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Surgical Treatment for Parkinson’s Disease
April 11th is highlighted in medical calendar as Parkinson’s Disease Awareness Day: an occasion to talk about parkinsonism, its diagnosis and modern methods of treatment. The video from news.am refers to neurosurgical treatment of parkinsonism at "Arabkir" Medical Center emphasizing how effective deep brain stimulation with neuromonitoring can be and how important it is for improving the quality of human life. The 60-year-old man has had Parkinson's disease for over 10 years. He had been receiving drug treatment for many years, but the medications are no longer helpful, and even cause some complications. According to neurologist Zaruhi Tavadyan in a conversation with NEWS.am Medicine, the man had problems with work, social activities, and quality of life. The doctors at “Arabkir” Medical Center suggested a surgical treatment method - deep brain stimulation, which will allow him to return to his active life. “Parkinson’s disease is a chronic progressive neurological disorder of the central nervous system. Its classic symptoms are mainly motor: slowness in motion, tremor, impaired gait, coordination problems, muscle stiffness, and many non-motor symptoms like depression, sleep disorders, pain, etc. All of these symptoms together have a significant impact on the quality of life. During this disorder and drug treatment, patients may experience complications related to the treatment, irregular response to medications, irregular movements. At a certain point, it becomes difficult for patients to continue their treatment with conventional medications alone” says Zaruhi Tavadyan. She also mentions that deep brain stimulation has been used as a treatment method for over two decades. It allows for continuous adjustments in the patient’s mobility over time and helps them to remain active. Deep brain stimulation is a surgery, during which electrodes are placed in specific areas of the brain, which are then connected to a stimulation device implanted under the skin in the chest cavity. The device generates electrical impulses that inhibit abnormal brain activity. This is a complex operation, and surgeons need to find the correct position of electrodes without damaging the motor area of the brain. In the past, the surgery was performed with local anesthesia as the patient had to perform some tasks during the operation in order to evaluate the method's effectiveness and safety. For example, violinist Roger Frisch is known to have played the violin during this type of operation. Today, in “Arabkir” Medical Center, deep brain stimulation is performed with modern technology, neuromonitoring, and there is no longer a need to keep the patient awake, says neurosurgeon Sevak Badalyan. “In our center, deep brain stimulation is performed under general anesthesia and under the control of neuromonitoring, which has many advantages. Firstly, the patient is in a more comfortable state under general anesthesia, and neuromonitoring allows us to adjust the electrode's position and avoid possible side effects of stimulation. Neuromonitoring is a widely used method nowadays. It involves closing an electrical circuit, i.e . a stimulation of the corresponding area is done and the stimulus is recorded from the peripheral muscles. In other words, it can be facial muscle, upper or lower limbs, therefore, it will be facial nerve or hypoglossal nerve, depending on the specifics of the operated region. The goal is to avoid the damage to relevant areas and pathways” he says. Before the operation, doctors carefully study the patient's brain MRI image, find target nuclei and insert electrodes virtually. Then, right before the operation, contrast CT-scan is performed, the results of which are then combined with MRI. To determine the precise place of where electrodes should be placed, a special coordinate system called stereoscopic circle, is used, Niko Arzumanyan, the head of the Neurosurgery Service has noted. “The intervention consists of several stages. In the first stage of the operation, a special metal device is attached to the patient’s head, which helps us to create a virtual coordinate system, and by combining the results of the computed tomography and MRI imaging through the appropriate program, we are able to get coordinates we need, and with the corresponding coordinates, insert the electrodes in the right place with an accuracy of up to 0.6mm” he says. Niko Arzumanyan mentions that deep brain stimulation has been used in “Arabkir” Medical Center for over a year now, and all the operated patients are satisfied with the results. All of this became possible thanks to the latest equipment and digital technologies acquired by the center. Deep brain stimulation is used not only to treat parkinsonism, but for other neurological and even psychiatric disorders as well, says Zaruhi Tavadyan. “Deep brain stimulation is used primarily for Parkinson’s disease, as well as for genetic or essential tremor, and in pediatrics for some types of dystonia. By now, the indications for deep brain stimulation are increasing, the field is expanding, and in the future this method will be used for movement disorders as well, and not only. For example, it can be used in psychiatry, but for now it is used for movement disorders such as classical parkinsonism, essential tremor and dystonia”, she says. 3-4 weeks after the surgery, when the patient’s wounds have healed, the doctors will run the stimulator and make the adjustments. As a result, the patient's slowness of movement, tremor, gait and speech will be corrected, the use of medication will be reduced, which will significantly improve his quality of life.
