Movement disorders can be challenging to diagnose and treat. However, there’s hope for those who may be suffering. While conservative treatment, including lifestyle modifications, is still typical for newly diagnosed patients, there are several surgical advances that improve quality of life for some patients.
What exactly is a movement disorder?
According to the US National Library of Medicine, these disorders are the diseases that cause problems with any movement. The most common of these are Parkinson’s disease and essential tremor.
Carter Gerard, MD and functional neurosurgeon at the Swedish Neuroscience Institute, goes a step further and defines movement disorders by saying this: “There are multiple parts of the brain that control, modify and regulate normal movements. When those processes become abnormal, then the disease can manifest as positive symptoms such as tremors, or negative ones such as slow movements or rigidity.”
There is not a single factor responsible for causing movement disorders; often there are both genetic components and environmental components. Practices such as staying active can help slow the progression of diseases, and with the help of physical and occupational therapy, patients with mild symptoms can use tools like weighted utensils to continue with their daily activities. But what happens when the symptoms are no longer mild?
In the early days of treatment, Gerard says neurosurgeons focused on creating lesions in the brain that would alleviate symptoms. However with advances in pharmaceuticals, medications became the first line of treatment. When patients began living longer, doctors needed other options and returned to the idea of creating lesions or stimulating part of the brain to create results.
So, what are these treatments and technologies?
Gamma Knife radiosurgery does not actually require a surgical incision. Instead, doctors use planning software and special equipment to locate and remove small targets in the brain. The treatment delivers about 200 tiny radiation beams to the tumor. While each beam has little effect individually on the tissue it passes through, a strong dose is delivered where the beams meet.
The therapy delivers results with minimal radiation to healthy tissues and usually only requires a single dose that can be administered in one day.
Deep brain stimulation (DBS)
With this therapy, surgeons implant electrodes into the brain and a pacemaker-like device into the patient’s upper chest. The device has electrodes that emit electrical impulses that affect certain cells and chemicals in the brain. Deep brain stimulation may be used to treat essential tremor and Parkinson’s disease along with epilepsy, dystonia and obsessive-compulsive disorder.
Patients are often sent home with a special doctor-programmed remote control and may be able to make adjustments to their pulse generator.
With focused ultrasound, a lens is used to concentrate multiple ultrasound beams onto a target that can be as small as 1×1.55 mms and located deep inside the brain. As with Gamma Knife radiosurgery, when the beams pass through, there is no effect until they converge on a single point and then the energy results in a biological effect or change.
“Previously, with Gamma Knife treatment, we couldn’t test the patient’s response before we made a lesion,” Gerard says. “The dose was given and then weeks or months had to pass in order to identify if there were any results or side effects that would be permanent. Whereas now with focused ultrasound, we can keep the patient awake and test the area of the brain we are affecting by transferring energy or sound through the skull to see the reaction before we make the permanent lesion.”
How do doctors choose the proper treatment?
Gerard says there are specific benefits, advantages and disadvantages to each therapy. Because of that, the most important thing for each patient to do is make sure they have an accurate diagnosis. To confirm accurate diagnosis patients are evaluated by a multidisciplinary Movement Disorders team because each patient’s symptoms and response to medications will determine what treatments they are most likely to benefit from. Working with a team with experience in the risks and benefits can help patients make informed decisions.
“If people are suffering with these things,” Gerard says. “There’s a lot of hope. In a seemingly hopeless time, no one needs to suffer alone with a movement disorder. These treatments can make a significant impact on a patient’s quality of life.”
The Swedish Neuroscience Institute provides advanced, progressive treatment for a wide range of brain, spine and central nervous system conditions. We have world-renown neurosurgeons and neurologists, leading-edge operating rooms, telehealth access and a specially trained Inpatient Neurology Team.