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Printable Handouts
Navigable Slide Index
- Introduction
- Potential conflicts of interest
- Acknowledgements
- Collaborators and contributors
- Former fellows and trainees
- Outline
- We control your brain
- Your brain controls everything
- Ethical guiding principle
- Many people are suffering
- Deep brain stimulation: “the misnomer”
- Is it time for a name change?
- Newer term(s)
- How does DBS work?
- Circuit disorders “loops”
- Electrode implantation for deep brain stimulation
- We don't know how it works
- Mechanism of action (1)
- Mechanism of action (2)
- Mechanism of action (3)
- Mechanism of action (4)
- One astrocyte interacts with 2 million synapses
- Local effects of deep-brain stimulation (DBS)
- DBS leads
- Insertion site in sub thalamic nucleus
- Histopathology of a DBS lead
- DBS tract view in the left hemisphere
- Network effects of deep brain stimulation
- Evolving from disorders to symptoms (1)
- Questions needed to be asked
- Fast track referral
- Consider your DBS candidates in three groups
- DBS - shortcomings
- Dyskinesia
- Evolving from disorders to symptoms (2)
- Ask what symptom is bothersome
- Tailor the target (disease/symptom)
- The rematch
- Trial of DBS for Parkinson's disease - 2006
- Trial of DBS for Parkinson's disease - 2010
- Trial of DBS for Parkinson's disease - 2012
- Bilateral DBS vs. best medical care therapy 2009
- Randomized target comparisons
- Randomized studies: do they inform us?
- Unilateral GPi vs. unilateral STN: both effective
- VTA: compare trial unilateral STN or GPI DBS
- Bilateral GPi vs. STN - 2010
- Bilateral GPi vs. STN - 2013
- More equal than the field assumed
- The rematch - STN
- The rematch - Gpi
- The rematch - a draw
- Scorecards for STN vs. Gpi
- Improvements in study design
- Stimulation: patient-specific models of DBS
- STN outcomes change when shifting stimulation
- It matters where the stimulation is delivered
- Randomized DBS trials: not yes or no
- Target profiling
- ICDs and DDS could emerge post-DBS
- Better understanding adverse events
- Surgical effect?
- Stimulation effect
- Tremor after implantation, on and off stimulation
- Micro lesion effect and clinical symptoms (1)
- Micro lesion effect and clinical symptoms (2)
- Tolerance and disease progression
- Basal ganglia progressive atrophy
- Using brain signature patterns: the future of DBS
- DBS of STN suppresses oscillatory beta activity
- DBS in patients with Tourette's syndrome
- Meeting the public health challenge
- Over a hundred thousand of devices worldwide
- DBS failures (1)
- DBS failures (2)
- Horizon
- Thank you
Topics Covered
- Deep Brain Stimulation
- Mechanisms of action: What is the science and biology behind DBS
- Screening for DBS: The use of an interdisciplinary team
- Targets for DBS: The possible brain targets
- Tailoring DBS: How to make personalized therapy
- Evidence Base: Review of the recent randomized studies of DBS
- Adverse events: The issues that may emerge with DBS
- Horizon: What will future therapies look like
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Okun, M.S. (2014, June 2). Deep brain stimulation for Parkinson’s disease [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved November 23, 2024, from https://doi.org/10.69645/QLPM4879.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Michael S. Okun has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Michael Okun,
I'm a professor of neurology
at the University of Florida at
the Center for Movement Disorders
and Neurorestoration, and I'm
also the national medical director
for the National
Parkinson's Foundation.
And today I'm going to be
presenting a lecture on deep brain
stimulation for Parkinson's disease.
And it's going to be a nice
overview of the field for people
who may be interested in this topic.
0:26
These are my conflicts of interests.
And I have no industry
conflicts of interest,
I don't take any
personal contributions
from any industry sources.
And all of the deep
brain stimulation work
is funded either by the
National Institutes of Health
or by foundations.
0:44
This is a picture of our group.
And I always like to
acknowledge the group here
that is so outstanding in
the Center for Movement
Disorders and Neurorestoration.
We're located in Gainesville,
Florida in the United States.
And this is the group that makes
all the special things happen,
and so when I talk to you
about deep brain stimulation
and some of the work that our
group has done and collaborated
with other groups, you'll know
I'm speaking for many people,
not just myself.
1:12
This is a list of
many of those people
who I am deeply indebted to in
the deep brain stimulation area,
particularly Kelly Foote
who is our neurosurgeon
at the University of Florida.
1:24
This is a picture of a
several of our trainees,
as we have a large training program
for people who come from all
over the world to learn
about deep brain stimulation.
And I think it's really interesting,
now that we've had over 30 fellows,
that we see neurologists,
neurosurgeons, psychiatrists,
and now even physical
medicine and general docs who
are interested in this area.
And I think it's a
really important point
to make that this is a bionic age-
there over 100,000 of these devices
implanted and that number is growing
tremendously and growing fast.
And because of that, we're seeing
quite a bit of interest for people
in training and in education,
but also a need to inform people
in emergency rooms and
in general practices
that these types of
devices are here to stay
and we'll all have to
learn to deal with them.
So I think that this talk on deep
brain stimulation for Parkinson's
disease will become more and
more important as the next decade
evolves.