From
Dr. Amr Moursi
3 Eras of Parkinson's Surgery: Destroy → Modulate → Respond
With Dr. Amr Moursi
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Parkinson's Disease 3 items
Chapter 1 of 3 · In-Depth Reviews
Ablation era
Era 1: The Ablation Era - Permanent Lesions for Parkinson's
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What the experts said
Parkinson's surgery has evolved through 3 revolutions over 70 years
In the ablation era, thalamotomy in the VIM silenced tremor
Pallidotomy in the GPi eased rigidity, slowness, and dyskinesias
Ablative lesions were permanent and could not be undone or adjusted as disease progressed
In 1987 in Grenoble, Benabid switched on high frequency stimulation above 100 hertz and tremor vanished instantly and reversibly
Stimulating the STN produced the same benefit as destroying it, demonstrating the benefit was never about the tissue
DBS allows surgeons to adjust amplitude, frequency, and pulse width and treat both sides safely
The early STEM trial confirmed DBS beat medical therapy on quality of life
Adaptive DBS devices record local field potentials from the STN
Pathological beta oscillations at 13 to 30 Hz suppress movement in Parkinson's disease
Adaptive DBS fires stimulation when beta oscillations appear and eases off when they fade
Adaptive DBS results in less unnecessary current, longer battery life, and fewer side effects