DEEP BRAIN STIMULATION DBS Sally Rowland PDNS Patient Selection - - PowerPoint PPT Presentation

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Dec 08, 2022 162 likes •342 views

DEEP BRAIN STIMULATION DBS Sally Rowland PDNS Patient Selection for DBS Parkinsons STN Subthalamic nucleus Tremor Vim Thalamus Dystonia Gpi Pallidum Parkinsons Parkinsons (PD) is a chronic,

SLIDE 1

DEEP BRAIN STIMULATION DBS

Sally Rowland PDNS

SLIDE 2

Patient Selection for DBS

Parkinson’s STN Subthalamic nucleus
Tremor Vim Thalamus
Dystonia Gpi Pallidum

SLIDE 3

Parkinson’s

Parkinson’s (PD) is a chronic, progressive

neurodegenerative disorder

The condition is caused by the reduction of

Dopamine producing cells in the substantia nigra (part of the basal ganglia) within the brain

The loss of Dopamine (a neurotransmitter)

results in uncoordinated movement.

Second most common movement disorder

(1 in 500 people in UK – 127,000)

SLIDE 4

PD anatomy - video clip

SLIDE 5

Clinical Features of Parkinson’s

Bradykinesia/Akinesia

(‘Mask-like appearance’ when it affects the face)

Tremor
Rigidity
Postural Instability
(80% of dopamine-producing cells are lost

before the motor symptoms occur)

SLIDE 6

Clinical Features Essential Tremor

Single or bilateral hand tremor
40% of patients have a head tremor
20% have a voice tremor

SLIDE 7

Clinical Features of Dystonia

Dystonia is a syndrome of sustained

muscle contractions

Frequent twisting repetitive abnormal

postures

Generalized Dystonia refers to a

combination of body parts that are affected

SLIDE 8

How is Parkinson’s treated?

Medication
Supplemental therapies
Exercise
Physical Therapy
Speech therapy
Environmental modification
Gait aids
Surgical treatment
DBS (Deep Brain Stimulation)

SLIDE 9

PD medication video clip

SLIDE 10

When medication is not enough?

As PD progresses medications may fail to

provide adequate symptom control

Medications used at the levels required for

adequate symptom control may produce adverse side effects

Motor complications, ie dyskinesia
Cognitive and psychiatric problems
Nausea, hypotension and other

systemic effects

SLIDE 11

When should DBS be considered?

When, despite adequate medication the patient

experiences troublesome motor symptoms, which might include:

Wearing off – off periods that contain

troubling bradykinesia, rigidity, tremor and /or gait problems

Troubling dyskinesia
Motor fluctuations

SLIDE 12

PD and DBS – video clip

SLIDE 13

Walking PD patient – on and off

SLIDE 14

PD patient - DBS switch on - off

SLIDE 15

DBS is not a cure BUT:

DBS improves patients quality of life
It is a reversible procedure
Non destructive vs ablative procedure
Can be non invasively fine tuned to

individuals needs

Cost effective – reduction of medication in

STN patients

Long term safety profile (0.4% mortality

comparable to total hip replacement)

SLIDE 16

DBS kit

Patient programmer Activa PC, extensions, leads

SLIDE 17