Mail converted by MHonArc 2.6.10

PIENO Google Custom Search

Site Hosting donated by & Grant from The Parkinson Alliance

Parkinsn Current Topics

Thalamic Stimulation System

Hello Friends,

No electronic files, I'm sorry, specially for myself because I'll have to do a lot of typing by myself; it is a good exercise for my fingers. 1) I try to find the electronic files ==> a small chance, because they are in the States, probably at the editor's 2) I scan the printed files==> the disadvantage of this method is that the file must be attached and it can give some problems. 3) I can type it all ==> Cost me a lot of time, but I can do it parts.

So it will be the third possibilty :

The addresses of the Firms in some countries is the first part:

EUROPE

Medtronic Europe S.A./N.V. Woluwe Office Garden Woluwedal 26 1932 St. Stevens woluwe Belgium telephone 32-2 716 88 11 FAX 32-2 7 16 88 11

AUSTRALIA Medtronic Australasia Pty Ltd 50 Strathallen Avenue Northbridge NSW 2063 Australia Telephone (61-2) 958 29 99 FAX (61-2) 958 70 77

AUSTRIA Medtronic Ges. m.b.H. Handelskai 388/Top 852 A-1020 Wien Austria Telephone (1) 720 60 92 Fax (1) 720 60 99

BELGIUM N.V. Medtronic Belgium S.A. Boechoutlaan 55 1853 Strombeek-Bever Belgium telephone (32-2) 460 20 55 Guard-duty (32-2) 424 24 00 fax (32-2) 460 26 67

CANADA Medtronic of Canada Ltd. 6733 Kitimat Road Missisauga, Ontario L5N 1W3 Canada telephone (905) 826-6020 Fax (905) 826-6620 Toll free 1-800-268-5346

LATIN AMERICA Medtronic, Inc. 450 Fairway drive Suite 103 Deerfield Beach, Fl 33441 USA telephone (305) 428-8556 Fax (305) 428-8984

THE NETHERLANDS Medtronic B.V. Frankrijkstraat 101 5622 AE Eindhoven Telephone (31-4) 045 08 55 Fax (31-4) 045 64 45

SWEDEN Vingmed Svenska AB Haradsvagen 18 S-175 63 Jarfalla Sweden Telephone (46-8) 761 79 70 FAX (46-8) 363 30 50

SWITSERLAND Medtronic (Schweiz) AG Bahnhofstrasse 60 Postfch 709 CH-8600 Dubendorf 1 Switzerland Telephone (01) 802 7000 FAX (01) 802 7010

UNITED KINGDOM Medtronic Ltd. Suite 1, Sherbourne House Croxley Business Center Watford Herts WD1 8YE United Kingdom Telephone : (44-923) 212213 Fax (44-923) 241004

UNITED STATES OF AMERICA Medtronic, Inc 7000 Central Avenue, NE Minneapolis, MN 55432-3576 USA Telephone (612) 574-4000 Fax : (612) 574-4879 Toll Free : 1-800-328-2518 (24-hour consultation time)

The electric Stimulation is not often used. It is only usefull for patients with severe Parkinson tremor. And I don't know if it is proved as a good solution. Who knows what damage the lead makes. Wasn't that damage not nough to stimulate the brains.?

Thalamic Stimulation System (part 2)

Hello Friends,

The continuing story of thalamic Stimulation. I typed this from a brochure from the company Medtronic called : "Thalamic Stimulation System, Therapy Reference Guide"

Section 1 : OVERVIEW OF THALAMIC STIMULATION FOR TREATMENT OF TREMOR

Uses and patients Benefits

Stimulation of the ventral intermediate (VIM) nucleus of the thalamus (figure 1; it shows a picture of a head, with the spot where the lead is implanted) is indicated as a therapy for patients with disabling tremor who are not suitable candidates for drug therapy or whose tremor has not been adequately controlled by drug therapy

Many patients treated with thalamic stimulation gain substantial control over otherwise refractory tremor. their quality of life improves as they are able to participate more fully in daily activities.

Definition: tremor

Tremor is defined as the rhytmic, oscillating movements of a body part due to repetitive patterns of muscle contraction and relaxation. It is classified as :

* Rest tremor -- occurs during rest * Postural tremor --occurs when limbs are upright (working against gravity) * Kinetic tremor -- occurs during limb movement

The origin of tremor is thought to be in the brain.Stimulation of the VIM nucleus inhibits tremor, Allthough the exact mechanism is unknown.

