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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