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DBS Phase 1 > Phase 1 DBS Training > Flashcards

Phase 1 DBS Training Flashcards

1
Q

What is the target for DBS for PD?

A

STN and GPi (Subthalamic Nuclueus) (Globus Pallidus Interna)

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2
Q

What is the target for DBS for dystonia?

A

GPi

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3
Q

What is the target for DBS for tremor?

A

VIM: Ventral Intermediate Nucleus

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4
Q

What is the definition of dyskinesia?

A

uncontrolled involuntary muscle movements and the undesired effects that come secondary to medications

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5
Q

What is dystonia?

A

movement disorder characterized by sustained muscle contractions causing twisting and repetitive movements or abnormal postures

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6
Q

What is the most common form of tremor?

A

Essential Tremor

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7
Q

What is GPi and what is it the main target for?

A

Globus Pallidus Interna, main target for Dystonia (also PD)

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8
Q

What are the 4 symptoms of PD?

A

tremor, bradykinesia, rigidity, postural instability

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9
Q

What causes Dystonia?

A

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

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10
Q

What is more common, PD or tremor?

A

Tremor, tremor is of the most widespread movement disorders

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11
Q

What is cerebellar tremor?

A

effects the extremitites, intention tremor that occurs at the end of a purposeful movement, caused by lesions on cerebellum

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12
Q

What is the definition of tremor?

A

a neurological movement disorder characterized by rhythmical, involuntary movement of a body part.

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13
Q

What is Parkinsonian Tremor?

A

Usually first sign of PD, characterized as “rest tremor”, meaning occurs when a body part is not voluntarily activated

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14
Q

What is dystonic tremor?

A

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

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15
Q

What is essential tremor?

A

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

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16
Q

What is the cause of ET?

A

unknown, however believed that certain parts of the cerebellum may be affected, most hereditary

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17
Q

What is action tremor?

A

tremor that is produced by voluntary contraction of muscle

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18
Q

What is the frequency of tremor?

A

low <4Hz
medium 4-7Hz
high >7Hz

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19
Q

Is ET rest tremor or action tremor? What is the frequency and what is the DBS target? Is it unilateral or bilateral implant?

A

action, specifically a postural and/or kinetic tremor, 4-12Hz, unilateral implant, DBS target is VIM

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20
Q

True or False: Alcohol reduces tremor amplitude.

A

True in about 50%-90% of cases but tremor usually worsens after the effect of alcohol has worn off

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21
Q

Is PD tremor rest or action? What is the frequency and what is the DBS target? Is it unilateral or bilateral implant?

A

rest, 3-6Hz, bilateral implant with STN, GPi target

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22
Q

What are the 3 Tremor Rating Scales?

A

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

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23
Q

Besides DBS, what is a surgical option for ET?

A

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

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24
Q

Are patients implanted unilateral or bilateral for ET?

A

unilateral implant contralateral to the side of the body with the most severe tremor, bilateral patients suffered more side effects

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25
Q

What is the DBS target for tremor?

A

VIM: Ventral Intermediate Nucleus in the thalamus

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26
Q

Tremor is more prevalent than PD? T/F

A

True

27
Q

Tremor that occurs during handwriting is an example of?

A

Task-specific tremor

28
Q

Tremor that occurs during any voluntary movement is known as?

A

Kinetic tremor

29
Q

The frequency range of tremor for ET patients falls within the range of?

A

4-12Hz

30
Q

PD is characterized by ___ tremor while ET is characterized by ___ tremor?

A

rest-action

31
Q

____ is a form of ET treatment that involves a lesion to the thalamus.

A

Thalamatomy

32
Q

Most ET patients have their DBS implanted bilaterally. T/F

A

False, unilateral implant contralateral to the worst side of the tremor

33
Q

How many people worldwide are living with PD?

A

7-10 million

34
Q

Men are ___ times more likely to have PD than women

A

1.5 times

35
Q

What is the cause of PD?

A

cause is unknown, risk factors include genetics, age, sex and environment

36
Q

What causes PD and in what part of the brain?

A

loss of dopamine in Substantia Nigra

37
Q

What is dopamine?

A

neurotransmitter responsible for transmitting signals between the SN and other brain regions

38
Q

How do you diagnose PD?

A

2 of the 4 primary motor signs, one always being bradykinesia

39
Q

What tools are used to evaluate PD?

A

UPDRS
Hoehn and Yahr (0-5, 0 no signs, 5 highest)
ADL
PDQ-39

40
Q

What is the goal of medical management for PD?

A

replenishing or mimicking lost dopamine, lowest but most effective dose

41
Q

Approximately ____ of dopamine generating cells are lost before motor symptoms are observed.

A

60-80%

42
Q

What is the commercial name of the levodopa/carbidopa combined drug used to treat PD?

A

Sinemet

43
Q

The undesired effects that come secondary to medications are called ______, which are abnormal involuntary movements

A

diskinesia

44
Q

DBS can provide much better treatment than a patients ON state with medications. T/F

A

False

45
Q

Dystonia is the ___ most common movement disorder. Put them in order.

A

third, 1) tremor 2)PD 3) dystonia

46
Q

What are the 3 ways to categorize dystonia?

A

Cause (etiology)
Age of Onset
Body Distribution: generalized, segmental, hemidystonia, multifocal, focal

47
Q

How do you classify dystonia by cause?

A

primary (hereditary) and secondary (outside factor)

48
Q

Early onset dystonia begins at what age? What about late onset?

A

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

49
Q

What is Blepharospasm?

A

affecting the muscles around the eyes and can lead to excessive blinking

50
Q

What are the rating scales for dystonia?

A

BFMDRS (Burke-Fahn-Marsden)

TWSTRS (Toronto Western Spasmodic Torticolis Rating Scale)

51
Q

What is doparesponsive dystonia (DRD)?

A

general term used to describe forms of dystonia that respond to levodopa, if DRD is suspected, drs will give a dose to confirm

52
Q

Which type of dystonia affects 2 or more unrelated body parts?

A

multi-focal dystonia

53
Q

What is the most common type of dystonia?

A

focal, (cervical)

54
Q

Explain the 5 different types of dystonia

A

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

55
Q

Name 3 types of focal dystonia

A

blepharospasm, laryngeal dystonia, cervical dystonia

56
Q

What are pharmacologic treatments for dystonia?

A

dopaminergic therapy, anticholinergic drugs and baclofen

57
Q

What are treatment options for dystonia?

A

PT, Botox, pharmacologic treatment, surgery, DBS

58
Q

DBS has been proven safe and effective for the treatment of limb, head and neck tremor. T/F

A

False-limb tremor but more research is needed for head and voice

59
Q

What are the side effects of being implanted with DBS for tremor?

A

more if bilateral, dysarthria, paresthesia, headache and tremor

60
Q

Which rating scales are often used specifically for ET?

A

TRS, ADL, UPDRS

61
Q

What are the 4 tremor syndromes?

A

cerebellar, dystonic, parkinsonian, essential

62
Q

ET most commonly affects ____ extremities and the frequency range of tremor is ____?

A

upper, 4-12Hz

63
Q

How does the ADL work?

A

100% completely independent

0 vegetative state

64
Q

What is UPDRS?

A

Unified Parkinson’s Disease Rating Scale, the higher the score the worse the Parkinson’s symptoms, 0-4, part 3 tests motor

DBS Phase 1 (6 decks)

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