MotionDisorders.com
Title
Indiana University Movement Disorder Surgery Program
Contact
- HostRocket Customer
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- Clifton Park NY
- United States 12065
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- +1.5183713421
Description
Surgical therapies are reserved for patients who have disabling symptoms of Parkinson's Disease (PD). When tremor, slowness, rigidity, balance and dyskinesia (wiggly, writhing movements) are no longer adequately controlled by medications, the patient may be evaluated to determine if they are a candidate for MDS.
The operation usually recommended in this situation is bilateral or unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) (figure 1). This procedure offers approximately 50% improvement in control of PD symptoms. There is often 50% reduction in antiparkinsonian medication dosage once the stimulator is activated, which is usually done 2-4 weeks after the device is implanted. DBS of the STN is extremely effective at reducing dyskinesia. There is usually a dramatic reduction of wiggling, writhing movements that are called "choreifrom dyskinesia" that typically occur at the peak dose of levodopa response. In large part, this relief from dyskinesia is related to the dramatic reduction in antiparkinsonian medication dose. The painful foot cramping and twisting, called "dystonia" that often occurs at the end of a dose cycle of levodopa can often be remedied by this form of treatment. It is now appreciated that stimulation of the STN is more effective for control of PD tremor than is the thalamus, which was the previous choice target for this problem. The other symptoms of PD that include muscle rigidity and slowness likewise improve with DBS.
One of the unexpected benefits of DBS of the STN has been the significant improvement in sleep. It is well recognized that patients who have more hours of sleep and have better quality of sleep have better control of their PD symptoms the following day.
