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MOVEMENT DISORDERS

Parkinson’s Disease

The ideal candidate for deep brain stimulation will have had Parkinson’s disease for at least three years. The following are other conditions used to evaluate candidates:

When to consider:

  • Significant resting, action or postural tremor not responsive to medications. These types of medications may include:
    • levodopa
    • dopamine agonist
    • anticholinergics
    • amantadine
    • beta-blockers
    • primidone
    • benzodiazepines
  • Persistent bothersome motor fluctuations, such as dyskinesia or end-of dose wearing off, and motor symptoms that continue to show a good response to levodopa

     

  • Idiopathic Parkinson's disease with motor symptoms that are becoming difficult to treat because of medication side effects or intolerance

    When not to consider:

    • Individuals with significant cognitive impairment or behavioral difficulties are not candidates for pursuing DBS.
    • DBS does not tend to help the atypical parkinsonian syndromes, such as:
      • corticobasal degeneration
      • progressive supranuclear palsy
      • multiple system atrophy
      • diffuse Lewy Body disease.
    • It also does not help with secondary parkinsonism such as vascular parkinsonism due to previous strokes.

        To refer your patient for DBS at Ohio State’s Center for Neuromodulation, you can

        or

        • Call the intake coordinator at 855-255-0550 for further assistance

        Essential Tremor

        The ideal candidate for deep brain stimulation will have had essential tremor for at least three years. The following are other conditions used to evaluate candidates:

        When to consider:

        • Severe postural or action tremor of the upper extremities interfering with quality of life
        • Lack of response to medications typically used for tremor including:
          • beta-blocking agents
          • primidone, anticholinergics
          • benzodiazepines
          • anticholinergics
          • trials of levodopa
        • Patients with lower extremity or head/neck tremor can also benefit from DBS, but tremor in these areas may not respond as well

        When not to consider:

      • Tremor that does not interfere with quality of life
      • Individuals with tremor who have not had adequate trials of medications
      •  

        To refer your patient for DBS at Ohio State’s Center for Neuromodulation, you can

        or

        • Call the intake coordinator at 855-255-0550 for further assistance

        Dystonia

        The ideal candidate for deep brain stimulation will have had dystonia for at least three years. The following are other conditions used to evaluate candidates:

        When to consider:

        • Primary dystonia not responsive to trials of multiple medications, botulinum toxin therapy or other treatment
        • Most effective for primary or idiopathic dystonia (such as DYT 1)
        • Secondary causes of dystonia, such as after a stroke or after trauma, have inconsistent results with limited benefit from DBS. However, DBS may be considered when all other medication therapies have been exhausted

        When not to consider:

        • Secondary dystonia caused by injury or other structural lesion to the brain or spinal cord.
        • Symptoms of dystonia are not causing significant impairment or disability

         

        To refer your patient for DBS at Ohio State’s Center for Neuromodulation, you can

        or

        • Call the intake coordinator at 855-255-0550 for further assistance

        PSYCHIATRIC DISORDERS

        Obsessive Compulsive Disorder (OCD)

        When to consider:

        Severe OCD that is treatment-resistant and which has been managed by an expert psychiatrist and behavioral therapists. The general selection criteria include:

        • 18 years or older
        • Diagnosis of OCD with documented duration of at least five years
        • Have OCD rated as severe
        • Failure to respond to three well-documented trials with selective serotonin reuptake inhibitors (SSRI)
        • One failed trial of SSRI with clomipramine
        • One failed trial of SSRI with an atypical antipsychotic
        • 20 cognitive behavior therapy sessions with exposure and response prevention

        When not to consider:

        • History of psychotic disorder
        • Bipolar mood disorder
        • Severe personality disorder
        • Serious suicidal behavior
        • Current or unstable remitted substance abuse or dependence
        • Pregnant or nursing women

         

        To refer your patient for DBS at Ohio State’s Center for Neuromodulation, you can

        or

        • Call the intake coordinator at 855-255-0550 for further assistance

         

        PAIN

         

        When to consider:

        • Failed back syndrome (FBS), low back syndrome or failed back
        • Radicular pain syndrome or radiculopathies resulting in pain secondary to FBS or herniated disk
        • Post-laminectomy pain
        • Peripheral neuropathy
        • Complex Regional Pain Syndrome (CRPS)

         

        When not to consider:

        • Dependence on pain medication
        • Co-morbid condition that would make surgery not safe

        To refer your patient for spinal cord stimulation at Ohio State’s Center for Neuromodulation, you can

        or

        • Call the coordinator at 855-255-0550 for further assistance
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