FAQ'S
Who Is A Candidate For Deep Brain Stimulation?
Patients suffering from disabling tremor due to Parkinson's Disease or Essential Tremor, that cannot be controlled by medications, or who experience intolerable side effects from their medications, may be candidates for Deep Brain Stimulation therapy.
Deep Brian Stimulation has been show effective for the treatment of chronic pain associated with tremor and is currently being used in some types of chronic, intractable pain.
What Are The Benefits Of Deep Brain Stimulation?
Deep Brain Stimulation therapy significantly reduces tremor in about 80% of patients. The amount of tremor reduction varies. Most patients experience almost complete relief on the side of the brain treated.
Some patients experience partial tremor relief, allowing them to be more functional. Some patients do not benefit. Reduction in tremor is associated with improvement in performance of daily living activities.
What Are The Side Effects Of Deep Brain Stimulation?
At times there may be some side effects associated with Deep Brain Stimulation such as problems with balance, speech, and numbness. These are usually reversible, mild and accepted. The use of Brain Mapping minimizes the chances of complications.
What is Brain Mapping?
Before starting and before finalizing a Deep Brain Stimulation therapy, the effectiveness of the therapy is tested, during surgery, using a technique called Brain Mapping.
Brain mapping consists of microelectrode stimulation and recording techniques. Brain mapping is used to optimize the placement of the implantable electrode or lesion ,in the case of thalamotomy or pallidotomy, in the brain, by collecting data on the patient's neurophysiological response to an extensive series of test stimulations.
Brain mapping also helps increase the benefits and decrease the risks of potential complications associated with surgical intervention.
Can the patient control or adjust the amount of electrical stimulation to the brain according to his needs?
In Deep Brain Stimulation therapy, either the doctor or the patient can adjust the amount of stimulation as needed to optimize tremor relief as well as minimize its side effects. The neurosurgeon uses a specialized computer to adjust multiple stimulation parameters.
In addition, the patient uses a hand-held control device that can vary the stimulation activity between high, low and off settings.
For example, patients can adjust their stimulation level to high when their tremor increases as a result of stress, or they can turn off their stimulation completely when they go to sleep. (Tremor is usually reduced or ceases with sleep.)
Who Performs Deep Brain Stimulation?
Functional stereotactic neurosurgeons with a specialty in involuntary movement disorders perform Deep Brain Stimulation.
After determining that a patient is a candidate for surgical intervention, the appropriate tremor control procedure must be chosen for the individual candidate.
What Other Neurosurgical Procedures Are Used To Treat Tremor?
The procedures for tremor control include Deep Brain Stimulation (above ), Thalamotomy and Pallidotomy.
Thalamotomy
Thalamotomy is a neurosurgical procedure that involves the placement of a surgical lesion within the thalamus region of the brain.
The thalamus is located deep within the brain, near its base, and serves as a major relay station for impulses traveling from the spinal cord and cerebellum to the cerebral cortex.
During the operation a small region of the thalamus is ablated.
This surgical treatment for tremor has been shown to reduce tremor symptoms in most patients.
Pallidotomy
Pallidotomy is a neurosurgical procedure that involves the precise placement of a surgical lesion within an area of the brain called the globus pallidus, which has become overactive in the Parkinson's patient.
The Globus Pallidus is a structure deep within the brain that serves as a relay point and coordinates signals from various parts of the brain controlling movement and sensation.
During the procedure a small region of the globus pallidus is ablated.
Reducing the brain cell activity within this area can substantially improve function in patients with Parkinson's Disease.
Pallidotomy is mainly used to control symptoms other than tremor in Parkinson's Disease, such as stiffness, and rigidity. However it can also help control tremor. It has also recently been used successfully in dystonia patients.
Deep Brain Stimulation
Deep Brain Stimulation involves the implantation of an insulated wire electrode in the thalamus region of the brain. The electrode is connected to a pacemaker like pulse generator that is implanted beneath the skin in the patient's chest area.
