1. The Effects of Deep Brain Stimulation on the Motor Symptoms of Parkinson’s Disease Aaron Mulheren Kathryn Wilson, MSN, APN Milind Deogaonkar, MD Science Internship Program for Nursing

2. Background: Deep Brain Stimulation A procedure in which an electrode(s) are surgically implanted into a specific target of the brain to help treat motor non-motor symptoms by electrical stimulation -Electrodes placed uni- or bi-laterally depending on patient’s symptoms

3. Background: Deep Brain Stimulation DBS can reduce tremor, bradykinesia, rigidity, and gait impairment. Research has shown that DBS may improve dystonia, Tourette syndrome, and certain disorders, such as pain, depression, and obsessive compulsive disorder [OCD] -However, these are not FDA approved treatments. Diagnosis determines the target in the brain.

4. Background: Surgical Candidacy Patients must go through rigorous screening process to determine if they are a surgical candidate for DBS. -Candidacy based on how patient responds to Parkinson’s medications using UPDRS scoring system. Video-taped off and on medications for use at Patient Management Meeting. -Candidates also go through a psychiatry screening as well as a neuropsychological evaluation. -A multi-disciplinary team ultimately decides on whether the patient is a good candidate.

5. Background: Surgery

6. Background: Second Surgery 1-3 weeks after the initial electrode placement, a second surgery occurs in order to place an “implanted pulse generator (IPG)” in the person’s chest and connect it to the electrode. -This may be done at same time of electrode placement

7. Background One month post- operatively, the patient will receive his/her first programming.

8. Purpose of Study To determine the percentage of improvement in the motor symptoms of patients with Parkinson’s disease before and after Deep Brain Stimulation surgery at the Center for Neurological Restoration (CNR).

9. Methodology Data acquired from patient records, under the criteria that the patient had undergone DBS surgery in order to treat Parkinson’s Disease from 05/01/10 – 05/01/11. Motor scores based on the Unified Parkinson’s Disease Rating Scale (UPDRS Scores) – range from 0 to 108, where 0 is normal and 108 is unable to do anything at all. Average improvement determined by comparing these scores from pre-operatively to 9-12 months post- operatively.

10. Results Taken from a pool of 30 individuals with Parkinson’s Disease -24 male/6 female -3 GPI / 26 STN / 1 VIM -Average age: 63.8

12. Results Pre-op off meds: 40.3 (n=28) Pre-op on meds: 22.9 (n=30) 1 Mo. Post-op on both: 16.3 (n=21) 3-6 Mo. Post-op on both: 17.3 (n=19) 9-12 Mo. Post-op on both: 16.5 (n=8) Average improvement of 59% P value less than 0.00

13. Conclusions Deep Brain Stimulation improves the motor symptoms of Parkinson’s Disease more than medication alone, and the improvement lasts through the end of at least the first year.

14. Recommendations / Future Study Repeat study to ensure maintaining this level of excellence. All patients asked to return at one year interval. All patients get on stim/off med at the benchmark intervals. (1, 3, 6, 12 months)

15. Acknowledgements My gratitude for guidance and support goes to: -The Office of Civic Education Initiatives -Kathryn Wilson, MSN, APN -Kevin McLaughlin, RN -Milind Deogaonkar, MD