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    Brain 'Pacemaker' Treats Parkinson's

    Study Shows Surgery Called Deep-Brain Stimulation Treats Symptoms of Parkinson's Disease

    Who's a Good Surgery Candidate? continued...

    "Many patients who could benefit from this treatment are not getting it," he says. "And conversely, some patients who are not good candidates are having the surgery."

    The study by Volkmann and colleagues from the German Parkinson Study Group included 156 patients with advanced Parkinson's disease and severe movement problems. They were randomly assigned to receive the best available drug therapy or deep-brain stimulation with drug treatments given in modified doses.

    Most drug therapy used to treat Parkinson's replenishes the brain's dopamine levels. Other treatments work by mimicking dopamine, a chemical involved in movement.

    All the patients in the study were younger than 75, and their average age was 60. Patients with dementiadementia, those who had very poor response to the dopamine drug L-dopa, or those who were unsuitable for surgery for other medical reasons, were excluded.

    Careful Screening Critical

    Okun points out that the study participants were younger than the typical patient who is considered for surgery in the U.S., and they were very carefully screened -- all factors, he says, which undoubtedly played a role in their good response.

    He adds that evaluation by a team of various specialists is an essential step for patients being considered for deep-brain stimulation.

    The team should include: a neurologist specializing in movement disorders who evaluates patient symptoms both on and off L-dopa treatment; a neuropsychologist who evaluates cognitive performance; a neurosurgeon; and possibly even a psychiatrist.

    "Anyone who is considering this surgery needs to be evaluated at a specialized treatment center with this multidisciplinary team in place," he says. "And patients will need multiple adjustments once the device is in place."

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