In August 1997, following more that 12 years of clinical research, the Food and Drug Administration approved a breakthrough neurosurgical treatment for tremor due to Essential Tremor and Parkinson's Disease. Deep Brain Stimulation (DBS) uses mild electric pulses to stimulate the brain and block the signals that cause tremor.
The stimulation of the thalamus is controlled by either the doctor or the patient using a small hand -held device that raises or lowers the amount of electrical pulses that are sent to the implanted wire lead. Deep Brian Stimulation has been show effective for the treatment of chronic pain associated with tremor. It is currently being used in some types of chronic, intractable pain.
If You Suffer From Tremor Of Any Kind Along With Chronic Pain - A Treatment Option Click Here ! (this should lead to the page called.
Pain and Chronic Pain Resources
- Institute's Brain Resources and Information Network (BRAIN) at: National Institute of Neurological Disorders and Stroke,BRAIN
P.O. Box 5801
Bethesda , MD 20824
(800) 352-9424
http://www.ninds.nih.gov
- American Council for Headache Education
19 Mantua Road
Mt. Royal, NJ 08061
achehq@talley.com
http://www.achenet.org
Tel: 856-423-0258 800-255-ACHE (255-2243 )
Fax: 856-423-0082
Non-profit patient-health professional partnership dedicated to advancing the treatment and management of headache and to raising public awareness of headache as a valid, biologically-based illness.
- National Headache Foundation
820 N. Orleans
Suite 217
Chicago , IL 60610-3132
info@headaches.org
http://www.headaches.org
Tel: 773-388-6399 888-NHF-5552 (643-5552 )
Fax: 773-525-7357
Non-profit organization dedicated to service headache sufferers, their families, and the healthcare practitioners who treat them. Promotes research into headache causes and treatments and educates the public.
- National Foundation for the Treatment of Pain
P.O. Box 70045
Houston, TX 77270
markgordon@paincare.org
http://www.paincare.org
Tel: 713-862-9332
Fax: 713-862-9346
Not-for-profit organization dedicated to providing support for patients who are suffering from intractable pain, their families, friends and the physicians who treat them. Offers a patient forum, advocacy programs, information, support resources, and direct medical intervention.
- Mayday Fund [For Pain Research]
c/o SPG
136 West 21st Street , 6th Floor
New York , NY 10011
mayday@maydayfund.org
http://www.painandhealth.org
Tel: 212-366-6970
Fax: 212-366-6979
The Mayday Pain Project works to increase awareness and to provide objective information concerning the treatment of pain.
- American Pain Foundation
201 North Charles Street
Suite 710
Baltimore , MD 21201-4111
info@painfoundation.org
http://www.painfoundation.org
Tel: 888-615-PAIN (7246)
Fax: 410-385-1832
Independent non-profit information, education, and advocacy organization serving people with pain. Works to improve the quality of life for people with pain by raising public awareness, providing practical information, promoting research, and advocating the removal of barriers and increased access to effective pain management.
- Arthritis Foundation
1330 West Peachtree Street
Suite 100
Atlanta , GA 30309
help@arthritis.org
http://www.arthritis.org
Tel: 800-568-4045 404-872-7100 404-965-7888
Fax: 404-872-0457
Volunteer-driven organization that works to improve lives through leadership in the prevention, control, and cure of arthritis and related diseases. Offers free brochures on various types of arthritis, treatment options, and management of daily activities when affected.
Parkinsons Disease and Tremor Resources
The following Parkinsons Disease related resources have been compiled in order to help you obtain additional information:
- The National Parkinson Foundation, Inc.
1501 NW 9th Avenue , Bob Hope Road
Miami , FL 33136
800-327-4545
800-433-7022 ( Florida )
- American Parkinson Disease Association
1250 Hylan Blvd
Staten Island , NY 10305
718-981-8001
800-233-2732
- American Parkinson Disease Association - California
14551 Friar Street
Van Nuys , CA 921411
818-908-9951
- Parkinson's Disease Foundation, Inc.
