Deep Brain Stimulation for Parkinson’s Diesase and Movement Disorders
Frequently asked questions about Deep Brain Stimulation

What is Deep Brain Stimulation?

Deep Brain Stimulation (DBS) is like a pacemaker for the brain. It sends electrical signals to the brain. It is primarily used for patients who have Parkinson’s diseasedystonia, or essential tremor (ET) who can’t control their disease with medication.

For those with Parkinson’s, DBS can reduce tremors and significantly improve slowness and stiffness; and make tremors disappear for those with ET. DBS can help relax muscles and improve abnormal postures caused by muscle contractions for those with dystonia. Eventually, DBS helps to increase quality of life.

Am i a good candidate for deep brain stimulation (DBS)?

Any patient with a movement disorder such as Parkinson’s disease, essential tremor, dystonia, torticollis, spasmodic torticollis, Tourette’s syndrome, other involuntary movements and tremor should consult with a movement disorders neurologist. Often, the movement disorders neurologist can recommend changes in medications that may reduce the need for DBS surgery. Before any patient is considered for DBS surgery, they are evaluated by multidisciplinary team, which has experience in DBS. The team includes a neurosurgeon, neurologist to discuss your expectations and concerns.

Is deep brain stimulation (DBS) approved by the Food and Drug Administration?

 Yes, DBS has Food and Drug Administration (FDA) approval.

 Does DBS prevent a person from using future treatments or cures that may come along?

No, DBS will not reduce future therapy options. DBS therapy is reversible and the system can be removed.

How effective is DBS therapy?

85–89% of people with Parkinson’s have clinically meaningful and significant improvement with DBS.

DBS therapy extends the control you already get from your medication for movement symptoms of Parkinson’s disease. It’s very important to mention that the success of  DBS depends on:

  • Good candidate selection for DBS therapy. DBS is not for everybody!
  • Good surgical placement of the DBS electrodes

Will I feel the stimulation?

Many people with a DBS system will not feel the stimulation at all. Some people may feel a brief tingling sensation when the stimulation is first turned on. If the stimulation changes or becomes uncomfortable, the doctor should be contacted immediately.

Will the neurostimulator be visible?

Depending on a person’s body build, the neurostimulator may be noticeable as a small bulge under the skin. However, the therapy is fully implantable and generally not visible, giving patients greater freedom compared with drug delivery therapies.

Is DBS therapy permanent?

No. DBS therapy is adjustable, so that the stimulation can be changed over time to maintain control over a patient’s symptoms. The system can also be turned off or removed if necessary.

Will I be able to increase or decrease the strength of stimulation?

In most cases, only the doctor can change the strength of stimulation. Depending on the system and a patient’s therapy needs, the doctor may prescribe a handheld patient programmer that allows a patient to choose from a range of stimulation settings that the doctor has preprogrammed.

Is it safe to have medical tests with a DBS system implanted?

Consult your doctor before engaging in any medical treatment or diagnostic tests, including MRI scan, mammogram, electrocauterisation and heart defibrillation. Diathermy (deep heat treatment) should never be used with an implanted DBS system.

Can stimulation be used during pregnancy?

DBS improves motor and behavioural disorders in all patients and allows reduction in, or even total interruption of, disease-specific medication during pregnancy.

Why should we choose Turkey to have dbs operation?

Because Turkey has relatively price advantage with high experienced physicians with best product brands which also other countries have. The doctor has a lot of experience in dbs and products can be supplied much more appropriate price in Turkey.

 

 

