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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

    These resources can help identify patients who may be candidates for deep brain stimulation.

    Parkinson's Disease

    Deep brain stimulation should be considered when pharmacological treatment alone is no longer adequately controlling motor symptoms of Parkinson's disease.

    Candidates

    Patients with Parkinson's disease may be candidates for deep brain stimulation if they:

    • Have symptoms of advanced, levodopa-responsive Parkinson's disease not adequately controlled by medications
    • Are suitable candidates for stereotactic neurosurgery

    The safety and effectiveness of deep brain stimulation therapy for Parkinson's disease have not been established for patients who:

    • Have a neurological disease other than idiopathic Parkinson's disease
    • Had a surgical ablation procedure
    • Are pregnant
    • Are under the age of 18
    • Have dementia
    • Have coagulopathies
    • Have moderate to severe depression

    Considering DBS for Parkinson's: Shelly Svoboda, MD

    A neurologist in Corvallis, Oregon, talks about when she considers DBS Therapy for her patients.

    Considering DBS for Parkinson's: Kenneth Martinez, MD

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

    Considering DBS for Parkinson's: William J. Marks, MD

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

     

    Assessment

    Assess for DBS is an app to help identify Parkinson's patients who may be appropriate referral candidates for deep brain stimulation. The app calculates a level of recommendation based on 6 absolute screening criteria and 7 relevant clinical variables. The recommendations reflect the opinions of a panel of leading neurologists who specialize in movement disorders and deep brain stimulation.

    Download Assess DBS PD

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

    Also available is the DBS Patient Referral Advisor, a similar software program available for desktop computers.


    Window of Opportunity

    Deep brain stimulation for Parkinson's disease has a window of opportunity when it may be most effective.

    The window opens when the patient is experiencing troubling motor symptoms not effectively controlled by medications. You may observe one or more of the following:

    • "On" time characterized by disabling dyskinesias (or other nonmotor side effects)
    • "Off" time characterized by disabling tremor, rigidity, or akinesia/bradykinesia
    • Unpredicable "on/off" motor fluctuations
    • Medication-resistant tremor

    The window closes when:

    • Symptoms no longer respond to dopaminergic medication.
    • The patient is severely disabled even in the best "on" state.
    • Medical conditions prevent surgery.
    • The patient has dementia.

    Introducing patients to DBS as a future option early in the disease progression can help prepare them to start therapy in time to take advantage of their window of opportunity.

     

    References
    1. Melamed E, Ziv I, Djaldetti R. Management of Motor Control Complications in Advanced Parkinson's Disease. Movement Disorders. 2007;22(Suppl.17)S379-S384.

    Essential Tremor

    Deep brain stimulation should be considered when a patient with essential tremor has disabling symptoms and medications are ineffective or have intolerable side effects.

    Candidates

    Patients with essential tremor may be candidates for deep brain stimulation if:

    • They have a disabling tremor of an upper extremity due to essential tremor or parkinsonian tremor.
    • The tremor causes a significant functional disability.
    • The tremor is refractory to pharmacological therapies.
    • They are suitable candidates for stereotactic neurosurgery.
    • The tremor is of physiologic origin.

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

    • 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

    Assessment

    The patient should be evaluated to determine the impact of essential tremor on daily life. Deep brain stimulation may be appropriate if:

    • The tremors interfere with activities of daily living such as eating, dressing, or writing.
    • Tremors prevent the patient from working.
    • Medications are ineffective or cause troublesome side effects such as sleepiness, dizziness, or thinking problems.

    Assess DBS ET is an online tool to help identify essential tremor patients who may be appropriate referral candidates for deep brain stimulation. The recommendations reflect the opinions of a panel of movement disorder neurologists, all with experience in the field of deep brain stimulation for the management of essential tremor. The tool is available as both an app and website.

    Download Assess DBS ET

    An app to help identify essential tremor patients who may be appropriate referral candidates for DBS Therapy.

     

    Dystonia

    Deep brain stimulation should be considered when a patient with chronic, primary dystonia cannot successfully manage symptoms with medication.

    Candidates

    Deep brain stimulation may be appropriate if the patient:

    • Has chronic, primary dystonia, including generalized and segmental dystonia, hemidystonia, and cervical dystonia (torticollis)
    • Cannot successfully manage symptoms with medication
    • Is 7 years of age or older
    • Is a suitable candidate for stereotactic neurosurgery

     

    Humanitarian Device: The effectiveness of this device for the treatment of dystonia has not been demonstrated. Learn more about HDE.

    Tools and Resources

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

    Parkinson’s Disease

    Assess DBS PD

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

    My Parkinson's Checkup

    Free online patient questionnaire designed to save time and improve communication during a consultation. At home, the patient answers 20 questions about symptoms, side effects, and everyday challenges, then prints a report as a starting point for your further questions and evaluation.

    Symptom Tracker Diary

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

    Essential Tremor

    Assess DBS ET

    An app to help identify essential tremor patients who may be appropriate referral candidates for deep brain stimulation.

    medtronic.com/assessdbs

    An online tool to help identify essential tremor patients who may be appropriate referral candidates for deep brain stimulation.

     

    United States