Deep Brain Stimulation : Surgical Treatment For Parkinson’s Disease
Y Joshi, G Gunjal, P Kaldhone, V Kadam
Citation
Y Joshi, G Gunjal, P Kaldhone, V Kadam. Deep Brain Stimulation : Surgical Treatment For Parkinson’s Disease. The Internet Journal of Pharmacology. 2008 Volume 7 Number 1.
Abstract
Parkinson’s disease (PD) is progressive neurological disorder. Levodopa induced diskinesia and sudden withdrawal of metoclopramide and anticholinergic drugs may precipitate syndromes; in this case deep brain stimulation is done. Deep brain stimulation (DBS) is treatment involving the implantation of medical device called brain pacemaker which sends electrical impulses to specific part of brain. Which controls muscle tone coordinates movements. DBS is three types i.e. centromedian stimulation, subthalamic stimulation, anterior stimulation. DBS is reversible. If a cure for Parkinson’s disease is developed, the therapy can be turned off and system can be removed. DBS performed in that case drugs are no longer working well and suffering from their side effects. DBS increases duration and quality of effect.
Introduction
Parkinson’s disease also known as paralysis agitans [1] it is slowly progressive neurone degenerative disease [12] due to deficiency of dopamine [3] which leads to hypokinesia ,rigidity, dradykinesia. [4] DBs therapy is aimed at restoring dopamine in the basal ganglia and antagonising the excitatory effect of cholinergic neurons. Thus re-establishing the correct dopamine and acetylcholine balance. Because long term treatment with Levodopa is limited by fluctuation in therapeutic responses [5] i.e. time progresses during treatment with Levodopa ,the effectiveness gradually declines. [6] sudden withdrawal of anticholinergic drugs may precipitate the syndromes and Phenothiazine, Phenytoine,Reserpine causing rigidity. [78]
Deep brain stimulation (DBS) is treatment involving the implantation of medical device called brain pacemaker which sends electrical impulses to specific part of brain. Which controls muscle tone coordinates movements. [9]
History
Parkinson’s disease was first described by James Parkinson. Initial medical therapy for Parkinson’s disease was not introduced until almost 60 years.[10] . Sir Victor Horsley is management in DBS surgery [12] .in 1980s during thalamic lesioning ,they observed that low frequency stimulation increased tremor, where as frequencies above 100Hz reduced tremor. [11] Food and drug administration (FDA) approved DBS as treatment for Parkinson’s Diseases in 1997. [9]
Basic Principle
Electrical current can excitable cells (neurons, muscles).The tingling sensation when short-circulating a low-power battery with fingers is good demonstration of excitation of neurones. [13]
Surgical Procedure
DBS is routinely performed with several Parkinson’s disease. Hans Berger made the human electrocephalogram (EEG) recording in 1924 using scalp electrode in patients with cranial brain deficits [141516] . The procedure for performing implanting a brain electrode varies somewhat from one medical center to anathor.The basic surgical method is called sterotaxis, a method useful for approaching deep brain targets through a small scull opening For stereotactic surgery, a rigid frame is attached to the patient’s head just before surgery, after the skin is anesthetized with local anaesthetics. A brain imaging (usually MRI) is obtained with frame in place. The various brain imaging techniques (functional magnetic resonce imaging (FMRI), electroencephalogram (EEG), position emission tomography (PET) used for detecting target site [19] . The images of the brain and frame are used to calculate the position of the desired brain target and guide instruments to that target with minimal injury to the brain .after frame placement, MRI, and the calculation of the target coordinates on a computer, the patient is taken to the operating room. At that point sedative medication is given and a patch of hair on the top of head is shaved. After administration of local anaesthetic to the scalp small opening is made in the scull.
To maximize the precision of the surgery, some surgical terms team employ a “brain mapping “procedure in which fine microelectrodes are used to recored brain cell activity in the region of the intended brain target to conform that it is correct, or to make very fine adjustments of 1to2 mm in the intended brain target if the initial target is not exactly correct. The brain mapping procedure no sedation but patient must be calm, cooperative and silent during the mapping or else the procedure must be stoped. The brain’s electrical signals are
Played on the audio monitor so that the surgical team can hear the signals and asses their Pattern. Since each person’s brain is different, the time it takes for the mapping is varies. From about 30 minutes to up to 2 hours for each side of the brain.
Once the target site has been confirmed by micro electro recording, the permanent DBS electrode is inserted. After the DBS electrode is inserted and tested. Intravenous sedation is resumed to make the patient sleepy. The electrode is anchored to the skull with plastic cap, and the scalp is closed with sutures. The patient then receives a general anaesthetic and is completely asleep for the placement of the placement of the pulse generator in the chest and the positioning of a connecting wire at this point the permanent DBs electrode is inserted and anchored with plastic cap. Then scalp is closed with sutures. Pulse generator in the chest and positioning of a connecting wire between the brain electrode and the pulse generator unit. This part of the procedure takes about 40 minutes [17181920212223242526272829] .
Advantages : []
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It is safe and effective.
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It can increases the duration,quality of your periods with good motor function and symptom relief.
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The drugs are no longer working well and suffering from their side effects.
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DBS is reversible. If a cure for Parkinson’s disease is developed, the therapy can be turned off and system can be removed.
Disadvantages: []
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Causing paralysis or coma
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Intracranial haemorrhage
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Infection
