Parkinson's Parkinson's Surgery and Advanced Therapies 1 — Questions and Answers
Question 1: What is the most widely used surgical treatment for Parkinson's disease?
- Pallidotomy
- Deep Brain Stimulation (DBS) (Correct answer)
- Thalamotomy
- Stem cell transplant
Correct answer: Deep Brain Stimulation (DBS)
Deep Brain Stimulation (DBS) is the most widely used surgical treatment for Parkinson's disease, offering adjustable and reversible therapy through implanted electrodes.
Question 2: Which brain structure is most commonly targeted in DBS surgery for Parkinson's disease to address motor symptoms?
- Hippocampus
- Thalamus
- Subthalamic nucleus (STN) (Correct answer)
- Amygdala
Correct answer: Subthalamic nucleus (STN)
The subthalamic nucleus (STN) is the most commonly targeted structure in DBS for Parkinson's disease, effectively reducing motor fluctuations and tremor.
Question 3: DBS therapy requires the surgical implantation of which set of components?
- Only electrodes placed in the brain
- Electrodes, extension wires, and an implanted pulse generator (Correct answer)
- A drug reservoir and pump only
- A cortical stimulator and EEG monitoring electrodes
Correct answer: Electrodes, extension wires, and an implanted pulse generator
DBS requires three implanted components: electrodes placed in the brain, extension wires running under the skin, and an implanted pulse generator (IPG) usually placed in the chest.
Question 4: Which Parkinson's symptom typically shows the LEAST improvement with DBS of the subthalamic nucleus?
- Tremor
- Rigidity
- Bradykinesia
- Postural instability and gait freezing (Correct answer)
Correct answer: Postural instability and gait freezing
Postural instability and gait freezing (axial symptoms) respond least well to STN DBS because these symptoms are often levodopa-unresponsive and mediated by non-dopaminergic pathways.
Question 5: A key requirement for DBS candidacy in Parkinson's disease is demonstrating which of the following?
- Age under 60 years
- A good motor response to levodopa (Correct answer)
- Absence of resting tremor
- Parkinson's symptoms for less than 2 years
Correct answer: A good motor response to levodopa
A positive response to levodopa is a critical predictor of DBS success, since DBS generally controls the same motor symptoms that respond to dopaminergic medication.
Question 6: MRI-guided focused ultrasound (MRgFUS) differs from DBS primarily because it:
- Requires implanted brain hardware
- Creates a permanent lesion without any surgical incisions (Correct answer)
- Is less effective for treating tremor
- Can be reprogrammed after the procedure
Correct answer: Creates a permanent lesion without any surgical incisions
MRgFUS uses focused ultrasound waves to create a permanent lesion in brain tissue without any incisions, implants, or skull openings, making it a non-invasive approach.
Question 7: Which brain target is primarily used in MRI-guided focused ultrasound (MRgFUS) for Parkinson's disease tremor?
- Subthalamic nucleus
- Globus pallidus internus
- Ventral intermediate nucleus (VIM) of the thalamus (Correct answer)
- Caudate nucleus
Correct answer: Ventral intermediate nucleus (VIM) of the thalamus
The ventral intermediate nucleus (VIM) of the thalamus is the primary target for focused ultrasound treatment of Parkinson's tremor, as it is a key relay in the tremor circuit.
Parkinson's Parkinson's Surgery and Advanced Therapies 1
What is the most widely used surgical treatment for Parkinson's disease?