page 1 Inp t to/from the Brain ut/OutpuOutputs: uscles Control one’s own mSynthetic speech Control one’s environment Inputs: Sensory (vision, hearing) Reduce pain s Damp epileptic feedback loopReplace lost neuron linkages Regulate behavioral pattern generators Ho ing of the brain? w to treat mis-wirDrug replacement Injections, pills Infusion pumps Surgically implanted prosthesis (electrodes) Cortical (shallow) Deep (basal ganglia) Peripheral Regeneration lantation Stem cell impNerve guides Limits of Drug Therapies Effective dose decreases Duration of effect decreases Side-effects increase Stem cell implants trial of Parkinsons cell therapy Results of clinicalAdult Stem Cells Brain Control (or …What To Do When Your Circuits Don’t Work) Eric E. Sabelman, PhD, Functional Neurosurgery Bioengineer, Kaiser Permanente Medical Grouppage 2 Why Deep Brain Stimulation? hen medication is ineffective for: Symptomatic treatment w Parkinson’s Disease Tremor syndromes Pain syndromes Primary dystonia DOPA responsive dystonia Tardive dyskinesia Tourette’s Syndrome Anorexia Nervosa Obsessive-compulsive disorder Depression Symptoms of Parkinson's Disease tremor rigidity slowed gait (bradykinesia) motor block or “FOG” Deep Brain Stimulation Surgery at Kaiser Redwood City PD Patient Evaluation/Screening P& MRI rocess 1. Initial 1 hr consultation 2. Exclusionary criteria? 3. If anxiety related surgical risk factor noted, refer patient for relaxation training 4. Diagnostic evaluation - 1 hr to overnight 5. 2nd or further: appointment(s) fa. medication b. diagnostic studies c. monitoring 6. Neuropsychological testing - 4 hrs 7. Case discussed by Review Board 8. Follow up appointment to discuss recommendations & 1 hr surgery option(s) – 9. Schedule surgery 10. Presurgery MR & CT imaging 11. Perioperative instructions – 1 hr 12. Post-surgical in-patient care – 3 days 13. Stimulator programming at 2, 6, 12 months – 4 hrs Steps to insure targeting accuracy Accuracy of +/- 0.5 mm requires: • MRI localization of STN relative to anterior & posterior commisures • Fuse MRI & CT for bone landmarks nce to MRI • Ventriculogram at surgery start as refere• Bilateral plane X-ray to locate electrode • Recording multiunit neuron signals at known electrode depths • Repeat X-ray & recording for each track Brain Control (or …What To Do When Your Circuits Don’t Work) Eric E. Sabelman, PhD, Functional Neurosurgery Bioengineer, Kaiser Permanente Medical Grouppage 3 Operating room setup for DBS surgery: RWC OR-6 - stereotactic floorstand & intraoperative CR X-ray units & printer In the Operating Room DBS specialty team Neurosurgeon Nurse practitioner r/physicist BioengineeHospital staff Anesthesiologist Scrub tech se Circulating nurHo spital servicesPerioperative Radiology Mapping and permanent DBS electrodes inserted stereotactically Brain Control (or …What To Do When Your Circuits Don’t Work) Eric E. Sabelman, PhD, Functional Neurosurgery Bioengineer, Kaiser Permanente Medical Grouppage 4 Intraoperative Microelectrode Navigation Final surgical steps: Test stimulation after DBS implantation Implant pulse generator Post-surgical electrode location confirmation Does DBS help? Kaiser Permanente Medical Center Neurosurgery Department 1150 Veterans Blvd., Redwood City, CA 94063 Gary Heit, PhD MD (650) 299-2285 [email protected] Eric E. Sabelman, PhD (650) 299-4146 [email protected] Brain Control (or …What To Do When Your Circuits Don’t Work) Eric E. Sabelman, PhD, Functional Neurosurgery Bioengineer, Kaiser Permanente Medical
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