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Deep Brain Stimulator
Live on the Web
Wednesday, April 24, 2002
at 5:00 PM EST
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The world's first live Internet broadcast of a deep brain stimulator implantation for Parkinson's
disease will take place this month at Wake Forest University Baptist Medical Center.
The deep brain stimulator therapy was approved by the U.S. Food and Drug Administration just
three months ago for treatment of all movement symptoms of Parkinson's, which can include tremor, slowness of movement
and rigidity. During the procedure, electrodes are positioned in the patient's brain and connected to the stimulator,
which is implanted under the collarbone.
The program on Wednesday April 24 will be the state's first live webcast of a surgical procedure
of any kind. The live webcast will begin at 5 p.m. on Wednesday April 24 and can be accessed through the Medical
Center's main web site: www.wfubmc.edu. The webcast will also be archived for viewing anytime during the next year.
About the Procedure
The deep brain stimulator (DBS) was approved by the Food and Drug Administration (FDA) in 1997
for implantation in the thalamus for the treatment of tremor, including essential tremor.
In January 2002, the device was
approved for implantation in the subthalamic nucleus and globus pallidus to relieve other motor symptoms of Parkinson's
disease, including rigidity, slowness of movement and a "freezing" of basic motor skills. The 2002 approval
also allows bilateral implantation.
The DBS, often called a "pacemaker
for the brain," works by emitting a constant stream of electrical impulses, blocking the brain signals that
cause symptoms.
"It fires electrical impulses
so rapidly it shuts the neurons down," said Stephen Tatter, M.D., neurosurgeon.
The device is connected to a battery
pack that is implanted just under the collarbone. The patient can turn it on or off by waving a magnet across the
battery.
Tatter said that the DBS is considered
superior to thalamotomy, destroying targeted neurons in the thalamus, because it does not permanently destroy brain
tissue. The DBS is reversible and can be re-programmed if side effects develop.
"This dramatically adds to
our ability to help the medically refractory subset of the population afflicted by Parkinson's disease," said
Tatter. "Now, movement disorders neurologists can use electricity as a medication for Parkinson's. Since the
electricity is surgically delivered precisely to the most appropriate location, it avoids some of the side effects
associated with systemic drug administration."
The recent approval opens the possibility
of controlling all of the motor symptoms of Parkinson's disease.
"Being one of the 20 most
experienced centers in the country with this device allows us to break new ground with respect to controlling the
multiple motor symptoms," said Tatter. "We are implanting electrodes in both the thalamus and the subthalamic
nucleus to allow rigidity and freezing to be treated while simultaneously entirely eliminating tremor--a technique
not widely available elsewhere."
Researchers have found that the
DBS can significantly improve symptoms of Parkinson's disease. A study of 138 patients showed that with the device,
the percentage of time during the day that patients had good mobility - with no involuntary movements - increased
from 27 percent to 74 percent. The results were reported in the New England Journal of Medicine (Sept. 27, 2001).
"As we've become more experienced
positioning the device, we're able to benefit the majority of movement symptoms that people with Parkinson's have,"
said Tatter. "By changing which of four leads are firing and the rate at which they're firing, you're basically
changing which neurons are being shut off by the device."
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Our Physicians
Stephen B. Tatter, M.D., Ph.D.
Assistant Professor, Department of Neurosurgery
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CME
Information
CME Registration will be available
on the day of the event, Wednesday, April 24, 2002 by clicking HERE.
Target Audience: Neurosurgeons, Neurologists and Rehabilitation
Medical Specialists
Learner Objectives: At the conclusion of this continuing
medical education activity, the participant should be better able to: 1. Identify candidates for surgery in whom
the potential of a surgical procedure are likely to outweigh the risks of the procedure for the following areas
potentially amenable to functional neurosurgical intervention. Choose the most appropriate surgical intervention
(if any) from among lesioning procedures and neurostimulatory procedures for the following disorders: Parkinson's
disease, PD-like syndromes, familial and other dystonias, essential/familial tremor, other types of tremor caused
by multiple sclerosis, trauma or stroke. 2. Compare and contrast radiofrequency thalamotomy, Gamma Knife thalamotomy
and thalamic deep brain stimulation with respect to potential side effects, complications and ideal patient selection
for the following disorders: Parkinson's disease and tremor. 3. List potential complications of stereotactic neurosurgery
for movement disorders.
Accreditation: The Wake Forest University School of
Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical
education for physicians.
Credit: The Wake Forest University School of Medicine
designates this educational activity for a maximum of 1.0 hours in category 1 credit toward the AMA Physician's
Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the activity.
Faculty Disclosure: As
an accredited CME sponsor, Wake Forest University School of Medicine requires that its speakers comply with the
ACCME Standards for Commercial Support of CME. All speakers have been asked to disclose any significant financial
interest or relationship that they may have with the manufacturer(s) of any commercial product/service that is
discussed as part of their presentation. Their responses are listed below. The commercial support standards also
require that their presentation be free of commercial bias and that any information regarding commercial products/services
be based on scientific methods generally accepted by the medical community. When discussing therapeutic options,
they have been asked to use only generic names. If it is necessary to use a trade name, then those of several companies
are to be used. Further, should their presentation include discussion of any unlabeled/investigational use of a
commercial product, they are required to disclose this information.
In the spirit of full disclosure, the following information is provided:
Stephen B. Tatter, MD, Ph.D. has received an honorarium and travel reimbursement from Medtronic
in the past.
Archives
Web broadcast of Deep Brain Stimulator will be available April 29, 2002.
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