient selection, 2) appropriate selection of the brain area for stimulation, 3) precise positioning of the electrode during surgery, and 4) experienced programming and medication management.

For Parkinson’s disease, DBS of the subthalamic nucleus improves the symptoms of slowness, tremor, and rigidity in about 70% of patients . Most people are able to reduce their medications and lessen their side effects, including dyskinesias. It has also been shown to be superior in long term management of symptoms than medications .

For essential tremor, DBS of the thalamus may significantly reduce hand tremor in 60 to 90% of patients and may improve head and voice tremor.

DBS of the globus pallidus is most useful in treatment of dyskinesias , dystonias, as well as other tremors. For dystonia, DBS of the GPi may be the only effective treatment for debilitating symptoms. Though recent studies show little difference between GPi-DBS and STN-DBS.

Patients report other benefits of DBS. For example, better sleep, more involvement in physical activity, and improved quality of life.

Recent research in animals suggest that DBS may “protect” or slow the death of dopamine nerve cells . While the scientific data is inconclusive, observation of DBS patients show potential slowing of the disease relative to their pre-DBS condition.