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Deep Brain Stimulation for Movement Disorders

  • Education and Training
  • Efficacy
  • Products and Procedures
  • Reimbursement and Practice Management
  • Indications, Safety, and Warnings
  • Patient Selection

    There are many factors critical to the success of deep brain stimulation. One of the most important is patient selection.

    Patient Assessment

    Best results are achieved when the patient is fully informed about the therapy risks and benefits, surgical procedure, follow-up requirements, and self-care responsibilities.

    Patient Assessment for Parkinson’s Disease

    To obtain maximum benefits from DBS Therapy, patients with advanced, idiopathic Parkinson's disease must be referred at the optimal time, or during a "window of opportunity" when the therapy may be most effective.

    Window of Opportunity

    Patient is experiencing troubling motor symptoms not effectively controlled by medications.

    • "On time characterized by disabling dyskinesias (or other nonmotor side effects)

    OR

    • "Off" time characterized by disabling tremor, rigidity, or akinesia/bradykinesia

    OR

    • Unpredicable "on/off" motor fluctuations

    OR

    • Medication-resistant tremor

    DBS Therapy Exclusion Criteria

    • No longer responsive to dopaminergic medication
    • Severely disabled even in the best "on" state
    • Medical conditions that prevent surgery
    • Dementia

    According to the American Academy of Neurology (AAN), "10% to 20% of people with PD may be eligible for surgical treatments.1


    When Medtronic DBS Therapy Is Appropriate

    DBS Therapy should be considered when the patient, despite optimal medical therapy, reaches a stage where the daily burden of PD begins to cause significant interference with:

    • Daily function
    • Occupational activities
    • Important leisure time pursuits
    • Basic activities of daily living
    dbs-dr-svoboda-th
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    Clinician Perspective on Considering DBS Therapy (Shelly Svoboda, MD)

    (1:25)

    A neurologist in Corvallis, Oregon, talks about when she considers DBS Therapy for a patient with Parkinson's.

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    Clinician Perspective on Considering DBS Therapy (Kenneth Martinez, MD)

    (1:07)

    A neurologist in Los Angeles talks about when he considers DBS Therapy for a patient with Parkinson's.

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    Clinician Perspective on Considering DBS Therapy (William J. Marks, Jr., MD)

    (:35)

    A neurologist in San Francisco talks about his goals when considering DBS Therapy for a patient with Parkinson's.


    Is Your Patient an Appropriate Referral Candidate for DBS therapy?

    A patient referral advisor app, called Assess for DBS, simplifies and clarifies the identification of Parkinson's disease patients who may be appropriate for referral to a specialized DBS center or implanter for further evaluation. The free app is compatible with iPad® and iPhone® and available on the Apple App Store.

    Download Assess for DBS

    An app to help identify Parkinson's disease patients who may be appropriate referral candidates for DBS Therapy.

    The Medtronic DBS Patient Referral Advisor, an online tool using the same recommendations, is available for use on computers.

     


    Use in Specific Populations

    Medtronic DBS Therapy for Parkinson's disease therapy is appropriate for patients who meet the following criteria:

    • Patients should have symptoms of advanced, levodopa-responsive Parkinson's disease that are not adequately controlled by medications; and
    • Patients should be suitable candidates for stereotactic neurosurgery

    The safety and effectiveness of deep brain stimulation therapy for Parkinson's disease has not been established for the following:

    • Patients with neurological disease origins other than idiopathic Parkinson's disease
    • Patients with a previous surgical ablation procedure
    • Pregnancy or delivery
    • Pediatric use (patients under the age of 18 years)
    • Patients over the age of 75 years
    • Patients with dementia
    • Patients with coagulopathies
    • Patients with moderate to severe depression

     

    Patient Assessment for Essential Tremor

    Medtronic DBS Therapy for Essential Tremor is appropriate for patients who meet the following criteria:

    • Patients should have disabling tremor of the upper extremity due to essential tremor or parkinsonian tremor
    • The tremor should constitute a significant functional disability
    • The tremor should be refractory to pharmacological therapies
    • Patients should be suitable candidates for stereotactic neurosurgery

    Patients should be carefully selected to assure that their tremor is of physiologic origin. Also, patients must be appropriate candidates for surgery. To help ensure maximum benefits from the neurostimulation system, long-term, post-surgical management of patients is recommended.

    Stimulation parameters should be adjusted such that maximal tremor suppression is achieved with minimal side effects. High parameter values may indicate a system problem or less than optimal lead placement.

    Use in Specific Populations

    The safety and effectiveness of deep brain stimulation therapy for essential tremor has not been established for the following:

    • Bilateral VIM stimulation
    • Patients with neurological disease origins other than essential tremor or Parkinson’s disease
    • Patients with a previous thalamotomy or surgical ablation procedure
    • Patients who are pregnant
    • Patients under the age of 18 years
    • Patients over the age of 80 years

    Patient Assessment for Dystonia*

    Medtronic DBS Dystonia Therapy is appropriate for patients who meet the following criteria:

    • Patients with chronic, intractable (drug refractory) primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia (torticollis), for individuals 7 years of age and older
    • Patients should be suitable candidates for stereotactic neurosurgery

    To help ensure maximum benefits from the neurostimulation system, long-term, post-surgical management of patients is recommended. Stimulation parameters should be adjusted such that maximal symptom suppression is achieved with minimal side effects. High parameter values may indicate a system problem or less than optimal lead placement. Patients should be informed of the risks of higher parameters, which may result in possible excessive charge destiny, as noted in the Medtronic DBS Therapy Information for Prescribers.

    * Humanitarian Device: The effectiveness of this device for this use has not been demonstrated. Learn more about HDE.

    References
    1. AAN Guidelines Summary for patients and their families: medical and surgical treatment for motor fluctuations and dyskinesias in Parkinson’s disease, April 2006.

    Tools and Resources

    Use these tools and resources to help identify candidates for deep brain stimulation for movement disorders.

    Parkinson’s Disease

     Assess for DBS

    An app to help identify Parkinson's disease patients who may be appropriate referral candidates for DBS Therapy.

    Parkinson’s Disease “On” Time Patient Diary

    The diary explains the importance of keeping an “on” time diary and includes instructions for completing it. 

    United States