The hope for the people with Parkinson disease

Neurological surgeons from the Homolka Hospital and those from the Clinic of Neurology 1st. Faculty of Medicine Charles University have implanted a stimulation electrode into a new target in the brain. The results are outstanding and the femail patient is almost without any troubles.

The treatment by Deep Brain Stimulation (DBS) helps Czech patients since 29 years ago. The Center for Intervention Therapy of Motoric Disorder (i TEMPO) in Prague connects the physicians from Clinic of Neurology 1st. Faculty of Medicine Charles University as well as from the Departement of Stereotactical and Radiation Neurosurgery at the Homolka Hospital. Just in this Centre the woman with Parkinson disease underwent in February the DBS treatment, oriented towads a new region of the brain, as a first treatment in the Czech Republic.

The deep simulation of the brain is a neuromodulation therapeutic method, which is used in treatment of selected patients with central disorders of mobility (Parkinson dissease, essencial shivors or dystony ) in case when the farmacologic treatiment itself fails to ensure optimal compensation of the state of movement. The success of DBS is connected with a number of key steps. Firs of all , it is necessary to find a correct choice and preparation of potential candidate. The following step is the actual operation itself, when the neurological surgeon introduces by means of stereotaxis with a minimal aproach and millimetre precision the stimulation electrode into the selected nukleus deep in the brain.

The electrode is then connected by a cable with a generator of electrical pulses (called a neuro- stimulator), which is like a kardiostimulator placed in the subcutaneous region of the under the collarbone. The stimulation is sput on for the first time about one month after the operation. Then a period of early postoperation management follows (3-6 month), when the stimulation parameters and the farmacotherapy are modified step by step, so as to get the optimal DBS therapy effect. Each patient with DBS is lasingly and regularly followed and, according to the evolution of the disease, the stimulation parameters can be modified if desired. In the whole DBS programme is shared within the frame of i TEMPO by a multibranche team of neurologists, neuro-chirurgiens, psychiatrists, psychologists and many specialyzet people.

Parkinson disease is the second most common neurod generative disease. In the Czech Republic there are about 30-50 thousand patients. DBS is indicated rather in the early stages of Parkinson dissease. The most often choice of an anatomic target is the brain for stimulation is the subtalamic nukleus (STN). DBS STN has a very good effect on all classic symptoms of the Parkinson disease: shivors, stiffness and retardation of movements.

Our patient (a woman 62 years old) was not suitable for implantation into STN, because she had some symptoms which are not usual for Parkinson disease, and which we could not sufficiently treat. The problem was in action shatter of the right arm, i.e. the shatter that is the largest in the active movement of the arm, and significantly pertubs the movement of arms in tipical movements (eating, drinkong and writing).

Hence, neurological surgeons and neurologists from both places of work thus decided to apply on the patient a new goal – i.e. the so called PSA (posterior subthalamic area), which is the area of white and grey matter, which has been for a log time a source of uncertainty where it should be anatomically classified.

Why this nontraditional area?

PSA is a unique place communicatuing a larger number of brain structures in the deap parts of brain, which play their role in different clinical symptoms of disordes of mobility. From our point of view, it was important that the previous researches and experience indicated that the DBS of this region might meaningfully affect, apart from classic symptoms of Parkinson disease, also the action tremor, „ as explained by Jaromir May, MD, Ph.D, from Departement of Stereotactic and Radiation Neurosurgery of the Homolka Hospital, who implanted a stimulator and an electrode into the brain of the patient. „

The results of the first setting and subsequent ambulant control surpassed all expectations, the patient has now virtually no complaints“, said the neurologist and the head of the BDS se of the Clinic of Neurology 1st Faculty of Medicine Charles University, Filip Růžička, MD, Ph.D, who indicated the patient for operation.

„ Within the framework of the post-operation management, the patient will attends further adjustments in the stimulation setting and farmacotherapy, but even now the results is really excellent“.