News.am's reference to the recently performed complex surgery in the neurosurgical service of the “Arabkir” Medical Center intended to remove a child’s brain tumor and thus prevent epileptic episodes. The head of the Neurology and Epileptology service Biayna Sukhudyan, and the head of the Neurosurgery service Niko Arzumanyan provided details about the case, the surgery and, as a whole, about this problem and its modern solutions. In “Arabkir” Medical Center, a surgical treatment of epilepsy was performed on an 8-year old girl, using modern technologies. Studies have shown that the cause of the child’s epileptic seizures over several years was a large tumor, which compressed nearby areas of the brain. During the tumor removal, neuromonitoring was used to bypass the motor nerve fibers and avoid damage to the child’s motor functions. According to Niko Arzumanyan, the head of the Neurosurgery service who spoke with NEWS.am Medicine, the issue in this patient’s case was not the tumor itself, but the compression of nearby areas of the brain by the tumor, resulting in epilepsy. What is neuromonitoring? "Neuromonitoring was very important for this surgery, because the tumor was directly adjacent to the motor areas of the brain and cerebral cortex, as well as corresponding pathways. During the removal of every millimeter of the tumor, we use a special tool to stimulate the brain tissue. Depending on amount of electric current used to stimulate the brain and elicit a response, we estimate how far we are from the corresponding motor nerve fibers. The main goal of this is so that during the surgery and post-operative care we will not have any deficit and will not damage the motor ability of the body," he said. According to Niko Arzumanyan, surgical treatment of epilepsy with simultaneous monitoring is one of the new directions that is being developed in “Arabkir” Medical Center. Until now such operations were performed here with the participation of foreign partners, but now the doctors of “Arabkir” MC work independently. The surgery lasted almost 10 hours, because the tumor was quite large and solid. It took the doctors multiple efforts and hours to remove it without damaging the vessels and nerves of the brain. Biayna Sukhudyan, the head of the Neurology and Epileptology service of “Arabkir” Medical Center mentioned, that the child had been under the of doctors at “Arabkir” MC for several years, her illness appeared with seizures. Various examinations such as MRI and video-EEG monitoring were performed and right parietal tumor with epileptic activity were diagnosed. “For the first time in Armenia, tractography was performed, which allowed us to understand that the tumor does not include important nerve fibers, however, our neurosurgeons chose to use neuromonitoring during surgery to be safer,” she said. Video EEG Electroencephalography remains as one of the most important diagnostic tests for epilepsy. Video-EEG or video electroencephalography is one of the newest methods used in “Arabkir” MC. It is a study that records the electrical activity of the brain over a long period of time, which significantly increases the chances of accurate diagnosis of epileptic foci. “Electrodes are attached with special paste to the heads of our children and adults, and the patients remain in the hospital for 24, 48 or 72 hours. Then the doctor deciphers the results and tries to determine where that electrical activity comes from. If a number of studies confirm and coincide, all showing the same epileptogenic focus, then the patient's chances of overcoming the disease with surgical intervention in the future are quite high,” she explained. The operated child will undergo EEG monitoring again in a few months to check the effectiveness of the surgery. She will take her medicine for several years, after which, the doctors are sure that she will finally get rid of epilepsy and will live a full and healthy life. Epilepsy Statistics The head of the service, Biayna Sukhudyan stated that 70% of the epilepsy cases can be managed through medical treatment, while 30% are difficult to control, and 15% require surgical treatment. All children in Armenia with epilepsy are under the supervision of "Arabkir" Medical Center. Not only children, but many adults with epilepsy and other neurological disorders receive treatment in the hospital, according to Biayna Sukhudyan. “Currently over 3600 children aged 0-18 are under our care, all of whom have some form of epilepsy, whether genetic or acquired. Today we have adults and children under our control, and the state program includes people up to the age of 40 who may potentially be candidates for surgery. We also receive adults with drug-resistant epilepsy” she explained.
First time in Armenia: Surgical treatment of Parkinson’s Disease
Dear visitors and partners, We are happy to announce that the neurosurgical treatment of Parkinson’s Disease is now available in Armenia, at “Arabkir” Medical Center. Our neurology and neurosurgery service team successfully performs Deep Brain Stimulation (DBS). This treatment method has a high efficiency proven by long experience and scientific data, and monitors the motor function of patients, preventing and treating the motor complications of the medication treatment and significantly increasing the patients’ life quality, independence and physical performance. During this surgery, electrodes are implanted in damaged nuclei inside the brain. Those electrodes work with the help of a neurostimulator that is placed under the skin in the chest area. The programming and further management of the neurostimulator is done by a specialist and enables stable and continuous anti-parkinsonian and anti-dyskinetic results. This neurosurgical method is used to treat patients with generalized dystonia and drug-resistant essential tremor. Surgery is performed on patients, who have preoperative assessment. In order to master Deep Brain Stimulation and further regulation of the device, neurosurgeon Sevak Badalyan has trained in Bulgaria (University Hospital “Saint Ivan Rilski” of Sofia), neurologist Zaruhi Tavadyan has trained in Austria (Physical Disability Center of University of Innsbruck) and in Hungary (University Hospital of Szeged). For more information call Neurology and Neurosurgery Service` 060 400 300 /22 21/. * The article is intended for visitors and colleagues of “Arabkir” MC-ICAH.
060 400 300 /22 20/
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