710 West 168th Street
New York , New York 10032
212-923-4700
800-457-6676
- Parkinson's Educational Program
3900 Birch Street #105
Newport Beach , CA 92660
714-640-0218
800-344-7872
- The Parkinson's Institute
1170 Morse Avenue
Sunnyvale , CA 94089-1605
408-734-2800
- Parkinson's Support Groups of America (PSGA)
11376 Cherry Hill Road, #204
Beltsville, Maryland 20705
301-937-1545
- United Parkinson Foundation
833 West Washington Blvd
Chicago , IL 60607
312-733-1893
ADDITIONAL INFORMATION
BIBLIOGRAPHY
The following is a list of Dr. Chodakiewitz's publications on neurosurgical procedures, research and results:
PUBLICATIONS:
1. Tasker, R.R. , Lenz, F.A., Dostrovsky, J.O., Yamashiro, K. , Chodakiewitz, J. , and Albe-Fessard, D.G. , : The physiological basis of VIM Thalamotomy for involuntary movement disorders: International Symposium on sensorimotor integration implications for neurological diseases. Springer. Munich , April 21-24 1985 .
2. Tasker, R.R. , Dostrovsky, J. O. , Yamashiro, K. , Lenz, F.A. , Chodakiewitz, J. Effets sensitifs et moteurs de la stimulation thalamique chez l'homme. Applications cliniquesl Rev. Neurol., Paris . 1986 142:316-326.
3. Albe-Fessard, D. , Tasker, R.R. , Yamashiro, K. , Chodakiewitz, J. , Dostrovsky, J.O. : Simultaneous recordings in the human thalamus and cortex of an early evoked component. Applied Neurophysiology. 1985 48:77-78.
4. Albe- Fessard, D., Tasker, R., Katsumi Y., Chodakiewitz J. and Dostrovsky J. Comparison in man of short latency averaged evoked potentials recorded in thalamic and scalp hand zones of representation. EEG and Clin. Neurophysiology, 65, 405-4l5, 1986.
5. Rinaldi, P.C. , Young, R.F. Albe-Fessard D. ,Chodakiewitz J. Spontaneous neuronal hyperactivity in the medial and intralaminar thalamic nuclei of patients with deafferentation pain. J. Neurosurgery, 74, 415-421, 1991
6. Chodakiewitz J. , Parkinson's Report, National Parkinson's Foundation,. Vol XI, Issue IV, 4th quarter, 1990, P.11.
7. Chodakiewitz J. , J. Neurosurgery, Vol. 75, No. 5, ll/91, p.832-833
8. Chodakiewitz J. , Parkinson's Report, 3rd quarter, l993, Vol. X1V, Issue III , P.22, National Parkinson's Foundation publication.
9. Chodakiewitz J. , It's a Pain, Newsletter of the American Israeli Medical Society, 2, 5-6, 1996
10. Chodakiewitz J. , Parkinson's and Other Shaking -New Hope, Newsletter of the American Israeli Medical Society, 2, #2, 07/93.
11. Chodakiewitz J., Managing Chronic Intractable Pain, Western Journal of Medicine, Epitome article, 1995.
ABSTRACTS AND PRESENTATIONS:
1. Tasker, R. , Dostrovsky, J.C. , Yamashiro, K. , Albe-Fessard, D. , Chodakiewitz, J. : Thalamic and scalp evoked potentials, simultaneous recordings in man. The World Society for Stereotactic and Functional Neurosurgery Meeting, Toronto Canada , 1985.
2 Young R.F. , Rinaldi P.C. , Albe-Fessard D. , and Chodakiewitz J. Single units recorded from intralaminar thalamic nuclei in patients with deafferentation pain exhibit hyperactivity. Soc. Neurosci. Abstr. vol. 16(2), p. 1073, 1990.
