Ασκήσεις Φυσικοθεραπείας

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FAQ - Parkinson's disease & DBS
  • What is Deep Brain Stimulation (DBS) and how does it work?
    DBS represents a surgical therapeutic approach for Parkinson’s disease (PD), involving implantation of electrodes which send electrical impulses to specific brain regions (nuclei). The electrical stimulus, characterized by certain parameters (intensity, frequency, pulse width) has the ability to normalize the function of neuronal circuits, proved to be disturbed in PD.
  • When should DBS be considered as a treatment option?
    DBS mainly concerns PD patients, who respond to dopaminergic therapy, but causes motor complications (dyskinesias) or it is insufficient. Therefore, since PD symptoms can no longer be adequately managed pharmacologically, surgical treatment with DBS should be considered as an option.
  • How does DBS benefit patients suffering from PD?
    DBS is highly effective in symptoms such as tremor, rigidity and bradykinesia. Moreover, relieves patients from dyskinesias and limits their motor fluctuations during the day. DBS may be less effective in balance or cognitive disorders. Overall, DBS can remarkably improve the functionality of PD patients, providing a very satisfactory quality of life.
  • Is DBS an experimental treatment method?
    DBS is not experimental for PD. It represents a therapeutic approach, for which effectiveness and safety have been proven through a large number of studies. To date, the role of DBS in treating PD is well established.
  • How are the candidates for DBS selected?
    The selection of the ideal candidates requires the collaboration between the neurologist, the neurophysiologist, the psychiatrist and the neurosurgeon. This medical team following a specific pre-operative protocol, which involves a series of tests, identifies the subgroup of PD patients who actually need DBS. The neurosurgeon takes final responsibility and decides if the surgery is possible, as well as the type of surgery.
  • Which PD patients are ideal candidates for DBS?
    In order to proceed with DBS, the following criteria should be fulfilled:
     
    • diagnosis of idiopathic Parkinson’s Disease,
    • disease duration 5 years at least,
    • severe motor symptoms (dyskinesias, on – off),
    • disease unmanageable with dopaminergic medications,
    • Positive response to levodopa (positive L-dopa challenge test, >30%),
    • Hoehn and Yahr Stage 2 – 4 (moderate – severe disease, patient able to walk during the on state),
    • Patient younger than 75 years old,
    • Normal cognition and absence of active psychiatric disease.
       
  • Which patients should be excluded from DBS therapy?
    Patients should be better excluded from DBS surgery if something from the following is true:
     
    • Secondary Parkinsonism {e.g. Progressive supranuclear palsy (PSP), Multiple system atrophy (MSA), Parkinsonism of Vascular Etiology etc.},
    • Limited response to levodopa (negative L-dopa challenge test, <30%),
    • Walking or speech disturbances as major symptoms,
    • Severe cortical atrophy in pre-operative MRI,
    • Co-morbidity (e.g. severe cardiovascular or pulmonary disease, uncontrollable hypertension, coagulation disorders, malignancies),
    • History of dementia or of pharmaceutically resistant depression,
    • Patient or familial environment unwilling to collaborate with the medical team.
       
  • What does the surgical procedure involve?
    The first and longer part of the surgical procedure involves the stereotactic targeting and the implantation of the electrodes. During this part, which is done under local anaesthesia and anaesthesiological monitoring, the patient remains awake in order to be in continuous communication with the medical team. The final part of the procedure, requiring general anaesthesia, involves the implantation of a pulse generator (battery) in the anterior thoracic wall and its connection with the electrodes.
  • Which are the procedure’s possible complications?
    Intracranial haemorrhage, head and neck or the pulse generator’s inflammation represent the major intra-operative or early post-operative complications of the surgical procedure. It may be a minor, limited as much as possible by taking the appropriate precaution measures, but still existing risk.
  • How is post-operative programming adjusted?
    The electrodes are usually activated 10 days after surgery. Until then patients continue with their pre-operative medication. During activation the best setting of parameters is selected, which may vary among patients, so the optimum therapeutic outcome is achieved. For the selection of the best setting for each patient, regular visits to the therapist are deemed necessary during the first post-operative period.
  • Is medication discontinued after DBS?
    Main purpose of surgery is patients’ relief from the symptoms and their functional improvement, not the discontinuation of medication. However, there is often a need of adjusting or reducing medication, in order to ovoid the possible adverse effects which the synergy of DBS and drugs may cause. In some cases, taking into consideration patient’s age and disease’s severity, DBS gives the ability of reducing the medication, thus more therapeutic modulations are available, in case PD evolves in the future.
  • Which are the possible adverse effects of DBS?
    Careful initial patient selection and intra-operative control minimize the likelihood of adverse effects. Still, electrical impulses may possibly cause symptoms such as speech or visual disorders, involuntary muscle contractions, dyskinesias, paraesthesias, deterioration of balance disorders, cognitive or behaviour problems. DBS is, nevertheless, totally reversible, being one of the major advantages of this method. Any adverse effects disappear after stopping or modifying the electrical stimulus. Once the right setting is selected, the maximum therapeutic benefit is provided without any adverse effects. What is more, with this technology the patients themselves have the opportunity to adjust their setting, apparently within certain settled by the therapist limits, so that it meets with their every-day needs.
  • How long does DBS’s therapeutic result last for?
    Up to date experience proves that DBS represents a method with long-lasting effectiveness. Concerning the hardware life duration , a quick intervention under local anaesthesia is required for the replacement of the pulse generator, approximately 5 years after surgery.
  • Does DBS surgery make PD “disappear”?
    DBS surgery, as well as all the existing medications constitute symptomatic kind of therapies only. They may relief the patients from their disabling symptoms, sometimes in such a degree that they live a completely normal life, however PD still exists or even progresses. Even though various theories have suggested that DBS may protect from or stop the progression of PD, this hasn’t been proved so far. To date, not any etiologic and non-experimental treatment for PD actually exists.
  • Is DBS effective in other conditions other than PD?
    Apart from PD, DBS represents an effective treatment option for tremor, dystonia, some psychiatric conditions (depression, obsessive compulsive disorder) and epilepsy.

    Zinovia Kefalopoulou M.D