Parkinson Disease, Essential Tremors and Dystonia Clinical Trial
Official title:
Deep Brain Stimulation in the Treatment of Intractable Movement Disorders ( Parkinson's Disease, Essential Tremors and Dystonia)
The aim of this study is to observe the efficacy of Deep Brain Stimulation in the treatment of Parkinson's disease,Essential Tremors and Dystonia in our locality.
Movement disorders are clinical syndromes result from disturbances of basal ganglia function
with either an excess of movement or a paucity of voluntary and involuntary movements,
unrelated to weakness or spasticity. Movement disorders are synonymous with basal ganglia or
extrapyramidal diseases. Movement disorders are conventionally divided into two major
categories-hyperkinetic and hypokinetic.
Hyperkinetic movement disorders refer to excessive, often repetitive, involuntary movements
that intrude upon the normal flow of motor activity and it includes include Essential
Tremors, Dystonia, Chorea, Dyskinesia, and Athetosis.
Hypokinetic movement disorders refer to akinesia (lack of movement), hypokinesia (reduced
amplitude of movements), bradykinesia (slow movement) and rigidity. In primary movement
disorders, the abnormal movement is the primary manifestation of the disorder. In secondary
movement disorders, the abnormal movement is a manifestation of another systemic or
neurological disorder.
The basal ganglia include the striatum (caudate. putamen, nucleus accumbens), the subthalamic
nucleus (STN), the globuspallidus [internal segment. external segment, ventral pallidum
(VP)]. and the substantianigra pars compacta (SNpc) and substantianigra pars reticulata
(SNpr).
Surgical therapies for the treatment of movement disorders can be divided into two broad
categories: ablative and restorative. The most common structures targeted during stereotactic
surgery for movement disorders are the motor thalamus, the globuspallidus internus and the
subthalamic nucleus. Ablative surgical therapies for Movement disorders include thalamotomy
and pallidotomy. Restorative surgical therapies include deep brain stimulation and
transplantation of fetal tissue, cell lines that express trophic factors, or somatically
delivered gene therapies. The theoretical advantage of Deep Brain Stimulation over ablative
procedures is the lack of tissue destruction especially with deep brain stimulation. This is
particularly appealing for patients needing bilateral procedures.
Parkinson's disease is the best example of a hypokinetic movement disorder. The interest in
surgery has been prompted by the growing realization of the limitations of drug therapy for
these movement disorders, improvement in neuroimaging capabilities, enhanced stereotactic
surgical techniques and better understanding of functional organization of the basal ganglia
and its pathophysiology of these movement disorders. There are many theories on how does Deep
Brain Stimulation works in the treatment of movement disorders, these theories include
Neurostimulation, Neuroinhibition, and Release of neurotransmitters. Deep brain has the
following advantages over ablative surgery: No destruction of brain tissue can adjust
stimulus parameters, Perform bilateral operations, significant reduction (50-75%) in
medication, and it is completely reversible.
Since the introduction of deep brain stimulation almost 20 years ago, there has been an
immense resurgence in interest in the surgical technique. However, the investigators are
still asking some of the same questions. How can the investigators improve the targeting?
What is the optimal target? In addition, the investigators have started asking some new
questions such as how does deep brain stimulation work, and what other disorders can deep
brain stimulation be applied to?
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