CC March 2016 Deep Brain Stimulation (DBS) for Parkinson's Disease

echoecho's version from 2016-05-31 00:47


Question Answer
DBS was initially Food and Drug Administration approved for treating what?essential tremor
DBS now has indications for treating what three medical conditions?1) Parkinson's disease 2) OCD 3) refractory epilepsy
*** List the indications for DBS in Parkinson's?1) disease progression despite optimal medical therapy 2) development of debilitating side effects such as medication induced dystonia
*** DBS can reduce _____, improve ____ ______ and reduce ____-_____ _____?tremor; improve motor function; reduce medication-related dystonia
Although improved motor function is the primary goal of DBS, cognitive improvement may be seen in some patients with concomitant ____ _____ ______?Lewy Body dementia
Is medical therapy including lovodopa/carbidopa (Sinemet) contraindicated in DBS?no
DBS may help manage what or permit what, thus limiting adverse effects?1) manage medication-related dystonia 2) permit decreased doses of Parkinson's medications
Does duration of medical therapy determine whether DbS is indicated or contraindicated in Parkinson's disease?no
Is age a contraindication to DBS?no; although older patients have a greater number of co-morbid conditions, which may increase perioperative risk
In the past, patients were often required to pass what challenge test prior to DBS, but recent studies indicate that patients who fail the test may still benefit?levodopa
What is the levodopa challenge test?discontinuing anti-Parkinson's medications for 12 hours, at which time a Unified Parkinson Disease Rating Scale assessment is performed ( The patient is then given a supra-therapeutic dose of Levodopa and re-evaluated about 45 minutes post-administration. A 30% improvement in the UPDRS is predictive for a positive response to DBS, although, as noted, patients who "fail" this test may also benefit
DBS therapy in Parkinson's disease most commonly involves electrode placement in either what two areas?1) globus pallidus internus (Gpi) OR 2) subthalamic nucleus (STN)
Implantation may be unilateral or bilateral, which is more common?bilateral
Implantation in the STN (subthalamic nucleus) improves ____ ______ to a greater degree than GPi (globus pallidus internus), however GPi implantation is associated with better cognitive outcomes?motor function
List the complications of DBS?1) hemorrhagic stroke 2) infection 3) seizures 4) hardware dysfunction
*** SUMMARY = DBS is approved for treatment of 4 medical conditions?1) essential tremor 2) Parkinson's disease 3) obsessive compulse disorder 4) refractory epilepsy
*** SUMMARY = In Parkinson's disease, DBS can help manage what?medication-related dystonia and/or allow for a decrease in medication dosages
*** SUMMARY = Are medication therapy with levodopa/carbidopa, duration of medication therapy and age, contraindications to the use of DBSno