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--------------E2A2D8A61E1A6F4F1C024544 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Ruth Clark + Robin, My understanding is the same as yours about STN stimulation. I wonder whether STN is getting confused with the more generic term of deep brain stimulation (DBS). There are 3 locations in the brain (which I am aware of) that stimulators are being used for treatment of PD- 1- the thalamus- which is useful for tremor and is to my knowledge the only FDA approved use of the stimulator. I believe that means that any trained neurosurgeon is able to do the procedure and get reimbursed by insurance or Medicare. 2- the globus pallidum (which is essentially a reversible and adjustable palidotomy) 3- and the subthalamic nucleus. The later 2 are considered experimental. I am not sure whether surgeons other than those specifically designated by the FDA to research this use can legally use the stimulator for STN or GP stimulation. The later 2 locations are useful for bradykinesia and dyskinesia. The most recent data come from a group in France which has published the article in the New England Journal of Medicine 2 weeks ago giving extremely promising results. There however is some increased risk of stroke (over a palidotomy) in the Subthalamic procedure since that area of the brain is more vascular and closer to vital structures. I spoke with one of the FDA authorized neurosurgeons Dr. Penn at Rush-Presbyterian in Chicago. His numbers of STN and GP procedures done are quite small but no one in the US has significant numbers of STN procedures). The early indications are that it is relatively safe and helpful. Like you Joan, I am quite interested in writing or talking with anyone who has had the STN procedure since I am seriously considering it for myself. If anyone has any conflicting or additional information please let me know. Also I would check carefully to see if the center that you are considering going to for STN a stimulator evaluation is in fact doing STN and not just thalamic stimulation. (unless your symptoms are primarily tremor) Charlie Charles T. Meyer, MD Middleton (Madison), Wisconsin Go Packers beat Pittsburgh (Sorry Jim Cordy) Go Badgers- Beat Michigan ".Joan Waterman" wrote: > Robin, > > Again I'm confused! I thought it was made clear less than a week ago, that > the STNDBS was NOT approved yet by FDA and was only being done still as an > experiment. I was clearly under the impression that it was being done as a > thalmic implant and only for tremors. When did all these centers suddenly > receive approval for the STN implant? > > I was supposed to be notified when Mayo-Jacksonville was ok'd, but I have > heard nothing about it from them. I do have another appointment there this > month, so surely they will tell me something then. > > I would certainly like to hear from some of those PWPS who have had the > subthalmic implant as to the success/failures of this DBS. > > Ruth Clark 67/9 --------------E2A2D8A61E1A6F4F1C024544 Content-Type: text/html; charset=us-ascii Content-Transfer-Encoding: 7bit <!doctype html public "-//w3c//dtd html 4.0 transitional//en"> <html> Ruth Clark + Robin, <p>My understanding is the same as yours about STN stimulation. I wonder whether STN is getting confused with the more generic term of deep brain stimulation (DBS). There are 3 locations in the brain (which I am aware of) that stimulators are being used for treatment of PD- <p>1- the <b>thalamus</b>- which is useful for tremor and is to my knowledge the only FDA approved use of the stimulator. I believe that means that any trained neurosurgeon is able to do the procedure and get reimbursed by insurance or Medicare. <br>2- the <b>globus pallidum</b> (which is essentially a reversible and adjustable palidotomy) <br>3- and the<b> subthalamic nucleus.</b> <p>The later 2 are considered experimental. I am not sure whether surgeons other than those specifically designated by the FDA to research this use can legally use the stimulator for STN or GP stimulation. The later 2 locations are useful for bradykinesia and dyskinesia. The most recent data come from a group in France which has published the article in the <i>New England Journal of Medicine</i> 2 weeks ago giving extremely promising results. There however is some increased risk of stroke (over a palidotomy) in the Subthalamic procedure since that area of the brain is more vascular and closer to vital structures. <p>I spoke with one of the FDA authorized neurosurgeons Dr. Penn at <i>Rush-Presbyterian</i> in Chicago. His numbers of STN and GP procedures done are quite small but no one in the US has significant numbers of STN procedures). The early indications are that it is relatively safe and helpful. <p>Like you Joan, I am quite interested in writing or talking with anyone who has had the STN procedure since I am seriously considering it for myself. <p>If anyone has any conflicting or additional information please let me know. Also I would check carefully to see if the center that you are considering going to for STN a stimulator evaluation is in fact doing STN and not just thalamic stimulation. (unless your symptoms are primarily tremor) <br> <p>Charlie <p>Charles T. Meyer, MD <br>Middleton (Madison), Wisconsin <p><b>Go Packers beat Pittsburgh (Sorry Jim Cordy)</b><b></b> <p><b>Go Badgers- Beat Michigan</b><b></b> <p> <br>".Joan Waterman" wrote: <blockquote TYPE=CITE>Robin, <p>Again I'm confused! I thought it was made clear less than a week ago, that <br>the STNDBS was NOT approved yet by FDA and was only being done still as an <br>experiment. I was clearly under the impression that it was being done as a <br>thalmic implant and only for tremors. When did all these centers suddenly <br>receive approval for the STN implant? <p>I was supposed to be notified when Mayo-Jacksonville was ok'd, but I have <br>heard nothing about it from them. I do have another appointment there this <br>month, so surely they will tell me something then. <p>I would certainly like to hear from some of those PWPS who have had the <br>subthalmic implant as to the success/failures of this DBS. <p>Ruth Clark 67/9</blockquote> </html> --------------E2A2D8A61E1A6F4F1C024544--