6
A gel that is continuously pumped into the small intestine during walking hours
Duopa
Name target site for deep brain stimulation:
Globus pallidus internus, subthalamic nucleus, ventral intermediate (thalamus)
PD
What are the 3 target sites for deep brain stimulation?
1. PD (Parkinson's disease)
2. ET (essential tremor)
3. Dystonia
Name target site for deep brain stimulation:
Ventral intermediate (thalamus), ventralis oralis anterior and posterior (thalamus)
ET: essential tremor
- Surgically implanted medical device to deliver electrical stimulation to targeted areas in the brain
- electrodes are on BG
Deep brain stimulation
- Lead: insulated wire with electrodes that is implanted in the brain
- Extension: insulated wire placed under the scalp
- Neurostimulator: pacemaker-like device that is the power source
- Small battery
- Computer chip programmed to send electrical impulses to control systems
- Programmed about every 6 months after initial procedure
DBS components
- Dopamine replacement
- Treats the symptoms: motor
- Multiple types: original formula (Sinemet), extended release (Rytary), rescue dose (Imbrija--inhaler)
- Duopa - a gel that is continuously pumped into the small intestine during walking hours
- Side effects: dyskinesias, nausea, fatigue, dizziness
- Protein effect
Carbidopa/levodopa
How many leads will a person with PD need for DBS?
One or two
Two: walking and balance
One: just for the tremor
T/F: Both leads for DBS can be placed at the same time?
FALSE.. cannot be placed at once because of overload of the brain
Name target site for deep brain stimulation:
Globus pallidus internus
Dystonia
What is stage 1 of DBS?
DBS lead placement
How often are the DBS programmed? How often do batteries need to be changed?
Programmed: every 6 months
Batteries changed: 3-5 years
How many leads are needed for cervical dystonia for DBS?
Two leads are needed
What is stage 2 of DBS?
Neurostimulator is implanted (4 weeks after lead placement)
- Clear diagnosis of ET and ruled out other neurological problems
- Adverse effects on QOL by interfering significantly with ADLs
- Attempted treatment with variety of medications
- Patient and family understand the nature and complexity of DBS, including that the therapy is too new to guarantee successful treatment in any individual case
Who is a DBS candidate
- NO FES
- Every 3-5 years the batteries have to be replaced
- No MRI
Precautions/contraindications to treatment of someone with DBS
- PD decreases pain threshold
- Mood changes exacerbate pain
- People with PD cannot tolerate pain meds
- Surgery requiring anesthesia --> poor outcome
Clinical pearls related to pain
How can bradykinesia and hypokinesia affect ADLs?
Impact eating by missing the mouth
Cannot shave
May not be able to brush teeth
- Idiopathic PD
- Younger: less than 69 years old
- Significant response to dopamine replacement medications
- medication refractory symptoms: on/off fluctuations, dyskinesias
- no or little cognitive dysfunction
Who is a candidate of DBS
- City of residence
- Who lives with you?
- Caregiver assistance
- Single level or multi level
- Bathrooms
- Shower or tub
- Grab bars
- Driving status/transportation
- Equipment
Home environment
- Cervical: forward head
- Rounded shoulders
- Thoracic kyphosis
Upper quarter **
- Involuntary flexion of the thoracolumbar spine when standing, walking, or sitting, which completely disappears in the supine position
- Defined as flexion of 15-45 degrees at the hips (L5)
- Fatty infiltration into muscles
- Functional impairments: difficulty driving, unable to look people in the eye, unable to carry or pick up items, difficulty swallowing, dyspnea, back pain
- Prevalence: around 10%
Camptocormia **
- Scoliosis
- Increased/decreased lumbar lordosis
- Posterior pelvic tilt
Lower quarter **
- Orientation
- Command following
- Executive functioning
- Safety awareness
- Hypophonia
- Memory - SLUMS, MoCA
Cognition and communication