Parkinson’s disease patients benefit from expert management of deep
brain stimulation
23 July 2006
Electronic stimulation of the brain is the most effective surgical
treatment for advanced Parkinson's disease. Patients may benefit from the
direct involvement of a neurologist with expertise both in movement
disorders and in deep brain stimulation, according to an article to be
published in the September 2006 print issue of Archives of Neurology.(1)
Deep brain stimulation is a surgical procedure that involves implanting
electrodes into the brain to electronically stimulate areas that control
movement, treating Parkinson’s disease symptoms such as tremor, stiffness
and problems walking. It is the most effective surgical treatment for
advanced cases of Parkinson’s disease and involves intensive patient
management, including adjustments of electrical currents and medication
dosages as a patient’s condition changes. Many medical centres delegate
these responsibilities to personnel who do not have extensive experience in
Parkinson’s disease care, such as surgical nurses, fellows or
neurophysiologists, according the article.
Elena Moro, M.D., Ph.D., and colleagues at University Health Network,
University of Toronto, Ontario, studied whether the outcomes resulting from
deep brain stimulation could be improved with the direct involvement of a
neurologist with specific expertise both in the treatment of movement
disorders in general and in deep brain stimulation in particular.
The neurologist changed the electric stimulation settings during the
procedure and also adjusted the medications that patients received
afterward. The patients underwent assessments for Parkinson’s disease
symptoms before and after their reprogrammed treatment, with following
assessments at an average of 5 months (range 1 hour to 14 months) after the
reprogramming.
Of the 44 patients, 24 (54.6 %) showed additional improvement in their
Parkinson’s disease symptoms; 16 (36.4%) were unchanged; and four (9.1%)
worsened. The patients who did improve experienced fewer tremors and less
rigidity and bradykinesia (slowness of movement) and also had reductions in
their medication dosages. The four patients who worsened had more speech and
gait problems and were returned to their original settings.
“Further improvement of parkinsonian signs can be achieved in the
majority of patients even after long-term stable stimulation,” the authors
conclude. “Improved patient outcomes from subthalamic nucleus deep brain
stimulation are obtained when postoperative care is personally managed by a
neurologist expert in movement disorders and deep brain stimulation who is
directly responsible for stimulation programming and simultaneous drug
adjustments based on observed clinical responses to changing stimulation
parameters.”
Reference
1. Arch Neurol. 2006;63:(doi:10.1001/archneur.63.9.noc60069)
Link to article:
http://archneur.ama-assn.org/cgi/content/full/63.9.noc60069v1
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