Baclofen Pump Therapy for Spasticity
Baclofen Pump Therapy for Spasticity

Baclofen is a medication used to treat spasticity and relax the muscles. If necessary, it can be used oral or intrathecal (through spinal cord) way by physicians. When used orally, the doses administered may cause toxicity, side effects, or lack of efficacy. Because of this fact, intrathecal baclofen has a much higher effect at much lower doses because the active ingredient drug is not inserted into the blood brain barrier when given directly to the cerebrospinal fluid.
In the treatment of spasticity, baclofen may be administered intrathecally to the cerebrospinal fluid by pump if the oral baclofen is not sufficient or the side effects are high. The pump, which is surgically implanted to the patient’s abdomen by the neurosurgeon, may deliver the drug to the cerebrospinal fluid within 24 hours at the appropriate dose for the patient. Dose adjustments that the doctor considers appropriate are made by controlling the skin with an external device. When the drug is put into the pump, it can be done over the skin with needles without the need for surgery at certain intervals. Generally, the pump refilling frequency is every six months. The frequency of this medication refilling may vary depending on the dose used and the volume of the pump.
The baclofen pump can be replaced about 6-7 years after surgery because of its battery life. At the end of this period, a small surgical procedure is needed to replace only the pump. It is very important for the physician to have a baclofen pump implantation, experience with the device and the medication to get a positive result from the therapy.
In diseases that cause spasticity, such as spinal cord injuries, brain injury, cerebral palsy, or multiple sclerosis, the patient is first tested to see if the drug will benefit from a spinal cord. If there is a significant decrease in the patient’s contractions at the end of the test, the device is placed on the patient and the pump is given to the patient 24/7 at the determined dose. Thus, the patient’s contractions are reduced, maintenance is facilitated and daily activities are gained.
The external programmable baclofen pump with its own special control can be adjusted to give different doses at different times during the day when required.

What are the benefits of doing Baclofen Pump in Turkey?
• Product availability of best quality and best brand
• Lower prices compared all over the world
• Avaliability of high-experienced physicians about baclofen pump

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Deep Brain Stimulation for Parkinson’s Diesase and Movement Disorders
Deep Brain Stimulation for Parkinson’s Diesase and Movement Disorders

Deep brain stimulation is based on the logic of stimulating certain regions of the brain through an electrode (a cable) and a generator (a small device called neurostimulator). Nowadays, Parkinson’s disease which cannot use medication due to drug resistance or side effects of medication, Essential tremor disease, Dystonia, obsessive compulsive disease and epilepsy disease are used with confidence and with FDA approval.
During this operation, which can be performed for the most part awake, the patient does not feel any pain. First of all, an electrode (a cable) is placed in the targeted areas of the brain during the operation, which is started with a local anesthetic (local drug). Then, the patient is put to sleep and the neurostimulator is placed under the collarbone. At the end of the operation there is no device part outside.
The electrical currents given to the brain by the neurostimulator are at very low levels and can be adjusted at any time via a remote control or even completely switched off. Thanks to these features, the device does not cause any damage to the brain and even when the neurostimulator is turned off, the patient can be completely restored. Therefore, this neurostimulator does not cause permanent damage to the brain.
The neurostimulator has the ability to be recharged and has a remote wireless rechargeable feature such as wireless rechargeable mobile phones.
After the operation, the activated neurostimulator is adjusted according to the needs of the patient and if the disease progresses, the power and other characteristics of the current can be increased if needed. Thanks to the support of the neurostimulator after a successful operation, the drugs used can be reduced. The continuous operation of the neurostimulator minimizes the deterioration between drug intake hours in the patient.
Patients who are hospitalized the day before to make the necessary preparations can be discharged on the day after the operation if any undesirable condition develops.

What are the benefits of doing Deep Brain Stimulation in Turkey?
• Product availability of best quality and best brand
• Lower prices compared all over the world
• Avaliability of high-experienced physicians about deep brain stimulation

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Advances in deep brain stimulation could lead to new treatments
Advances in deep brain stimulation could lead to new treatments

Nature Reviews Neurology suggests that recent advances in deep brain stimulation (DBS) for Parkinson’s disease could lead to treatments for conditions such as obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome and depression. The authors of the paper, from the Geneva University Hospitals (HUG), University of Geneva, University of Tübingen and the Wyss Center for Bio and Neuroengineering, argue that bi-directional electrodes that can stimulate and record from deep brain structures could have applications beyond Parkinson’s disease.

Other bi-directional brain-computer interfaces (BCIs) have been in development in recent years, notably for the real-time signal processing of neuronal activity to allow control of a robotic arm directly from the brain in people with paralysis.

