Deep Brain Stimulation For parkinson’s disease Jake Morris

Background Prevalence Parkinson’s Disease Symptoms 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

Modern Treatments Levodopa Dopamine Agonists Surgery (Deep Brain Stimulation)

Brief history 1874 First report of human cortical stimulation 1950s Intraoperative stimulation identifies deep structures 1960s High frequency stimulation of ventrolateral thalamus diminishes tremors 1976 Cerebellar stimulation used transcutaneously on patients with cerebral palsy 1990s Implantable pacemeaker combined with brain electrodes creates DBS technology

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

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

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

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

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

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

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.