 |
 |
Date: Tue, 1 Sep 1998 10:16:23 -0400 From: "Bonnie Cunningham, R.N." <[log in to unmask]> Subject: DOctor says operate operate Dear Hillary and Bonnie, Some clarifications about DBS are in order: 1. DBS surgery is EXACTLY like pallidotomy or thalamotomy surgery until the very end. Whatever mapping techniques are used with pallidotomy or thalamotomy are also used with DBS surgery, including microelectrode guidance. In a pallidotomy or thalamotomy, after the target is localized, a probe is driven into the brain, down to either the globus pallidus or the VIM nucleus of the thalamus and the tissue is heated to destroy the cells in a small area. With DBS surgery, a long flexible tube, with a stiff wire inside is driven down exactly the same pathway through brain tissue to either the thalamus or the globus pallidus. The stiff wire is then removed, and the flexible electrode lead is fixed to the skull. The DBS is definitely NOT placed on the surface of the brain. 2. The DBS is currently FDA approved only for implantation into the thalamus for tremor control. Clinical trials are currently ongoing in the USA to show that when the DBS is implanted into the globus pallidus or another nearby motor control nucleus the subthalamic nucleus (STN) the results are very similar to a pallidotomy (except of course, you can turn it off if there are side effects). There has been enough evidence collected in Europe so that the DBS can be implanted in both areas. As with a pallidotomy, drug-induced dyskinesias, rigidity and bradykinesia are all helped by DBS implantation into the globus pallidus or the STN. Downsides of the DBS is that you have to replace the batteries (surgery) and the usual hassles of having any kind of permanent implant. Hopefully your neurologist or surgeon knows all of this. Best wishes, Andy Blatz Dear Hillary: The "choice" of Pallidotomy vs. DBS (Deep Brain Stimulation) is related to what your particular symptoms are and what it is exactly that you are attempting to control. Pallidotomy is intended to help symptoms such as rigidity and dyskinesias. This is the more invasive surgery of the two as a probe actually passes into the brain. DBS will control tremors only. This surgery requires that electrodes be placed ON the brain, so nothing actually passes through the brain. There is a control box that is implanted into the chest muscle, much like a cardiac pacer, with thin wires run up the vessels in the neck to the electrodes. While tremors can be very debilitating for some, it is more often that rigidity is the most debilitating part of PD. My best wishes to you as you make this decision. Sincerely, Bonnie Cunningham, R.N. Patient Services Director NPF