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Neuroscience (SNI) Blog

'deep brain stimulation' Neuroscience (SNI) posts

The benefits of DBS and neuromodulation: helping patients

After working in the field of neuromodulation for the past 25 years, I have seen many advances in the field; both in our understanding of the nervous system, and new technology designed to target specific neuronal pathways that will offer the best outcome for patients. It is an exciting field with new investigations that lead to ever expanding knowledge. However, what really keeps me interested in the field after all these years is the opportunity and privilege to be a part of our patients lives on a daily basis. The picture and comment shared below from a grateful patient who had DBS with us two years ago says it all…

"I look back on my experience at Swedish with a grateful heart... thankful for every day I've been given.."

How much tremor is too much?

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

New considerations given about when to refer for Deep Brain Stimulation

Every year in the fall, our Swedish DBS Team has a table in the exhibit area at the Hope Conference for Parkinson's Disease. It is a wonderful opportunity to meet people in the PD community, and spend time chatting with our other neuroscience colleagues from centers in the area.

I am always surprised by the numbers of people who come by and say, “I am not ready, my disease is not bad enough, I am too young, or I haven't had PD long enough”...

The Goal of DBS (Deep Brain Stimulation) Surgery

I met with several patients this week to discuss their personal journey to making the decision to pursue DBS surgery. Not surprisingly, they were well educated about their disease and treatment options.

Each patient reminded me that there is a lot of information and misinformation about surgery for movement disorders.

The most important advice I can give any patient or family is...

Deciding to have Deep Brain Stimulation (DBS) for PD, ET, or dystonia

Choosing to undergo elective deep brain stimulation (DBS) surgery is a big deal.

I have walked through the process with hundreds of patients over the past 10 years and see many struggle with the choice to undergo brain surgery, as they seek to improve their quality of life. Many people have adapted to compensate for the movement disorder with creativity and determination.

In spite of this, after the best medical options have been exhausted, DBS is increasingly offered as a viable treatment option.

Keys to making the best decision for you are:

Best seats in the house…or in this case, the OR

If you’ve ever wanted to sit in the gallery of Grey’s Anatomy and watch a surgery, we have something for you that’s a little more powerful. On Friday, we invite you to tune in to a livestream of a procedure that changes patients’ lives.

On Friday, Dec. 16, 2011 from 9 a.m. to 12 p.m. (PST), Drs. Ron Young and Ryder Gwinn, surgeons from the Swedish Neuroscience Institute, will host a livestream on this page to discuss the affects of Essential Tremor (ET), the Deep Brain Stimulation (DBS) surgical procedure used to treat ET and the other innovative treatment options for ET available at Swedish and throughout the country.

ET is a progressive neurological condition that causes a rhythmic trembling of the hands, head, voice, legs or trunk. It is often confused with Parkinson’s disease and is often un-diagnosed.

The livestream will feature a video stream of a recorded DBS surgical procedure performed at Swedish, accompanied by a live web chat led by Drs. Young and Gwinn. The DBS device is like a pacemaker for the brain. During the surgery, a tiny wire is implanted in the area of the brain that controls abnormal movement. This wire modifies the brain’s electrical signals to help control tremors and other abnormal movements.

It gets better

Not only will you have a front seat (from the comfort of home or wherever your mobile device is) to see a life-changing surgical procedure, but you can also ask questions live to our surgeons about the surgery, essential tremor, and any other related questions you may have (like what is Gamma Knife?). And, we’ll have patients who will share their stories about the procedure and how it has changed their lives – for the better.

Tune in on Friday

You can watch the livestream ...

Gamma Knife Radiosurgery for Treatment of Essential Tremor

Essential tremor (ET) is the most common type of movement disorder, affecting approximate­ly four out of 1000 people, and is significantly more common, though less recognized, than Parkinson’s disease. ET affects men and women equally and is inherited as an autosomal-dominant condition in about 60 percent of cases.

Although often referred to as benign essen­tial tremor, it is hardly benign in patients who may not be able to write legibly, hold a glass of water or use a knife and fork. ET is primarily an action tremor of the upper extremities but may involve resting tremor of the head and neck and/or lower jaw, and also tremor of the voice. The latter may be so severe that speech becomes unintelligible.

Medication and surgical treatment options

Primidone and beta blockers are useful in re­ducing tremor in the early stages of ET, but as the tremor progresses, medical management often becomes less effective or side effects can prevent the use of adequate doses of medication. ET pa­tients then are candidates for surgical or radiosur­gical treatment.

The mainstay of the surgical treatment of ET is deep brain stimulation (DBS), in which an electrode is implanted in the ventral inter­mediate nucleus (VIM) of the thalamus. Neurosurgeons Peter Nora, M.D., and Ryder Gwinn, M.D., have been implant­ing DBS electrodes at Swedish Medical Center for several years. The treatment is effective, but it requires implantation of permanent hardware (wires and batteries) into the brain and chest wall. Patients who take anticoagulants or have severe cardio­vascular disease are not suitable candidates for DBS. These patients, however, may be candidates for radiosurgical treatment.

A new option for difficult-to-treat patients

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