Professor John Donoghue, director of the Wyss Center, says, “Interestingly the fields of brain-computer interfaces for movement restoration and deep brain stimulation for Parkinson’s disease have developed largely independently. Deep brain stimulation researchers tend to be neurologists or neurosurgeons while brain-computer interface researchers are often neuroscientists, roboticists and engineers. By working together and sharing information, we can learn from each other and potentially expand the reach of this technology so that it can help more people.”

DBS is typically used to relieve the shaking and rigidity associated with Parkinson’s disease. Although it has been used in more than 40 other brain targets, very few other disease indications for the treatment have been established. The latest closed-loop DBS systems sense changes in the following stimulation and automatically adapt the level of the next stimulating pulse accordingly. This adjustment in the way that stimulation is delivered allows for tailored, accurate treatment that may prove suitable for other disorders.

Advances in deep brain stimulation could lead to new treatments

Other areas that might benefit from closed-loop DBS include OCD, movement tics and psychiatric symptoms of Gilles de la Tourette syndrome, and depression—although early trials indicate that the exact position of the electrodes and stimulation parameters are critical.

The authors warn against the use of DBS for purposes beyond disease, and call for strong ethical standards that require and neural interfaces to respect and preserve people’s privacy, identity, agency and equality.

Neurostimulators with sensing capabilities are still in their infancy. They have still only been used in research settings and closed-loop DBS is not yet a long-term treatment solution for Parkinson’s disease, or any other disorder. These new systems will, however, soon become commercially available, bringing new treatment possibilities and new hope.

DBS improves patients' cognitive control by increasing power of brain rhythms
DBS improves patients’ cognitive control by increasing power of brain rhythms

In a new study that could improve the therapeutic efficacy of deep-brain stimulation (DBS) for psychiatric disorders such as depression, a team of scientists shows that, when DBS is applied to a specific brain region, it improves patients’ cognitive control over their behavior by increasing the power of a specific low-frequency brain rhythm in their prefrontal cortex.

The findings, published April 4 in Nature Communications, suggest that the increase in “theta” rhythms, readily detectable in EEG recordings, could provide neurosurgeons and psychiatrists with the reliable, objective and rapid feedback they’ve needed to properly fine-tune the placement and “dosage” of DBS electrical stimulation. In Parkinson’s disease, where DBS has been most successful, that kind of feedback is available through a reduction in a patient’s tremors. But for depression or obsessive-compulsive disorder, symptoms can be more subtle, subjective and slowly emergent.

“This is a major step forward for psychiatric brain stimulation,” said Alik Widge, the lead and corresponding author on the paper. Widge began the work while a clinical fellow at the Picower Institute for Learning and Memory at MIT and a research fellow at Massachusetts General Hospital (MGH). He is now an Assistant Professor of Psychiatry at the University of Minnesota Medical School. “This study shows us a specific mechanism of how DBS improves patients’ brain function, which should let us better identify who can benefit and how to optimize their individual treatment.”

DBS increases control

Heading into the research, the team, also led by Earl Miller, Picower Professor of Neuroscience at MIT and Darin Dougherty, Associate Professor of Psychiatry at Harvard Medical School and Director of the Division of Neurotherapeutics at MGH, knew that DBS applied to the brain’s ventral internal capsule and ventral striatum (VCVS) has shown mixed results in treating OCD and depression. A common feature of both conditions is a deficit of cognitive control, the function of controlling automatic or habitual behaviors through conscious will (for instance, overcoming recurring negative emotions that are a hallmark of depression). Cognitive control is performed in part by the prefrontal cortex, which is involved in circuits passing through the VCVS region. Moreover, theta rhythms are believed to be a means by which neurons in the prefrontal cortex could synchronize and drive the activity of neurons in other regions.

The team’s working hypothesis, therefore, was that DBS might help patients by increasing theta rhythms in these crucial cognitive control circuits linking prefrontal cortex to VCVS, thereby allowing the cortex to be more effective in controlling atypical emotions. If they could read out a patient’s theta rhythms and optimally amplify those with DBS, they reasoned, maybe they’d see an increase in cognitive control.

