Deep Brain Stimulation

Question 1

Idiopathic Parkinson’s disease causes motor and non-motor symptoms. List 4 of each.

Answer 1

Motor symptoms:
Rigidity, resting tremor, bradykinesia, gait freezing

Non-motor symptoms:
Dementia, loss of smell and taste, difficulty
speaking and swallowing, constipation

Question 2

What is one of the earliest signs of PD?

What is a late non-motor feature?

Answer 2

Loss of the sense of smell

Dementia

Question 3

Are abnormally brisk reflexes associated with PD?

Answer 3

No

Question 4

List 7 selection criteria for deep brain stimulation for PD.

Answer 4

1. Ensure they have PD and not another condition that mimics it.
2. Treated appropriately but has not responded well to
   drugs.
3. Healthy and cooperative
4. MRI of brain
5. Neuropsychological tests
6. Levodopa challenge test (DBS does not work if there is little or noresponse to levodopa)
7. Patient has realistic expectations

Question 5

What aspect of PD does DBS actually help?

Answer 5

Motor symptoms

Question 6

What feature of PD responds best to DBS?

Answer 6

Dyskinesia

Question 7

What three parts of the brain are commonly targeted for DBS?

Answer 7

Subthalamic nucleus
Thalamus/zona incerta
Globus pallidus interna

Question 8

What are the three phases of DBS?

Answer 8

Phase 1: electrode insertion
Phase 2: pulse generator insertion
„Phase 3: DBS adjustment

Question 9

What are the results of DBS? (3)

Answer 9

More time “on”
Medications reduced to <50%
Less dyskinesia

Question 10

What are the potential complications of DBS? (2)

What are the three reversible effects?

Answer 10

Infection
Lead migration or fracture
„ 
Speech disturbance
„Unsteadiness
„Depression

Question 11

What are 8 uncommon uses for DBS?

Answer 11

Pain
Epilepsy
Depression
Obsessive compulsive disorders
Addiction
Alzheimer’s disease
Schizophrenia
Tourette’s syndrome

Question 12

What is the only thing DBS is funded for in the UK?

Answer 12

Movement disorders

Question 13

What are the two forms of dystonia?

What is the usual target for DBS?

Answer 13

Focal dystonias (which affect one part of the body)
and hand)
Generalised dystonias (affect the whole body)

Globus pallidus interna