Tremor is a prominent signof Parkinson's disease (PD) and the only sign of essential tremor (ET), both of which can be treated with thalamic stimulation. Rest tremor is pathognomonic for PD, allthough postural tremor is not uncommon. In severe cases of PD, rest and postural tremor (mixed tremor) may be manifest. Postural tremor is typical of essential tremor, allthough kinetic tremor may also be present.

Tremor Therapy

Tremor is effectively managed pharmacologically in the majority of patients. When tremor becomes medically intractable and severly disabling, stimulation of the VIM nucleus may provide relief. Thalamic stimulation is non destructive and reversible. It can be used to treat bilateral tremor. The tremor-suppressing effect of thaamic stimulation have known since the 1920's. Very llittle, however, is known about the mechamism of action. According to Benabid et al. (1993), thalamic stimulation does not appear to suppress tremor by an excitatory or inhibitory effect. Rather, it is more likely that tremor supprression results from jamming the neuronal network processing proprioceptive inputs to the thalamus.

Stimulation Test

Patients are tested for tremor suppression typically as a first step in the stimulation system implant procedure. A test electrode is stereotactically placed in the brain to locate the target site. Then an external stimulator, such as the model 3625 Screener, is used to determine whether or not stimulation suppresses the tremor. If no tremor suppression occurs, the implant procedure is discontinued. If the tremor is suppressed satisfactorily, the model 3387 lead is implanted. The physician then has the option of either implanting the IPG immediately after the lead is implanted or using the screener for a trial period before implanting the IPG.

Thalamic stimulation System

To perform thalamic stimulation for the treatment of tremor, Medtronic provides a system of components consisting of an implantable pulse generator (IPG), lead, extension and external programmer (table 1; An overview of the components)

Therapeutic Efficacy

Clinical studies show that thalamic stimulation is effective in treating tremor. Table 2 summaries the clinical results.

Thalamic Stimulation System (part 3)

Hello Friends,

The continuing story of thalamic Stimulation. I typed this from a brochure from the company Medtronic called : "Thalamic Stimulation System, Therapy Reference Guide"

This is a test. I've attached two files: figure 1 and a piece of text, both scanned with my hand-scanner. I didn't use Binhex but tried "MIME". I hope it will work out very well, please let me know.

Kees Paap

********************** The first attempt was interrupted by me, because the file with the figure was too big. So no figure, just the text. Kees Paap

Patient Selection Indications: Electrical stimulation of the ventral intermediate (VIM) nucleus of the thalamus using the Medtronic thalamic stimulation system is indicated as a therapy for patients with disabling tremor who are not suitable candidates for drug therapy or whose. tremor has not been adequately controlled by drug therapy. Tremor suppression must be demonstrated during test stimulatiun, generally as a first step in the system

Contraindications: Implantation of the Medtronic thalamic stimulation system is contraindicated for patients in whom surgery or aneasthesia are contraindicated.

Thalamic stimulation is contraindicated for patients with a cardiac demand pacemaker or an implantable defibrillator or for those patients who will undergo magnetic resonance imaging ( MRI ) .

Thalamic stimulation is contraindicated if the patient's tremor is not suppressed during stimulation testing.

Thatamic stimulation is contraindicated for patients who are unable to use the control magnet or who do not have reliable help to operate the control magnet.

Stimu1ation test: To select patients for thalamic stimulation, a test stimulation is recommended. A test electrode is stereotactically placed to determine if stimulation will suppress the tremor. lf the tremor is suppressed, the Model 3387 lead is implanted. The physician then has the option of either implanting the IPG immediately after the lead is implanted or using the Model 3625 Screener for a trial period before implanting the IPG.

Precautions for patients selection:

* The patient must be informed and accept that thalamic stimulation may not always eliminate or even reduce tremor. Patients should understand the therapy, including risks and benefits, hardware, implant techniques, and follow-up schedule.
* The patient's physical condition must allow surgical interventions for implant, known risks of thalamic stimulation, and battery replacements.
* Patients who have had a thalamotomy or show clinically significant damage to the thalamus on the side to be are stimulated may not be good candidates for thalamic stimulation.

=========================================================================

Return To Index of Current Parkinson's Topics

PIENO Google Custom Search