Deep brain stimulation: A remarkable treatment for Parkinson's and Tremors by Okeanis Vaou, MD and Gregg Dyste, MD

1. First described in 1817 by James Parkinson
Loss of dopamine producing cells in the brain
Protein called alpha synuclein forms clumps in the
nerve cells called lewy bodies
Multiple factors contribute to disease progression
What is Parkinson Disease?

2. WHAT ARE THE SYMPTOMS?
MOTOR
Tremor
Slowness
Stiffness
Balance problems
Posture changes
Freezing of gait
NON-MOTOR
Cognitive changes,
dementia
Anxiety and depression
Constipation
Orthostatic Hypotension
Overactive bladder
Loss of smell
Sleep disorders

3. WHO GETS PD
• Affects over 1 million Americans
• About 60,000 diagnosed each year
• Most commonly affects people over 60
• Young onset PD – diagnosed age 50 and under
• Higher incidence in men

4. • DBS – high frequency stimulation applied to specific
targets
• Alters brain circuits
• Can lead to significant improvement in motor function
What is Deep Brain Stimulation?

5. WHEN SHOULD PATIENTS GET DBS?
Medications ineffective
Having bothersome side effects
Fluctuating symptoms
NO
Dementia
Severe depression
Prominent falls

6. Components of Successful DBS Therapy
• Appropriate patient selection
Reasonable expectations
• Accurate surgical DBS lead placement
•Optimal DBS device programming
•Medication management in concert with DBS
•Patient education and support

7. 10–20% of patients with Parkinson's disease are
candidates for DBS
The role of DBS is now viewed as a means of
maintaining motor function before significant disability
ensues
Not a last-resort intervention for end-stage Parkinson's
patients

9. Dyskinesias
Bradykinesia
Tremor
Rigidity
Responds to DBS
Speech
Balance
Freezing of gait
Resistant to DBS
Not Improved by DBS
Dementia
Depression
Psychosis
Constipation
Which Parkinson’s Disease Symptoms
Respond?

10. Motor Symptoms Improvements Maintained Up to 5
Years
In a 5-year study, DBS Therapy significantly improved
OFF-medication assessments of tremor, rigidity, and
akinesia/bradykinesia

11. Allina launched a new DBS program at ANW in April of 2015,
with high growth potential, which has been underutilized due to
the following issues:
Patient education and awareness of DBS, as well as
navigation to appropriate resources for movement disorders
requiring movement specialty care
Physician education on DBS, willingness to refer to movement
specialist at appropriate time, and awareness of the DBS
program at ANW
Identification of potential DBS patients from General Neurology
referral sources