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chuck172

dbs candidate

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I'm tremor dominant pd. positive  datscan. Diagnosed for two years. I have not had felt any tremor improvement with any drug. I've tried many. Am I a good dbs candidate?

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Yes, if you have tried maximally tolerated doses of agonists and levodopa then we consider DBS for medication resistant tremor.  It is usually a very good option.

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I keep reading that to be a good dbs candidate: "   Clear evidence of motor improvement with sinemet, with good motor function in the best on-medication state. A good screening test is the Unified Parkinson's Disease Rating Scale (UPDRS) part III, performed in 12 hours off of medication and repeated following a supratherapeutic sinemet dose. We require at least a 30% improvement in this score with sinemet. 

I am tremor dominant. The tremors show no improvement from sinemet. My neurologist has basically given up on me saying dbs is my only hope to stop the tremors. Is it?

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Could be; if you have tried high doses of Sinemet (300mg per dose) then this is possible (DBS could help and often does for tremor).

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I've taken three 25-100 sinemet pills three times a day, with no relief. That would be what you consider a high 300 mg dose, correct?

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900 mg a day and 300 per dose is considered a good trial for tremor. 

I always get a gastric emptying study to make sure meds are absorbing.  I also confirm the diagnosis of Parkinson by exam and on/off UPDRS testing.

Hope that helps.  Tremor may be resistant to dopamine.

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