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