The Los Angeles
Neurosurgical Institute
Neurosurgical Institute
 |  |  |  |
 |
 |
 |
 |
 |
 |
 |
 |
Ph: 310.659.6633 or 800-496-4544 | Fax: 310.659.6631| Email info@lansi.org | Web Site by Bemol Design |
The Movement Disorders Surgery Program at the Los Angeles Neurosurgical Institute
is a vital resource for individuals suffering from Parkinson's disease or other movement disorders
such as drug-induced dyskinesias, dystonias and atypical tremors that are unresponsive to
traditional treatment.
Because the nature of movement disorders is so unique, each patient receives an individually
tailored treatment plan. In addition, the Movement Disorders Surgery Program provides a
holistic approach to patient care, addressing the social and emotional problems that can
accompany a chronic illness.
Parkinson's Disease and Other Movement Disorders
Parkinson's disease is a progressive neurological disorder caused by a loss of nerve cells in a
small area deep within the brainstem. Patients usually experience the first symptoms of
Parkinson's disease in their 50s and 60s. These include:
At this time, there is no cure for Parkinson's disease. The disease is first treated by giving
patients drugs to stimulate the dopamine system or mimic its controlling effect on other nerve
cells. Although these are initially effective, prolonged use can lead to severe dyskinesias, which
are large uncontrollable movements, hallucinations and freezing episodes.
Dystonia
In neurological terms, dystonia refers to a movement disorder marked by continuous muscle
contractions that cause abnormal posture. Dystonia symptoms can be:
A Comprehensive Approach
Each patient in the Movement Disorders Surgery Program is first evaluated to ensure that he or
she is a good candidate for surgical intervention. This includes a detailed history and physical
examination. A Uniform Parkinson's Disease Rating Scale is also given along with other rating
scales. Neuropsychological testing and neuroimaging are done as needed. Many of these scales
and tests are also done after surgery to assess its results objectively.
Surgery
Patients for whom more conventional drug therapies have failed may benefit from sophisticated
surgery including:
Pallidotomy surgically destroys certain cells that are responsible for the symptoms of Parkinson's
disease. These cells are located in the part of the brain controlling movement. The operation
may help correct problems in slow movement, tremor and imbalance. It is done while the
patient is conscious. The most dramatic result is the decrease in dyskinesia and tremor.
The surgical target within the brain is defined using MRI technology with a special stereotactic
frame attached to the head. Once the location of the overactive cells is precisely defined, a
lesion is made to destroy the cells. This process is guided by state-of-the-art digitized
microelectrode recordings and high resolution stereotactic imaging techniques available at the
LANSI..
In traditional thalamotomy, cells in the brain's thalamus are destroyed to correct a disabling
tremor in the hands or arms of persons who have few other symptoms. This procedure is also
done using a stereotactic headframe attached to the head, with the surgical target defined by
MRI technology.
The Movement Disorders Surgery Program at the Los Angeles Neurosurgical Institute
is one of the first centers on the West Coast to offer chronic deep brain stimulation (DBS). In
this approach, an electrode is placed in the focal point in the brain and stimulates the cells rather
than permanently destroy them. The surgeon can control how long the discharge lasts and how
intense it is.
is a vital resource for individuals suffering from Parkinson's disease or other movement disorders
such as drug-induced dyskinesias, dystonias and atypical tremors that are unresponsive to
traditional treatment.
Because the nature of movement disorders is so unique, each patient receives an individually
tailored treatment plan. In addition, the Movement Disorders Surgery Program provides a
holistic approach to patient care, addressing the social and emotional problems that can
accompany a chronic illness.
Parkinson's Disease and Other Movement Disorders
Parkinson's disease is a progressive neurological disorder caused by a loss of nerve cells in a
small area deep within the brainstem. Patients usually experience the first symptoms of
Parkinson's disease in their 50s and 60s. These include:
- Rigidity, which is related to an overactivity of cells in the spinal cord that control muscle
tone. It appears as an increased tone in the muscles and is present when the limbs are still.
Rigidity increases when the limbs are moving. - Akinesia, complete or partial loss of muscle movement. It includes slow performing of
voluntary movements, delayed motor initiation and difficulty reaching a target with a
single continuous movement. - Tremor or shaking palsy, which appears in the hands and sometimes the feet, of non-
moving limbs. The tremor may be worse on one side of the body than on the other and
may involve the head, neck, face and jaw. Tremors usually decrease when the hands are
stretched out in front of the patient or when the hands are moving (resting tremor). In
some individuals, however, the tremor may increase when the hands are in this position
(called sustention tremor). In others, the tremor increases when the hands are moving
(action tremor). While the resting tremor usually responds to some of the anti-
parkinsonian drugs, the sustention and action tremors generally do not.
At this time, there is no cure for Parkinson's disease. The disease is first treated by giving
patients drugs to stimulate the dopamine system or mimic its controlling effect on other nerve
cells. Although these are initially effective, prolonged use can lead to severe dyskinesias, which
are large uncontrollable movements, hallucinations and freezing episodes.
Dystonia
In neurological terms, dystonia refers to a movement disorder marked by continuous muscle
contractions that cause abnormal posture. Dystonia symptoms can be:
- Generalized, affecting all body parts
- Segmental, affecting adjacent body parts, or
- Focal, affecting only a single body part.
A Comprehensive Approach
Each patient in the Movement Disorders Surgery Program is first evaluated to ensure that he or
she is a good candidate for surgical intervention. This includes a detailed history and physical
examination. A Uniform Parkinson's Disease Rating Scale is also given along with other rating
scales. Neuropsychological testing and neuroimaging are done as needed. Many of these scales
and tests are also done after surgery to assess its results objectively.
Surgery
Patients for whom more conventional drug therapies have failed may benefit from sophisticated
surgery including:
- Stereotactic pallidotomy, used on patients with rigidity or akinesia
- Stereotactic thalamotomy, used on patients with tremors, or
- Deep brain stimulation, the most frequently performed procedure.
Pallidotomy surgically destroys certain cells that are responsible for the symptoms of Parkinson's
disease. These cells are located in the part of the brain controlling movement. The operation
may help correct problems in slow movement, tremor and imbalance. It is done while the
patient is conscious. The most dramatic result is the decrease in dyskinesia and tremor.
The surgical target within the brain is defined using MRI technology with a special stereotactic
frame attached to the head. Once the location of the overactive cells is precisely defined, a
lesion is made to destroy the cells. This process is guided by state-of-the-art digitized
microelectrode recordings and high resolution stereotactic imaging techniques available at the
LANSI..
In traditional thalamotomy, cells in the brain's thalamus are destroyed to correct a disabling
tremor in the hands or arms of persons who have few other symptoms. This procedure is also
done using a stereotactic headframe attached to the head, with the surgical target defined by
MRI technology.
The Movement Disorders Surgery Program at the Los Angeles Neurosurgical Institute
is one of the first centers on the West Coast to offer chronic deep brain stimulation (DBS). In
this approach, an electrode is placed in the focal point in the brain and stimulates the cells rather
than permanently destroy them. The surgeon can control how long the discharge lasts and how
intense it is.
THE MOVEMENT DISORDERS SURGERY PROGRAM for
PARKINSON'S DISEASE, TREMOR AND DYSTONIAS
PARKINSON'S DISEASE, TREMOR AND DYSTONIAS