Recent studies have suggested that qualifying Parkinson patients benefit from earlier treatment with deep brain stimulation, as reported in Clinical Neurology News. The study indicates that younger Parkinson disease patients are more likely to benefit from early brain stimulator treatment. There is information that may suggest that this therapy may have a protective effect in delaying the progression of Parkinson’s disease. Deep brain stimulation (DBS) was FDA approved in 2002 for treatment of Parkinson’s disease. Symptoms that are best controlled include tremor and dyskinesias although brain stimulation can also help reduce freezing and off time. Younger Parkinson patients develop motor complications such as dyskinesias, off time and freezing much earlier than older patients with Parkinson’s disease. As reported by Dr. David Charles, a Vanderbilt University Medical Center Parkinson neurologist, “No therapy…has bee shown to slow the progression of Parkinson’s.” The previous thinking was to wait until a patient had severe motor complications that could not be controlled with medications prior to considering DBS therapy. The new thinking, and research, is exploring benefits of DBS in earlier stages of Parkinson’s disease. In various reported cases, patients not only benefited from better control of their Parkinson motor symptoms but also had improved quality of life. Added advantages is that Parkinson patients treated earlier with DBS used less medications over an 18 month period, as shown in one small study. There are two studies currently looking at the benefits of early DBS therapy in Parkinson patients: EARLYSTIM is a French study and a smaller study at Vanderbilt University are in progress. It should be noted that Parkinson’s disease is a progressive neurodegenerative disorder. Even patients with DBS therapy do have progression of their symptoms. Memory loss can be a part of the Parkinson syndrome and is not helped by DBS therapy. DBS is not a substitute for optimal neurological and medication management of Parkinson symptoms. Dr. Kassicieh, at Sarasota Neurology, provides medical and neurological management for patients with Parkinson’s disease and brain stimulators. For more information click here.
Posted in Botox, Brain Stimulation, Memory Loss / Alzheimer's Disease / Dementia, Movement Disorders, Nerve Pain, Parkinson's disease, Stroke and tagged brain, Deep Brain Stimulation, Dr. Kassicieh, dyskinesia, dyskinesias, FDA, FDA approved, Memory loss, neurodegenerative, neurologist, Parkinson, Parkinson disease, Parkinson's disease, Parkinson-039s disease, Quality of Life, Sarasota Neurology, tremor, Vanderbilt University by Dan Kassicieh, D.O.
Essential tremor is a common disorder than is characterized by involuntary shaking of the head, jaw, hands or legs. It is estimated that there are 5-10 million affected individuals in the United States. Unfortunately, many patients are incorrectly diagnosed as having Parkinson’s disease when they actually have a form of essential tremor (ET). ET tends to run in families and can have onset anywhere from 20-60. Parkinson’s disease most commonly starts after the age of 60 and is generally thought not to be hereditary. The characteristics of essential tremor and Parkinson related tremor are quite different. Typically the tremor seen in Parkinson’s disease occurs in the hands and is seen with the hand at rest. The tremor has a unique “pill-rolling” quality to it. The Parkinson tremor stops when the individual moves or uses their affected hand. Essential tremor is not present when the affected limb is at rest. When an individual moves their arm or tries to grasp or hold an object, then their tremor becomes apparent. This is most readily seen when trying to write, hold a beverage container or use eating utensils. Writing is affected in both conditions. In essential tremor, the writing becomes jerky with a zig-zag appearance to letters whereas with Parkinson patients, their writing becomes progressively smaller, trailing off into a non-legible line. It is uncommon for Parkinson patients to have head, jaw or leg tremor. These are much more commonly seen in the ET population. Patients with Parkinson’s disease have other clinical features that benign tremor patients do not have.
Treatment for patients with essential tremor (benign tremor, familial tremor) is readily available. Many patients have already discovered that small amounts of an alcoholic beverage will temporarily stop their tremor. Medications used to reduce tremor severity may include primidone, clonazepam, propanolol, mirtazepine or Topamax. All of these medications can be helpful but there is a potential for side effects, as with any treatment. For patients with severe, disabling tremor that is not responsive to medical treatment, surgical treatment with deep brain stimulation can be very effective. This procedure is highly effective in minimizing or completely controlling tremor. It has been approved for use since 1997. This procedure can dramatically improve a patient’s quality of life.
In summary, if you or one of your family is affected by obvious tremor, it is in their best interest to see a movement disorder specialist to get the correct diagnosis and treatment. The treatment and prognosis of essential tremor and Parkinson’s disease is quite different. The medications used for one will not help the other. Significant problems with unwanted side effects can develop if each condition is not treated properly.
Posted in Brain Stimulation, Movement Disorders, Parkinson's disease and tagged Deep Brain Stimulation, Essential Tremor, movement disorder, Parkinson, Parkinson disease, Parkinson's disease, Parkinson's disease, Quality of Life, Topamax by Dan Kassicieh, D.O.
Deep brain stimulation is an innovative way to control severe tremor or some of the motor symptoms of Parkinson’s disease. This medical device was approved by the FDA in 1997 for treatment of patients with severe tremor that was not controlled by medications. A few years later, it was approved for treatment of Parkinson tremor and dyskinesias (involuntary head, arm and leg movements.) The main deep brain stimulation unit, manufactured by Medtronic, is called Activa Soletra. This is a small pacemaker-like device that is placed under the skin, just under the collar bone. The small electrode wire is then run under the skin, behind the ear and through the skull. The electrode tip is placed in a specific area in the brain that is responsible for tremor and dyskinesia control. A patient may need one or both sides done with a stimulator unit, depending on the severity and nature of their movement disorder. The risk of brain stimulator therapy is low other than at the immediate time of surgery. Once healed, patients can expect fewer side effects from deep brain stimulator therapy than from the several medications they may have to take to control their Parkinson symptoms. It should be noted that the best possible result from brain stimulator therapy will not exceed that of a Parkinson patient’s best response to levodopa therapy. Essential tremor patient’s can generally expect to completely stop medications that they are on for tremor control. Brain stimulator therapy is a safe, scientifically proven method for control of disabling tremor or other limb movements. It does not substitute for Parkinson medication but may help in reducing the amount of medication a patient has to take.
Posted in Brain Stimulation, Parkinson's disease and tagged Activa, Deep Brain Stimulation, dyskinesia, dyskinesias, Essential Tremor, Medtronic, movement disorder, Parkinson, Parkinson's disease, Parkinson's disease, Soletra by Dan Kassicieh, D.O.