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questions
1. is this primarily for tremor-dominant PWP?
2. does having this preclude you from other clinical trials down the road like DBS does? 3. what effect does this have on balance, rigidity, mood, sleep, constipation (what am I missing here?)... 4. what are the outcomes of the patient in Canada that had this done and the 7-8 patients in Korea that had this done? That would be very helpful to know! If anyone knows, please post/share! |
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http://neurosurgery.mgh.harvard.edu/...al/pallidt.htm PALLIDOTOMY Indications for Pallidotomy Only patients with treatment-resistant idiopathic Parkinson's disease that have clearly responded to dopamine replacement therapy in the past should be considered candidates for pallidotomy. While many of the cardinal symptoms of PD will respond to pallidotomy, the features of the disease which respond best are drug induced dyskinesias, painful dystonias, marked ON/OFF fluctuations, severe bradykinesia, and rigidity. Symptoms that may improve but do so less reliably are tremor, speech dysfunction and gait disturbance. Postural instabilitiy is rarely if ever helped. The ideal patient is young (< 50 years of age), suffers from asymmetric idiopathic PD and has severe ON/OFF fluctuations with drug induced dyskinesias. Hemidystonia is another indication for pallidotomy which appears to hold promise although the available data is limited. http://www.fusfoundation.org/disease...nsonian-tremor Compared to implantation of a deep brain stimulation device, focused ultrasound is a single procedure, and does not require subsequent procedures to replace batteries. It also does not involve the collateral damage to healthy tissue or the risk of blood clots and infections associated with implanting a foreign body. http://www.parkinson.org/sites/defau...on_Therapy.pdf Parkinson’s Disease : Guide to Deep Brain Stimulation Therapy Unlike DBS, pallidotomy should not be performed on both sides of the brain, and this is one major limitation of this surgery. Performing two pallidotomies can lead to permanent speech, swallowing, and cognitive problems. Patients with an existing pallidotomy who require a second surgery will usually have a DBS placed on the opposite side of the brain. ------ i think this ultrasound procedure can only be done on 1 side. |
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confusing...
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I have never read anything about PD that said any cells were "abnormal", only that a protein (a-syn) could misfold and cause clumps (which they find on autopsy)...does anyone know anything about this or did the man mis-speak? |
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and yet another theory...
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And saying those cells in the STN must be abnormal or we wouldn't have PD is assuming they are the cause of PD, and I have never heard of that before, either. If that's true, why doesn't this procedure work for all PWP and abolish all symptoms? I can't forget Dr. Jannetta's theory that PD is caused by a cerebral artery impinging on nerves in the brain and irritating them...he treated that lady for trigeminal neuralgia (who also had well documented PD going back 8 or 9 years, I think it was) and upon awakening, discovered that not only was her trigeminal neuralgia relieved by the Teflon pad placed under the cerebral artery in her brain, but her PD was gone. Her PD symptoms returned months later and on MRI they discovered the Teflon pad had slipped, so they had to go back in and secure it...and PD symptoms abated again. Seems pretty convincing of a cause and effect to me, at least for that patient. I've not been able to find out any more about that patient or Dr. Jannetta, though I have tried. If they are actually targeting the STN for destruction, that seems a much more radical (and scary!) procedure than just severing a nerve connection in the brain (which is still scary!!). |
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