PHYSICIAN ASSISTANTS Equal Parts Science and Art Oregon’s contribution to tremor relief through Deep Brain Stimulation THE EXAM ROOM WAS QUIET. The patient sat apprehensively in the exam chair, a rest tremor shaking his limbs unrelentingly. It was only a few weeks following his brain surgery. Though I had walked my patient through each of the steps we would take during the visit, his nervousness persisted. I switched on the neurostimulator. At first, nothing. Carefully, gradually, I increased the voltage, and the tremor gradually slowed until finally disappearing completely. Calm. For the first time in years, this man stopped shaking. Deep brain stimulation (DBS) is a procedure involving the delivery of high frequency stimulation to specific areas of the brain. Most commonly it is used in the treatment of movement disorders such as Parkinson’s disease and Essential Tremor. DBS for additional disorders such as obesity, dementia and depression is an active area of research. The story of DBS begins in the 1980s in Grenoble, France with a neurosurgeon by the name of Alim-Louis Benabid. Prior to the procedure’s development, lesion surgeries were performed to alleviate Shannon Anderson, MPAS, PA-C Oregon Health & Science University Intraoperative image from a deep brain stimulation procedure, composed of the patient's pre-operative MRI fused with the intraoperative CT scan. Yellow and green lines demonstrate the planned trajectory, while the red dot denotes the planned target (in this case, the globus pallidus pars interna). The DBS electrode appears as a white hyperdensity beneath the target dot. For more information about the PA Section of the Oregon Medical Association, please email OMA@theoma.org. 22 Medicine in Oregon www.theOMA.org
OMA Medicine in OR Spring 2016
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