Phase 1 DBS Training Flashcards
What is the target for DBS for PD?
STN and GPi (Subthalamic Nuclueus) (Globus Pallidus Interna)
What is the target for DBS for dystonia?
GPi
What is the target for DBS for tremor?
VIM: Ventral Intermediate Nucleus
What is the definition of dyskinesia?
uncontrolled involuntary muscle movements and the undesired effects that come secondary to medications
What is dystonia?
movement disorder characterized by sustained muscle contractions causing twisting and repetitive movements or abnormal postures
What is the most common form of tremor?
Essential Tremor
What is GPi and what is it the main target for?
Globus Pallidus Interna, main target for Dystonia (also PD)
What are the 4 symptoms of PD?
tremor, bradykinesia, rigidity, postural instability
What causes Dystonia?
cause is not fully understood but could be malfunction of the basal nuclei, could be lesions of GPi, **basal nuclei is made up of interconnected structures and controls the initiatiion and execution of motor function
What is more common, PD or tremor?
Tremor, tremor is of the most widespread movement disorders
What is cerebellar tremor?
effects the extremitites, intention tremor that occurs at the end of a purposeful movement, caused by lesions on cerebellum
What is the definition of tremor?
a neurological movement disorder characterized by rhythmical, involuntary movement of a body part.
What is Parkinsonian Tremor?
Usually first sign of PD, characterized as “rest tremor”, meaning occurs when a body part is not voluntarily activated
What is dystonic tremor?
may be first indication of dystonia, affects ppl of all ages, occurs usually when a patient is in a certain position or moves a certain way
What is essential tremor?
one of the most common tremor disorders, typically starts on one side of the body but in time both sides will be affected, onset is 40-50 years
What is the cause of ET?
unknown, however believed that certain parts of the cerebellum may be affected, most hereditary
What is action tremor?
tremor that is produced by voluntary contraction of muscle
What is the frequency of tremor?
low <4Hz
medium 4-7Hz
high >7Hz
Is ET rest tremor or action tremor? What is the frequency and what is the DBS target? Is it unilateral or bilateral implant?
action, specifically a postural and/or kinetic tremor, 4-12Hz, unilateral implant, DBS target is VIM
True or False: Alcohol reduces tremor amplitude.
True in about 50%-90% of cases but tremor usually worsens after the effect of alcohol has worn off
Is PD tremor rest or action? What is the frequency and what is the DBS target? Is it unilateral or bilateral implant?
rest, 3-6Hz, bilateral implant with STN, GPi target
What are the 3 Tremor Rating Scales?
TRS: Fahn-Tolosa-Marin clinical tremor rating scale, 0 no tremor to 4 severe
ADL: the higher the score the greater the disability
UPDRS: Unified PD Rating Scale, 0-4
Besides DBS, what is a surgical option for ET?
Thalamotomy for ET involves a lesion to the VIM of the thalamus, tremor improves by 55-90%, unilateral is recommended for refractory limb tremor, bilateral is too risky, thalamotomy has more adverse events than DBS
Are patients implanted unilateral or bilateral for ET?
unilateral implant contralateral to the side of the body with the most severe tremor, bilateral patients suffered more side effects
What is the DBS target for tremor?
VIM: Ventral Intermediate Nucleus in the thalamus
Tremor is more prevalent than PD? T/F
True
Tremor that occurs during handwriting is an example of?
Task-specific tremor
Tremor that occurs during any voluntary movement is known as?
Kinetic tremor
The frequency range of tremor for ET patients falls within the range of?
4-12Hz
PD is characterized by ___ tremor while ET is characterized by ___ tremor?
rest-action
____ is a form of ET treatment that involves a lesion to the thalamus.
Thalamatomy
Most ET patients have their DBS implanted bilaterally. T/F
False, unilateral implant contralateral to the worst side of the tremor
How many people worldwide are living with PD?
7-10 million
Men are ___ times more likely to have PD than women
1.5 times
What is the cause of PD?
cause is unknown, risk factors include genetics, age, sex and environment
What causes PD and in what part of the brain?
loss of dopamine in Substantia Nigra
What is dopamine?
neurotransmitter responsible for transmitting signals between the SN and other brain regions
How do you diagnose PD?
2 of the 4 primary motor signs, one always being bradykinesia
What tools are used to evaluate PD?
UPDRS
Hoehn and Yahr (0-5, 0 no signs, 5 highest)
ADL
PDQ-39
What is the goal of medical management for PD?
replenishing or mimicking lost dopamine, lowest but most effective dose
Approximately ____ of dopamine generating cells are lost before motor symptoms are observed.
60-80%
What is the commercial name of the levodopa/carbidopa combined drug used to treat PD?
Sinemet
The undesired effects that come secondary to medications are called ______, which are abnormal involuntary movements
diskinesia
DBS can provide much better treatment than a patients ON state with medications. T/F
False
Dystonia is the ___ most common movement disorder. Put them in order.
third, 1) tremor 2)PD 3) dystonia
What are the 3 ways to categorize dystonia?
Cause (etiology)
Age of Onset
Body Distribution: generalized, segmental, hemidystonia, multifocal, focal
How do you classify dystonia by cause?
primary (hereditary) and secondary (outside factor)
Early onset dystonia begins at what age? What about late onset?
early: before 26, starts with symptoms in the limbs and spreads to become generalized w/in 5 years
late: after 26, symptoms usually affect one body part, focal dystonias, cervical is most common
What is Blepharospasm?
affecting the muscles around the eyes and can lead to excessive blinking
What are the rating scales for dystonia?
BFMDRS (Burke-Fahn-Marsden)
TWSTRS (Toronto Western Spasmodic Torticolis Rating Scale)
What is doparesponsive dystonia (DRD)?
general term used to describe forms of dystonia that respond to levodopa, if DRD is suspected, drs will give a dose to confirm
Which type of dystonia affects 2 or more unrelated body parts?
multi-focal dystonia
What is the most common type of dystonia?
focal, (cervical)
Explain the 5 different types of dystonia
generalized: limbs, trunk and another body part
focal: one single body area
segmental: several adjoining parts of the body
multi-focal: two or more unrelated body parts
hemidystonia: multiple body parts only on one side
Name 3 types of focal dystonia
blepharospasm, laryngeal dystonia, cervical dystonia
What are pharmacologic treatments for dystonia?
dopaminergic therapy, anticholinergic drugs and baclofen
What are treatment options for dystonia?
PT, Botox, pharmacologic treatment, surgery, DBS
DBS has been proven safe and effective for the treatment of limb, head and neck tremor. T/F
False-limb tremor but more research is needed for head and voice
What are the side effects of being implanted with DBS for tremor?
more if bilateral, dysarthria, paresthesia, headache and tremor
Which rating scales are often used specifically for ET?
TRS, ADL, UPDRS
What are the 4 tremor syndromes?
cerebellar, dystonic, parkinsonian, essential
ET most commonly affects ____ extremities and the frequency range of tremor is ____?
upper, 4-12Hz
How does the ADL work?
100% completely independent
0 vegetative state
What is UPDRS?
Unified Parkinson’s Disease Rating Scale, the higher the score the worse the Parkinson’s symptoms, 0-4, part 3 tests motor
