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DBS IN GPI AND MEDS
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migvel posted:
DEAR DR. MARK
I'M MIGUEL, I'M 47, I WAS DX.PD SINCE MAY 2002, LAST AUGUST 2010, I HAD MY DBS SURGERY, I WAS IMPLANTED TWO ELECTRODES IN GPI BILATERALLY, I BOUGHT THE BRIO SYSTEM FROM ST.JUDE, PRIOR TO MY SURGERY MY MOST DISTURBING SYMPTHOMS WERE DISKINESIAS MAINLY IN MY LEFT SIDE, RIGIDITY, SPEECH PROBLEMS, ON/OFF FLUCTUATIONS, IMSONIA, BALANCE AND WALK PROBLEMS, (AND DYSTONIAS AT WAKE UP ON FEET IF DON'T TAKE SINEMET) .
AFTER SURGERY, I FELT VERY GOOD BECAUSE DISKINESIA GONE, BUT MY OFFS ARE MORE SEVERE.

MY INITIAL NEUROSTIMULATOR PARAMETERS WERE C.1 C.2 , AM.=1.0, RATE=130 Hz. P.W.=100, CONT. 1+ 2-, AND AFTER TWO WEEKS MY NEURO ONLY MODIFIED AM.=1.20

I DON'T UNDERSTAND WHAT THIS PARAMETERS MEAN, AND PRIOR TO MY SURGERY I WAS TAKEN 1 SINEMET PILL EVERY 3 HOURS, 2 PRAMIPEXOLE(SIFROL 1 mg) A DAY, AND 1 CLONAZEPAM AT NIGHT TO SLEEP.
MY DR. ONLY HAS INCREASED AM=1.40, BECAUSE HE SAID HE WANTS THE BATTERY EXTEND TO MAX. USEFUL LIFE, AND TOLD ME I MUST REDUCE LEVODOPA INTAKE, AND TOLD ME TO TRY NOW, WITH ROTIGONE PATCH 1/DAY, AZILECT 1/DAY AND STALEVO INSTEAD OF SINEMET BUT I TRIED STALEVO 50 AND OCCURS THAT MY OFFS ARE MORE SEVERE AND TRIED ALSO WITH STALEVO 100 MY ON TIMES MAKES ME FEEL BETTER A SHORT TIME AND THEN WHEN THE EFFECT RAISE TO PEAK I CANT TALK.
I COME BACK TO SINEMET BUT ARE THE EFFECTS ARE LESS BUT SIMILAR MY SPEECH IS VERY SENSITIVE TO SINEMET DOSES. LESS SINEMET=OFF SEVERE, REGULAR SINEMET= I HAVE TO WAIT TOO MUCH TIME TO TAKE EFFECT TO BE OK, MORE SINEMET= I CAN'T TALK, I HAVE 3 WEEKS USING THE PATCHES AND AZILECT AND I DONT FEEL ANY EFFECT OF THESE 2 MEDS. WHAT I SHOULD DO? I WILL APPRECIATE VERY MUCH YOUR COMMENTS
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DUKE MEDICINE
Mark A Stacy, MD responded:
Hi, Miguel
Thank you for your question. DBS parameters are often confusing. I first try to define the electrodes that best treat the symptoms - in your case dyskinesias. Your anatomic configuration is at this time an electrode 1 and 2-. This seems reasonable. Next is AMPLITUDE (now you are 1.2), and suggested range in in the literature is 2.5-3.6. You may wish to ask whether this may be increased. Next is pulse width (you = 100), and ranges from 90-120. Finally the frequency (you=130) should range from 90-120.

If these parameters cannot be changed, it would be reasonable to increase the dosage of your medications.


The rate is the number of


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