MR KEITH GOMES

Melbourne Brain and Spinal Neurosurgeon

Parkinson’s Disease and other Movement Disorders

Cranial Conditions

The term movement disorders refer to a group of neurological conditions that are categorised by impairment of the planning, control and execution of movement.

The brain consists of both grey and white Matter. Grey matter has a predominance of neurons while white matter has more connecting axons. Apart from the grey matter on the surface of our brain that forms the cortex, there are deeper collections of grey matter or nuclei.

A better understanding of the underlying abnormalities in these nuclei forms the basis of movement disorders such as Parkinson’s disease, Essential Tremour and Dystonia. This has allowed the development of both medical and surgical therapies. In particular it has allowed the development Deep Brain Stimulation (DBS).

DBS allows the application of controlled electrical stimulation to specific parts of the brain. The targets for stimulation reside in functional areas of the brain that lie beneath those of conscious thought and movement and are called the basal ganglia. Based on our current understanding of movement disorders it is the circuits that reside in this system that malfunction and cause the majority of movement disorders, like Parkinson’s disease.

The most common targets for DBS are the Subthalamic Nucleus (STN), Globus Pallidus Interna (Gpi) and Vim part of the thalamic nuclear complex. The selection of targets for DBS is generally determined by the nature of the underlying condition in terms of the clinical symptoms and signs, while taking into account individual patient factors and expected outcomes.

Parkinson’s Disease

Parkinson’s Disease is a progressive movement disorder that affects cells in the brain responsible for movement. When the neurons that produce dopamine die and the brain has less and less dopamine, symptoms of the disease become more apparent. Symptoms include tremors, decreased movement, rigidity, stiffness, slow movement and difficulty with balance.

First line treatment for Parkinson’s Disease includes medications. Unfortunately, as the disease progresses the effectiveness of medication decrease. Medications for Parkinson’s disease may also cause other abnormal involuntary movements such as dyskinesias (‘wriggles’)

When medications are no longer working well (this is referred to as symptoms being refractory to medication) or side effects related to medical therapy have become intolerable, Deep Brain Stimulation may be considered. In general, patients who have responded well to a medication called levodopa for Parkinson’s, have uncontrolled dyskinesia or disabling resistant tremor are candidates for surgery.

- Download Patient Information Sheet

Essential Tremor

Essential tremor (ET) is a common movement disorder that results in shaking of the hands, legs or vocal cords. The cause is unknown but has been found to have a familial basis. Essential tremor often commences before the age of 30. This disorder is quite debilitating, particularly when it affects the patient’s dominant hand.

ET is often confused with Parkinson’s disease because both conditions result in tremors. In ET, shaking usually first appears in both hands whereas in Parkinson’s the tremor usually starts on one side of the body before spreading to the rest of the body. In people with essential tremor the shaking is more pronounced when performing an action such as holding a cup. This is known as an ‘action tremor’.

Diagnosis of ET is made by a clinical assessment and this disorder can be reasonably controlled with medications including beta blockers. People with essential tremor with disabling symptoms that have not improved with medication may be considered suitable for Deep Brain Stimulation (DBS). Significant improvement of symptoms has been reported in 70-80% of cases who underwent DBS.

Dystonia

Dystonia is a movement disorder that results in involuntary muscle contractions. The contraction causes repetitive or twisting movements of the affected body part. This movement disorder ranges from mild to severe which can affect one muscle only or the entire body. It is the most disabling of movement disorders.

The classification of dystonia is primary or secondary. Primary dystonias are unaccompanied by other neurological abnormalities except tremor and occasionally myoclonus (a sudden, involuntary muscle jerk). First line treatment includes medical therapy. Primary dystonias are amenable to DBS. It has been found that certain genetic subsets of dystonia respond better to DBS and as such genetic testing is part of the evaluation.

Unlike DBS for Parkinson’s disease and essential tremor, the effects of surgery for dystonia may not be immediate.

For all appointments and enquiries, please phone 03 8318 4929

MAIN CONSULTING ROOMS

Mayfair Specialist Centre
Level 7
250 Victoria Parade
East Melbourne VIC 3002

Getting Here

ALSO CONSULTING AT

Knox Private Hospital
Suite 1A
262 Mountain Highway
Wantirna VIC 3151

Getting Here

Holmesglen Private Hospital
Suite A1
Paso Consulting Suites
490 South Road
Moorabbin VIC 3189

Getting Here