Deep brain stimulation: A remarkable treatment for Parkinson's and Tremors

First described in 1817 by James ParkinsonLoss of dopamine producing cells in the brainProtein called alpha synuclein forms clumps in

the nerve cells called lewy bodies Multiple factors contribute to disease

progression

What is Parkinson Disease?

WHAT ARE THE SYMPTOMS?MOTORTremorSlownessStiffnessBalance problemsPosture changesFreezing of gait

NON-MOTORCognitive changes, dementiaAnxiety and depressionConstipationOrthostatic HypotensionOveractive bladderLoss of smellSleep disorders

WHO GETS PD

• Affects over 1 million Americans• About 60,000 diagnosed each year• Most commonly affects people over 60• Young onset PD – diagnosed age 50 and under• Higher incidence in men

• DBS – high frequency stimulation applied to specific targets

• Alters brain circuits• Can lead to significant improvement in motor function

What is Deep Brain Stimulation?

WHEN SHOULD PATIENTS GET DBS?Medications ineffective

Having bothersome side effects

Fluctuating symptoms

NODementia

Severe depressionProminent falls

Components of Successful DBS Therapy• Appropriate patient selection

Reasonable expectations

• Accurate surgical DBS lead placement

•Optimal DBS device programming

•Medication management in concert with DBS

•Patient education and support

10–20% of patients with Parkinson's disease are candidates for DBS

The role of DBS is now viewed as a means of maintaining motor function before significant

disability ensues

Not a last-resort intervention for end-stage Parkinson's patients

Dyskinesias Bradykinesia

TremorRigidity

Responds to DBSSpeechBalance

Freezing of gait

Resistant to DBS

Not Improved by DBSDementia

DepressionPsychosis

Constipation

Which Parkinson’s Disease Symptoms Respond?

Motor Symptoms Improvements Maintained Up to 5 Years

In a 5-year study, DBS Therapy significantly improved OFF-medication assessments of tremor, rigidity, and akinesia/bradykinesia

Allina launched a new DBS program at ANW in April of 2015, with high growth potential, which has been

underutilized due to the following issues:

Patient education and awareness of DBS, as well as navigation to appropriate resources for movement disorders requiring movement specialty care

Physician education on DBS, willingness to refer to movement specialist at appropriate time, and

awareness of the DBS program at ANW

Identification of potential DBS patients from General Neurology referral sources