To find out, they worked with 14 volunteers at MGH, 12 of whom had previously received DBS treatment for depression and the other two for OCD. The researchers gave each participant a “conflict” task in which they had to identify the numeral in a sequence of three numbers that was different (like the “2” in “332”) despite the vivid and intentional background distraction of an emotionally evocative image (like adorable puppies or a vicious shark). An increase in cognitive control would mean a quicker reaction time in being able to identify the correct unique digit.

The researchers recorded brain waves of the subjects while they performed the task, once with DBS switched on and once with it off. What they found was that with DBS on, people indeed made their selection faster (overcoming the “interference,” or conflict of the emotional picture). There was no difference in accuracy, meaning that subjects were not sacrificing accuracy to gain more speed. Meanwhile theta rhythms in the cortex increased markedly in association with both the stimulation in VCVS and the behavioral improvement of the faster reaction time.

“This study demonstrates the value of closed-loop stimulation,” Miller said. “We read the brain’s natural rhythms and then enhanced them by stimulation. We augmented the rhythms that were already there. It suggests that brain rhythms play a role in cognition and that we can treat cognitive deficits by manipulating those rhythms.”

The authors acknowledged that the study was relatively small, and because all of the participants were receiving DBS as a treatment, the exact stimulation settings were different between individual participants. Widge cautioned that a more standardized study would be important to verify the results. However, the authors said that with further research, theta rhythms could provide a biomarker to calibrate DBS treatments for psychiatric disorders where cognitive control is crucial. Moreover, individual tuning of theta rhythms via DBS of the VCVS could lead to new treatments for psychiatric disorders where cognitive control – and the flexibility of behavior that comes from exerting conscious intent over recurring emotions or compulsions – is crucial.

“The current study demonstrates that DBS at an FDA approved target for psychiatric illness is shown to affect a specific symptom underlying multiple psychiatric illnesses, namely cognitive flexibility,” Dougherty said. “These findings suggest that looking at effects of DBS ‘underneath’ a diagnosis, at the symptom level, may lead to utility for other psychiatric illnesses in the short term and perhaps to more personalized medicine approaches to DBS in the longer term.”

source : news-medical.net

MS Diet & Nutrition
MS Diet & Nutrition

People with MS are well-advised to maintain a healthy diet, as diet can interfere with their energy level, bladder and bowel health, and possibly shift their immune system to a more inflammatory state.

Although a number of different diets are suggested as best for people with MS, solid evidence does not exist to support any one diet over another, leaving the issue much to an individual’s choice.  A number of MS specialists recommend their patients simply follow the same general diet guidelines recommended for the public at large by the American Heart Association and the American Cancer Society: one rich in healthy foods and rounded off by regular exercise.

The National MS Society also offers a list of special diets of possible interest to patients.

Pavan Bhargava, MD, published a review paper on a Society webpage, “Diet and Multiple Sclerosis,” in which he identified the most important dietary factors linked to MS: low levels of vitamin D, a high salt intake, and changes in gut bacteria (the gut microbiota).

He also identified possible mechanisms through which diet may affect MS:

  • Directly on the immune system, as  metabolism has been shown to have a role in the functioning of various immune cells. Some immune system cells also have receptors that respond to such foods as vitamin D and fatty acids, with research suggesting that certain fats are linked to inflammation and polyunsaturated fatty acids to lower inflammation.
  • Indirectly through gut bacteria that metabolize certain foods into short-chain fatty acids, which act in positive ways on the immune cells, and improve the regulatory function of T-cells. Diet also works to colonize the gut,or alter the bacterial mix there, which can shift the immune system away or toward an inflammatory state.
  • May affect components of the nervous systemby providing nutrients and other factors that might protect neurons and glial cells, important supporting cells of the brain (Glial cells include oligodendrocytes, which produce myelin.) Research is ongoing in this possible effect.

 

Different diets are recommended by different MS specialists, but there is insufficient evidence to recommend any specific one. But almost all have points in common, such as avoiding highly processed foods, foods with a high glycemic index and foods high in saturated fat, and recommend reducing fatty red meat intake and increasing consumption of fresh fruits and vegetables.