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SURGICAL TREATMENT OF PARKINSON'S DISEASE: A CLINICAL PROSPECTIVE STUDY WITH SIX YEARS FOLLOW UP

Author: Moneer K. Faraj منير خماس فرج
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2015 Volume: 13 Issue: 1 Pages: 45-50
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Deep Brain stimulation is well accepted now as amethod for treating refractory parkinsons disease.Objective:To describe deep brain stimulation in Iraq, emphasize the technically demanding procedure and to discuss the results on the patients after six years of follow up.Methods:A clinical prospective study of 8 patients with Parkinson’s disease underwent deep brain stimulation surgery in the Neurosciences Hospital. We performed 18 multiple stages operations from October 2007 to June 2008. The procedure begins with proper selection of patients, pre operative radiological studies, planning for targeting the subthalamic nucleus, the operation stage and the programming stage, which usually starts one-week post operatively.Results:One patient developed subarachnoid hemorrhage, another one have miss targeting and required retargeting surgery. A part from these complications all the patients had satisfactory outcome in controlling their symptoms during the six years follow up period.Conclusion:Deep brain stimulation is indicated for the treatment of refractory Parkinson disease. However it needs a well skilled personnel working as a team. The future of deep brain stimulation is remarkable as the list of indications is continually increasing to include other disease modalities.Key words:Parkinson's disease, deep brain stimulation, functional neurosurgery.


Article
SUB THALAMIC NUCLEUS DEEP BRAIN STIMULATION: IRAQI CASE SERIES

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Abstract

Background: Sub thalamic nucleus (STN) Deep brain stimulation (DBS) electrodes are implanted into STN and programmed by external pulse generator. DBS alleviates the cardinal Parkinson disease symptoms and reduce the need for levodopa and related drugs and eventually reduces levodopa-related motor complications in advanced Parkinson's disease.Objective: To evaluate the STN DBS implantation in Parkinson disease patients.Methods: A retrospective evaluation of data base of the patients operated on for STN DBS between Jan. 2010 and Jan. 2011. The study involved 11 patients (10 males and 1 female) with an age range between 39 and 65. Surgical implantation was done in the Neurosciences Hospital in Baghdad. Unified Parkinson's disease Rating Scale was reported before surgery and 3 monthly after implantation. Paired t test was used to test the significance of difference between 2 means.Results: Highly significant differences (P < 0.0001) in the activities of daily living, Tremor, Rigidity, Bradykinesia and Gait parameter. There was no difference in Postural stability before and after. There was 65% of the patients reduced their levodopa medication dosage after STN DBS. One patient out of 11 (9%) developed intracerebral hemorrhage. Conclusions: STN DBS is very successful in managing motor clinical manifestations in advanced Parkinson disease and reducing levodopa medication. Key worlds: Parkinson, Deep brain stimulation, subthalamic

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