3. Rinaldi P.C. , Young R.F. , Tronnier V.T. , and Chodakiewitz J. Electrical stimulation in the PVG region inhibits lateral thalamic neuronal activity recorded from chronic pain patients. 7th World Congress on Pain. Paris , France , 08/93.
4. Rinaldi P.C. , Young R.F. , Tronnier, Chodakiewitz J. Neuronal, Heart Rate and Blood Pressure and Behavioral Changes During Electrical Stimulation of the PVG Region. Meeting on MicroElectrode Techniques During Functional Stereotactic Surgery, 10/9 to 10/11/93 . Mexico City .
5. Rinaldi P.C. , Chodakiewitz J. Stereotactic Neurosurgery with Implantation of Deep Brain Stimulator for Failed TMJ. J. of Orofacial Pain, Abstracts of the 19th Annual Scientific Meeting on Orofacial Pain and Temporomandibular Disorders. 02/14-15 , 1994, Chicago, P. 102.
6. Chodakiewitz, J. Medial Thalamotomy Following DBS for Alleviation of Chronic Pain, Annual Meeting of the American Society for Stereotactic and Functional Neurosurgery, Marina Del Rey, California , 03-95.
7. Tronnier V.M. , Rinaldi P.C. , Albe-Fessard D. , Young R.F. , Chodakiewitz J. , Medial and Lateral Interthalamic Recordings of Evoked Potentials. Society of Neuroscience . San Diego , CA. Nov. 1995.
8. Rinaldi, P.C. , Parker, E.S. , Chodakiewitz, J. , Young, R.L. Cognitive Effects of Left Medial Thalamic Stimulation in two patients with deep brain electrodes for relief of chronic pain. Society of Neurosciences. Nov. 1996.
9. Lecture: "Neurosurgical Techniques in Chronic Pain" at Physical Medicine "Chronic Pain Symposium". Aug. 30-31 1997 . Marriots Laguna Cliffs Resort, Laguna Hills , California .
10. Young R . F. , Rinaldi P.C. , Chodakiewitz J. and Cojacaru J. Deep brain electrical stimulation for treatment of chronic pain fifteen years experience. Congress of the European Society for Stereotactic and Functional Neurosurgery, 1992.
CURRENT PROJECTS IN PREPARATION:
1. Reines, F. , Rinaldi, P. , Price, L. , Tewari, S. , Caiozzo, V. , Chodakiewitz, J. , Weber, P. Focused Research Project submitted to Research and Graduate Studies UCI .: "Brain stimulation with pulsed, focused, ultra sound". Submitted Jan. 1995.
2. Rinaldi, P., Young, R.F. , Tronnier, V.M. , Chodakiewitz, J. , "Electrical Stimulation in periventricular gray region modifies activity of thalamic neurons recorded from chronic pain patients. (pending release).
3. Parker, B., Rinaldi P. , Chodakiewitz, J. , Neuropsychlogical effects post functional stereotactic procedure compared to pre-op base line.
4. Young, R. , Chodakiewitz, J. , Rinaldi, P. , Updating results of chronic deep brain stimulation effects for contol of chronic pain.
5. Jones, T. , Chodakiewitz, J. , Young, R. , Rinaldi, P. , Clnical anatomical physiological findings and correlations on long term PVG and VC thalamic stimulation with long lasting, successful analgesia.
6. Chodakiewitz , J. , Tronnier, V. , Rinaldi, P. , Analgesia effects and correlations induced by spinal cord stimulator and/or deep brain stimulation.
7. Chodakiewitz, J. , Rinaldi, P. , Comparison of neuroaugmentation and/or ablations of the brain for control of chronic pain.
8. Chodakiewitz, J. , Comparison of analgesia effects induced by deep brain stimuation versus intrathecal infusion of opioids in controlling neuropathic pain.
