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Rajkot Press meeting to launch the campaign : "Conquering Parkinson's Disease"- We will not be defeated
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Surgery for Movement and Psychiatric Disorders
Dr. Paresh K DoshiIn-charge Stereotactic and Functional Neurosurgical
ProgramJaslok Hospital and Research Centre
Movement Disorders
•Parkinson’s Disease
•Tremors
•Dystonia
Parkinson’s Disease
•Tremors, slow movements, stiffness, postural instability
•8-20/10,000
•Usually associated with old age- young not uncommon
•Levodopa treatment most effective initially
Medical Management
•Levodopa- Dopamine replacement
•Other drugs:
•Dopamine agonists like ropinarole, pramipexole etc.
•Side effects:
•Nausea Vomiting
•Dyskinesias, Hallucinations, Constipation
Who is the best surgical candidate
•Usually >5yrs of disease
•on-off fluctuations
•Significant dyskinesias
•Off phase dystonia and pain
•Uncontrolled tremors
•Levodopa responsive symptoms
Parkinson’s Disease Target
STN7x9x5mm
Surgical strategies for Parkinson’s Disease
LesionLesion StimulationStimulation
Subthalamic nucleusSubthalamic nucleus
What is Deep Brain Stimulation
IPG
LEAD
What is Deep Brain Stimulation
STN Lesion
•Total no. of Movement Disorders Surgeries- 254
•Deep brain stimulation surgeries-182
•DBS for PD-162
Demographics
Surgery
Instantaneous relief
Real Estate Consultant Back on his Legs
Preop 1Y Postop
3Y Postop
TextDoctors Also!!!
N=30
N=26
59%
54%
Doshi et al, Neurology India 2004
Doshi et al, Movement Disorder 2006
Results
N=30
N=26
36%
38%
Doshi et al, Neurology India 2004
Doshi et al, Movement Disorder 2006
Results
STN Lesioning
After 5 years
Thank You