Movement disorders are a specialized field within neurology and describe a group of conditions in which the speed, amplitude and ease of motor control or function are negatively affected. Typically, these conditions are classified into either hyperkinetic or hypokinetic disorders, and they are best represented by essential tremor (ET) and Parkinson’s disease (PD) – the two diagnoses most encountered in the clinic. In the U.S., there are approximately 8 million patients living with these diagnoses (7 million with ET and 1 million with PD) with the prevalence of these conditions increasing with age.
While medications for ET and PD can and do reduce the burden of associated symptoms, a considerable number of movement disorder patients will experience marked disability. For example, patients may have intolerable side effects, contraindications or lack of response to first-, second- and third-line medications. In ET, up to 50% of patients do not adequately respond to medication.
Furthermore, no disease-modifying treatments are currently available for these conditions, and symptoms typically progress over time. Progression in PD, for example, comes with the risk of motor fluctuations manifesting in breakthrough end-of-dose symptoms, dyskinesias, dose failures and so-called “off” times – when symptoms return between medication doses.
Complicated medication regimens in both ET and PD often negatively impact quality of life. For many of these medication-refractory patients, however, deep brain stimulation (DBS) is a well-established and minimally invasive neurosurgical therapy effective for movement disorders.
DBS involves placing thin stimulating electrodes into deep regions of the brain that control motor function. A small pacemaker implanted in the chest sends electrical impulses through the electrodes, alleviating motor symptoms by normalizing aberrant brain activity.
In ET and PD, DBS improves tremor. In PD, DBS additionally improves motor fluctuations and dyskinesias.
Multiple, randomized controlled trials have demonstrated the robust effects of DBS and best medical therapy versus best medical therapy alone. Additionally, since DBS can be modulated over time, a patient’s therapeutic window can be expanded during programming sessions as symptoms progress.
Across landmark trials, DBS in PD increased “on” times without troublesome dyskinesias by 64.7%, reduced “off” times by 52.4% and lowered levodopa-equivalent daily doses by 37%. Most significantly, the benefits of DBS translate to improvements in patient-reported measures of health status and quality of life.
There is great patient need, both in our immediate community as well as throughout the state of Georgia, for access to minimally invasive neurosurgical options for the safe and effective treatment of movement disorders, and we are pleased to now offer DBS at Wellstar.
In addition to DBS, modalities such as botulinum toxin injection, neurorehabilitation, neuropsychological care, boxing and nurse advocacy continue to comprise the suite of highly specialized multidisciplinary therapeutics at Wellstar that are available for patients living with movement disorders.
