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Surgery for Movement and
Psychiatric Disorders
Dr. Paresh K Doshi
In-charge Stereotactic and Functional Neurosurgical Prog...
Movement Disorders
• Parkinson’s Disease
• Tremors
• Dystonia
Parkinson’s Disease
• Tremors, slow movements, stiffness,
postural instability
• 8-20/10,000
• Usually associated with old...
Medical Management
•Levodopa- Dopamine replacement
•Other drugs:
•Dopamine agonists like ropinarole, pramipexole
etc.
•Sid...
Who is the best surgical candidate
• Usually >5yrs of disease
• on-off fluctuations
• Significant dyskinesias
• Off phase ...
Parkinson’s Disease Target
STN
7x9x5mm
Surgical strategies for Parkinson’s
Disease
LesionLesion StimulationStimulation
Subthalamic nucleusSubthalamic nucleus
What is Deep Brain Stimulation
IPG
LEAD
What is Deep Brain Stimulation
STN Lesion
• Total no. of Movement Disorders Surgeries- 254
• Deep brain stimulation surgeries-182
• DBS for PD-162
Demographics
Surgery
Instantaneous relief
Real Estate Consultant Back on his Legs
Preop 1Y Postop
3Y Postop
TextDoctors Also!!!
N=30
N=26
59%
54%
Doshi et al, Neurology India 2004
Doshi et al, Movement Disorder 2006
Results
N=30
N=26
36%
38%
Doshi et al, Neurology India 2004
Doshi et al, Movement Disorder 2006
Results
STN Lesioning
After 5 years
Thank You
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  1. 1. Surgery for Movement and Psychiatric Disorders Dr. Paresh K Doshi In-charge Stereotactic and Functional Neurosurgical Program Jaslok Hospital and Research Centre
  2. 2. Movement Disorders • Parkinson’s Disease • Tremors • Dystonia
  3. 3. Parkinson’s Disease • Tremors, slow movements, stiffness, postural instability • 8-20/10,000 • Usually associated with old age- young not uncommon • Levodopa treatment most effective initially
  4. 4. Medical Management •Levodopa- Dopamine replacement •Other drugs: •Dopamine agonists like ropinarole, pramipexole etc. •Side effects: •NauseaVomiting •Dyskinesias, Hallucinations, Constipation
  5. 5. Who is the best surgical candidate • Usually >5yrs of disease • on-off fluctuations • Significant dyskinesias • Off phase dystonia and pain • Uncontrolled tremors • Levodopa responsive symptoms
  6. 6. Parkinson’s Disease Target STN 7x9x5mm
  7. 7. Surgical strategies for Parkinson’s Disease LesionLesion StimulationStimulation Subthalamic nucleusSubthalamic nucleus
  8. 8. What is Deep Brain Stimulation IPG LEAD
  9. 9. What is Deep Brain Stimulation
  10. 10. STN Lesion
  11. 11. • Total no. of Movement Disorders Surgeries- 254 • Deep brain stimulation surgeries-182 • DBS for PD-162 Demographics
  12. 12. Surgery
  13. 13. Instantaneous relief
  14. 14. Real Estate Consultant Back on his Legs
  15. 15. Preop 1Y Postop 3Y Postop
  16. 16. TextDoctors Also!!!
  17. 17. N=30 N=26 59% 54% Doshi et al, Neurology India 2004 Doshi et al, Movement Disorder 2006 Results
  18. 18. N=30 N=26 36% 38% Doshi et al, Neurology India 2004 Doshi et al, Movement Disorder 2006 Results
  19. 19. STN Lesioning
  20. 20. After 5 years
  21. 21. Thank You

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