Objective: DBS: surgical procedure of choice for PD. Albanian experience.

Background: Parkinson disease (PD) : the decrease of dopamine’s levels because of nigro – striatal degeneration, stimulates a cascade of events, causing resting tremor, rigidity, bradykynesia , hypokinesia, etc. The first line treatment is the replacement therapy & Levodopa is the most effective replacement therapy for PD.Llong-term management of PD with levodopa, may be followed by the development of motor fluctuations and dyskinesia. The fluctuations cannot be managed neither by addition of other PD medications nor by changes in levodopa dosing schedule. In this period the surgical treatments for PD are often considered. DBS is currently the surgical procedure of choice for PD.

Method: Cases report.

Results: We performed first bilaterally STN – DBS in PD on 2015, for 2 patients. Then we realized it for 2 other PD patients. So we have 4 PD patients implanted with STN – DBS. 3 of them were males and 1 female. The mean age: 58 years old. All of them had major parkinsonian symptoms ( tremor, rigidity, bradykinesia) and a lot of medications. We found the time of intervention, as the best indication time for it, as there were the adverse therapy effects appeared and before their complete social and professional invalidization. We performed UPDRS evaluation for all of them. After the intervention we swiched onn the DBS and performed their programming. We followed up all the patients, either clinically or DBS programming parameters. All our patients underwent bilaterally STN- DBS. There were no neurosurgical complications for all of them, no DBS failure or leads misplacement as well. All the major parkinsonian signs (tremor, slowness, rigidity) improved significantly with bilateral STN- DBS. Tremor was the symptom improved more with STN – DBS than with medications alone. There was marked reduction in dyskinesia as well. There were marked reduction in antiparkinsonian medications for our patients and the UPDRS were evidently improved for all of them.

Conclusion: DBS as new therapeutic method for movement disorders, include in its indications PD. Its application improves significantly the quality of life for PD patients, reduces major parkinsonian symptoms and reduces the adverse effects of antiparkinsonian medications, as well.

References: 1.Challenges in PD patient management after DBS: A Pragmatic Review Malco Rossi, MD, PhD,1 Ver_onica Bruno, MD, MPH,1,2 Julieta Arena, MD,1 _Angel Cammarota, MD,1 and Marcelo Merello, MD, PhD1,2,* 2. A history of Deep Brain Stimulations: Technological innovation and the role of clinical assessment tools Social studies of science : 43 ( 5) 707 – 728

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