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

2. Background Prevalence Parkinson’s Disease Symptoms
Neurodegenerative disorder caused by the death of dopamine-generating cells in the substantia nigra
Prevalence
% 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
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

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 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

7. 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

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 (2004): Web. 27 Sept
"Deep Brain Stimulation for Parkinson's Disease Patients." WebMD. WebMD. Web. 28 Sept
"Deep Brain Stimulation." National Parkinson Foundation -. Web. 27 Sept
"Deep-Brain Stimulation for Parkinson's Disease." New England Journal of Medicine (2013): Web. 27 Sept
"Parkinson's Disease." Wikipedia. Wikimedia Foundation, 26 Sept Web. 28 Sept
Perlmutter, Joel S., and Jonathan W. Mink. "Deep Brain Stimulation." Annual Review of Neuroscience (2006): Web. 26 Sept