Deep Brain Stimulation
Every body movement, from raising and lowering an arm to blinking, involves a complex interaction between the central nervous system (brain and spinal cord), nerves and muscles. Damage to or failure of any of these components may result in a movement disorder. Diseases affecting the brain may cause many movement disorders such as:
- Parkinson’s disease – Parkinson’s disease is a slowly progressive nervous system disorder with symptoms that include tremors, stiff muscles, slow movement and difficulties with walking or balance. With 50,000 to 60,000 new cases diagnosed yearly within the United States, Parkinson’s disease affects about one million Americans. There is currently no cure for Parkinson’s disease, but early diagnosis and management can improve patient success. Surgical treatment can be successful in reducing symptoms in the later stages. We offer deep brain stimulation (DBS) surgery for patients with poorly controlled symptoms.
- Tremor – A recurring shaking of a body part caused by unintentional muscular contraction. The most common cause is essential tremor. However, other conditions including Parkinson’s disease, stroke and multiple sclerosis can also cause tremor. We offer sophisticated brain imaging in the form of DaTscan#2122# that can assist with the diagnosis of tremor. DBS surgery is offered to patients with severe tremor not responding to medications.
- Dystonia – Involuntary muscle contractions which force certain parts of the body into abnormal and sometimes painful movements or postures. These can affect the neck (cervical dystonia or torticollis), the eyes (blepharospasm and hemifacial spasm) or the limbs (limb dystonia). We offer medications and botulinum toxin (Botox) injections to reduce the severity of the dystonic spasm.
- Gait problems – A variety of gait (walking) problems can occur as part of a movement disorder. Parkinson’s disease and dystonia can affect walking. We emphasize a preventive strategy aimed at improving gait and reducing the risk of falls. Appropriate medications as well as physical therapy are used as part of the treatment.
A correct diagnosis of any movement disorder is essential to delivering the appropriate treatment.
Our team will be using imaging technologies that include magnetic resonance imaging (MRI), computed tomography (CT) scan, DaTscan#2122#, electroencephalography (EEG) and electromyography (EMG) testing, as well as other neurophysiology assessment tools.
Movement disorders show a large variation between patients, showing different symptoms at differing degrees of severity. Treatment plans are individualized and are created based on the patient’s symptoms. We emphasize the use of standardized rating scales and clinical criteria to improve diagnostic accuracy as well as to assist with developing a multi-disciplinary plan of treatment.
By changing lifestyle routines, such as regular exercise and stress reduction, patients will start seeing benefits by preventing the functional decline that often comes with Parkinson’s disease and related disorders. Working with a physical therapist for their physical medicine and rehabilitative services help Parkinson’s disease patients improve and maximize their mobility by incorporating the latest rehabilitation strategies they put into practice-tailored treatment plans.
Some patients are unable to obtain sufficient relief through medications or physical measures. For these individuals, DBS surgery is a way out of this difficulty. While not a cure, it can set the clock back on the severity of the disease. Some patients can reduce medication doses thereby reducing the side effects. Tremor, involuntary movements (called dyskinesias) or muscle rigidity are symptoms that improve the most. Patients show a longer duration of action of medications following surgery.
The surgery is a three-part process that involves placing an electrode in the brain connected to a pacemaker device placed under the skin in the chest. The first part maps the brain using MRI techniques. To further improve the accuracy of the electrode placement, the team will use a brain mapping technique called microelectrode recording. The third part involves placing the pacemaker and connecting it to the brain electrode. Patients typically return home 2-3 days after surgery, although some may require a brief period of inpatient rehabilitation.
Quality of Life
Maintaining the quality of life for our patients is the ultimate goal. We work closely with each individual and alter the treatment plan as necessary. Ancillary measures such as physical and occupational therapy are used as needed. We will also advise on specific nutritional guidelines and watch the response to medications in patients with Parkinson’s disease. A detailed assessment of the patient’s medication list to minimize the possibility of drug and food interactions is also part of our approach.