Jump to content


E-Newsletter Signup Like us on Facebook Sign Up For Our e-Newsletter
Photo

Ted Talk on Deep Brain Stimulation (DBS) for Parkinson's and Other Neuropsychiatric Disorders


  • Please log in to reply
10 replies to this topic

#1 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 16 April 2012 - 06:19 AM

Dear Forum members,

Dr. Foote and I recently gave this talk on deep brain stimulation (DBS) for the TEDx series held at the University of Florida.

Here is the link:

http://mdc.mbi.ufl.e...-dr-kelly-foote

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#2 billheis

billheis

    Newbie

  • Members
  • Pip
  • 8 posts
  • Locationlongwood, fl

Posted 10 June 2012 - 10:44 AM

Dr. Okun, I just read in the article in the Washinton Post that some of the side effects of DBS are slurred speech and falling. Im on my second go round as the first time an infection set in and the surgeon went in three times to clean and apply antibioctics. The fourth time he pulled everything out. Because he trimmed the skin each time I had to little skin to close good and two weeks ago I had a plastic surgeon redo the area. Have your tuning experts been able to get rid of the falling problems? Because this time I have both slurred speech and falling issues. I was supposed to see you this comimg Monday or Tuesday but because of the new wound I put off until August.
Thank you, Bill (friend of Michael Church)

#3 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 10 June 2012 - 03:56 PM

Slurred speech and falling are very difficult to treat using DBS.

They can be side effects of the DBS surgery itself meaning if they don't change when you turn the device on or off they may be permanent. The most common issue that this occurs after DBS is verbal fluency (getting words out of the mouth). Other common issues after DBS are slurred speech and soft speech.

If it gets better when off DBS, then sometimes it can be re-programmed, but often it cannot (reprogramming strategies may be using bipolar configurations, turning one side off or reducing pulse width (as examples).

Falling is very hard to treat with DBS. Usually falling occurs as a result of disease progression. Occasionally the DBS is placed in a region important to motor function (e.g. the internal capsule) and moving the lead or reprogramming may help. Falling also may occur as a result of over-aggressive reduction in medications.

These are complex issues and can be hard to treat, as they may occur just from disease progression.

Hope that helps.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#4 billheis

billheis

    Newbie

  • Members
  • Pip
  • 8 posts
  • Locationlongwood, fl

Posted 25 June 2012 - 08:49 PM

Thank you Dr. Okun, last week my wound opened again after a plastic surgeon supossedly repaired it. So it was two days wide open, I kept it covered and it only developed a mild infection which infectious diesease doc is monitoring. I have picc line and recieve one bag of antibioctics daily. Dr. Razack is the surgeon and he is thinking that unless the skin is replaced in that area on my head, it might not seal again, and then there is the fact that this is the second one that been put in. The first one developed an infection imediately, and everything was pulled after 3 months. Waited until Jan of this year and tryed to reimplant and Dr. Razack used two battery units just incase. Well they took out the left side (which was the infected side the first time). When I woke up in post op my speech was almost 100% better and once I took a pill and it kicked in my walking was approx 90% better. I still have appt. with you set for August 6. I will fill you in on all all I've been through with this. At present with out meds adjusted to compansate for missing unit I am talking normal and walking with no walker or cane and no falling just like before 2nd DBS. I will give you my email just in case you only want to respond to me. Thank you and looking forward to seeing you in August . I' m in no hurry to put unit back in head ( battery pack still in chest) because my head on that side has been opened up 10 times in past 18 months. Hopfully your tuners can make best out of what I have.
Thank you
Bill Heiser ( billheis@yahoo.com)

#5 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 26 June 2012 - 11:26 AM

We are happy to see you Bill and glad to hear you are doing ok, despite all you have been through. It could be that the "lesional" benefit from your DBS and not the stimulation is causing much of the benefit. There was a recent article in Lancet Neurology about this issue.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#6 Steffy

Steffy

    Newbie

  • Members
  • Pip
  • 1 posts

Posted 27 June 2012 - 08:33 PM

I have been approved to have dbs, and certainly hope to have a better quality of life as a result. I have had a long history of severe migraine, now controlled by Depakote, and wonder if the scars in my brain could be a factor of my getting Parkinson's.

