                
|
 Dr. Frederick Lenz 
This website has been
developed to provide information about Deep Brain Stimulation,
or DBS, a neurosurgical procedure to implant electrodes, or stimulators,
into nuclei within the brain, especially for the treatment of movement
disorders.
Post-operatively, activation of these electrodes results in alleviation
of symptoms, specifically, stimulation of the motor thalamus (Vim) for
tremor, stimulation of the subthalamus (STN) for Parkinson's disease,
and internal segment stimulation of the globus pallidus (Gpi) for Parkinson's
disease, dystonia or dyskinesias. Primarily, there are two types of Parkinson's disease (PD) patients who may benefit most from deep brain stimulation: (1) patients with uncontrollable tremor for which medications have not been effective and (2) patients with symptoms that are well treated with medications but who experience severe motor fluctuations, including wearing off and dyskinesias, despite attempts to control such fluctuations with changes in medications. DBS is also used to treat Essential Tremor which is the most common movement disorder. In many cases, the tremor is mild enough to be effectively treated with medication. However, in cases where the tremor is severe, it can be disabling. The patient may need help with dressing (buttons), hygiene (shaving), etc., or have spills when eating or drinking. When Essential Tremor is this severe, then DBS becomes an option. Tremor is the only symptom in Essential Tremor, unlike Parkinson's. Therefore, the relief of marked Essential Tremor by DBS can make the patient functionally normal with significant improvement to their quality of life. The FDA has recently approved the use of DBS for the treatment of dystonia, a relatively uncommon but disabling movement disorder. Dystonia is a condition characterized by abnormal postures and twisting movements. Torticollis is an example of dystonia characterized by twisting movements of the neck. A number of studies have demonstrated the efficacy of DBS for dystonia. Therefore DBS is now an option when medical therapy fails. All patients considering DBS must be evaluated by a neurologist who specializes in movement disorders. Neurologists associated with this program can be contacted through the Johns Hopkins Parkinsons Disease and Movement Disorders Center or the Parkinson's and Movement Disorders Center of Maryland. The evaluation in necessary in order to determine whether the patient suffers from Parkinson's disease rather than one of the less common, but similar, movement disorders. It also is necessary to ascertain that there is at least a small amount of benefit from PD medications. Lastly, a cognitive evaluation is important in order to assess the patient's ability to participate accurately and actively in the surgical implantation of the stimulator, as well as in the post-operative process of programming the stimulator. A neurosurgeon will also participate in the patient's evaluation to assess the risks and benefits of surgery as well as to clarify the expected outcomes of surgery. |
