'neurosurgery' Neuroscience (SNI) posts

After working in the field of neuromodulation for the past 25 years, I have seen many advances in the field; both in our understanding of the nervous system, and new technology designed to target specific neuronal pathways that will offer the best outcome for patients. It is an exciting field with new investigations that lead to ever expanding knowledge. However, what really keeps me interested in the field after all these years is the opportunity and privilege to be a part of our patients lives on a daily basis. The picture and comment shared below from a grateful patient who had DBS with us two years ago says it all…

"I look back on my experience at Swedish with a grateful heart... thankful for every day I've been given.."

Tremor is a normal physiologic reaction to anxiety or stress, but it is not normal to have a tremor when performing typical daily activities.

People who develop a tremor while eating, drinking, writing or doing other common activities may have a movement disorder called Essential Tremor. This is actually the most common movement disorder, and can affect up to 4% of people over age 40. People who have this disorder can take medications to help minimize the tremor, but they don't often reduce the tremor by more than about half. Deep brain stimulation (DBS) is an excellent treatment option for people with severe tremor, and can nearly eliminate the tremor in many patients. Many patients aren't sure when their tremor is severe enough to warrant surgery, and much of our conversation in the office is to help answer this question.

There is no one answer that is right for everyone, but for me it has to do with how well someone is actually doing in their daily life:

I met with several patients this week to discuss their personal journey to making the decision to pursue DBS surgery. Not surprisingly, they were well educated about their disease and treatment options.

Each patient reminded me that there is a lot of information and misinformation about surgery for movement disorders.

The most important advice I can give any patient or family is...

Choosing to undergo elective deep brain stimulation (DBS) surgery is a big deal.

I have walked through the process with hundreds of patients over the past 10 years and see many struggle with the choice to undergo brain surgery, as they seek to improve their quality of life. Many people have adapted to compensate for the movement disorder with creativity and determination.

In spite of this, after the best medical options have been exhausted, DBS is increasingly offered as a viable treatment option.

Keys to making the best decision for you are:

In September, I co-authored this cover article in the Journal of Neurosurgery on the results of a study using ultrasound for the treatment of brain hemorrhage. The study involved 33 patients with spontaneous intracerebral hemorrhage who were screened for inclusion in a SNI clinical study known as “SLEUTH” (Safety of Lysis with Ultrasound in the Treatment of Intracerebral and Intraventricular Hemorrhage). You can the abstract and full text of the article or see background information on the study, and watch a related video on WebMD.

David Newell, M.D., neurosurgeon and co-executive director of the Swedish Neuroscience Institute (SNI), co-authored the cover article in the September Journal of Neurosurgery on the results of a study using ultrasound for the treatment of brain hemorrhage. The study involved 33 patients with spontaneous intracerebral hemorrhage who were screened for inclusion in a SNI clinical study known as “SLEUTH” (Safety of Lysis with Ultrasound in the Treatment of Intracerebral and Intraventricular Hemorrhage). Read the abstract and full text of the article. Read background information on the study. Watch a related video on WebMD.

 Washington State has one of the high est stroke mortality rates in the nation. To improve this situation, acute intervention al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in farction following a stroke.

A recent European study demonstrat ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des moteplase.