#7 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 30 June 2012 - 01:12 PM

I am not aware of a firm relationship between migraine and Parkinson.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#8 zackabenie

zackabenie

    Advanced Member

  • Members
  • PipPipPip
  • 56 posts
  • LocationRound Rock, Texas

Posted 26 June 2013 - 01:50 AM

I had my DBS surgery one year ago, and it has taken most of that year to get my energy level back up. My insomnia is much much worse, (sleeping every 2nd or 3rd night even with Lunesta, Serequil, and Trazadone all on board. I also noticed my verbal skills and my balance seem to have worsened. The tremors are all but controlled. Is the year to get back to speed normal?
Joelene -
Smile every day and laugh at least once at something the PD is now causing you to do. I personally love the "left" turns that happen as I walk. The smile really works - it makes everyone worry what you have been up to!

#9 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 26 June 2013 - 04:30 AM

A year is a little long to get back to normal after DBS. It is common to have problems getting words out of the mouth (verbal fluency) and to lose speech volume. Those two issues are expected. Fatigue and sleepiness I have seen after some DBS cases and I always get a sleep study. In many of my DBS patients we discover and treat a sleep disorder such as apnea and the fatigue resolves. The last thing I do is check the lead location by both imaging and also by clinical testing at each contact on the DBS lead.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#10 jnichols

jnichols

    Newbie

  • Members
  • Pip
  • 1 posts

Posted 02 January 2014 - 03:03 PM

Hello, my name is Julie Nichols.  I have a question about DBS surgery.  In the past, DBS surgery was used as  "last resort."  Now, movement disorder specialists are encouraging the surgery when patients are in the moderately disabled stage before dementia and other cognitive issues arise such as significant memory impairment or even mild dementia develops.  Right now, I am stage 3.5 according to the Unified Parkinson's rating Scale when I am off medication with a score of 65, and my cognition is healthy overall according to neurocognitive testing. Meaning, I have mild auditory memory issues and mild depression, but I don't meet the DSMIV criteria for dementia.  I am still able to work and raise a family with modifications and Siminet every three hours with Neupro; I have adverse reactions to Azliect.  I went undiagnosed with Parkinson's motor symptoms (not pronounced tremors) for many years such as rigidity/stiffness, jaw tremors, cramping in the right foot, muscle cramps in the right leg, and dystonia in my lower back with other non-motor symptoms starting in my twenties and into my 30s until the age of 41 when the tremors finally became very pronounced in October of 2012.  I finally reached a "tipping point" after years of being undiagnosed and was diagnosed on walking assistance.  I finally had to go to a top neurologist in Houston and responded robustly to Siminet.  I ran and did jumping jacks within one dose!  I felt as if my body was "put back together" when I responded to the drug.

 

Without medication, my tremors are "bilateral" now and my jaw tremor produces unintelligable speech when I'm off my meds.  My speech is near perfect with meds with a few stutters here and there, but my symptoms are not always controlled in-between doses, and wearing off periods happen quickly.  I respond very well to Siminet, but my body cannot handle Azliect as I said, nor can it handle but small amounts of the dopamine agonists.  The doctors are saying I'm a perfect candidate for DBS now. 

 

I realize that you haven't examined me, but does this sound like a good scenario for DBS?  I don't want to wait too long and not be a candidate.  I know that waiting one year too long can push me out of candidacy.  I have three kids to finish raising.

 

Thanks for your input.

 

Julie Nichols

 

 

 

 



#11 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,498 posts
  • LocationUniversity of Florida

Posted 03 January 2014 - 08:49 AM

Thank you for the question.  The recent publication of the EARLY STIM trial examined using DBS earlier and in younger patients (like you) and it showed an improved quality of life over just using medications (using the combination was better).  You are a little farther along than those patients but fit the phenotype.  In my practice younger fluctuating patients having a difficult time managing medications (with wearing off and dyskinesia) I consider DBS in that scenario.  I never rush the decision, and we have the potential candidates meet with our 7 specialty interdisciplinary team for a full evaluation and discussion of potential benefits and risks.


Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users