Led by Dr. Jonathan Riley, the UBNS comprehensive movement disorders team believes in a multidisciplinary approach to patient care. Members of the team are certified by the National Parkinson’s Foundation to provide supportive services to Parkinson’s disease patients and their families.

Our multidisciplinary movement disorders program specializes in the evaluation and treatment of:

• Parkinson’s disease
• Medically refractory epilepsy
• Huntington’s disease
• Essential tremor
• Dystonia
• Tics & other movement disorders
• Botulinum toxin injections for dystonia, blepharospasm and sialorrhea
• Medically refractory spasticity secondary to multiple sclerosis, spinal cord injury, traumatic brain injury, and stroke
• Gamma knife for tremor and tumors

Our patients have access to current drug studies and surgical treatments from our expert team. We also provide ongoing patient support and communication.

What You Can Expect

At their initial appointment, patients are first introduced to the movement disorders team before undergoing an in-depth interview, history, and exam with a fellowship-trained movement disorders neurologist, Dr. Kelly Andrzejewski.

Treatments

We offer our patients the most current medications for the treatment of movement disorders, including:

• Deep Brain Stimulation (DBS)
• Botulinum Toxin injections for the treatment of spasmodic torticollis, blepharospasm, focal dystonias, and spasticity
• Intrathecal baclofen pump therapy for the treatment of spasticity and dystonia
• Intracranial ablations for selected patients that are surgical candidates but not appropriate for long-term stimulation

We participate in the most appropriate experimental protocols for the surgical and medical management of movement disorders. Surgical management consists of either DBS or an ablative procedure to treat PD, essential tremor, and dystonia. Surgical procedures are performed by Dr. Jonathan Riley, who specializes in stereotactic procedures.

What Sets Us Apart

Each member of the comprehensive movement disorders team is a trained professional with expertise and passion for treating Parkinson’s disease and other chronic movement disorders. We treat the entire course of Parkinson’s and take pride in the level of care we offer for early, middle, and advanced stages of the disease.

Our team spends as much time as is necessary to properly and thoroughly assess each patient’s needs in order to devise and recommend the best course of treatment for that individual. We offer the most innovative treatment options and hold the distinction of being the only practice in Western New York to offer deep brain stimulation to treat Parkinson’s disease, essential tremor, and dystonia.

The same team familiar with your condition and treatment also implants and programs your device. We know your symptoms and manage your medications, making the DBS programming process just an extension of your treatment.

We are the largest provider of intrathecal baclofen therapy (ITB) for spasticity in the region.

Deep Brain Stimulation (DBS)

Deep Brain Stimulation is a surgical therapy that is extremely effective for properly selected patients who suffer from movement disorders such as Parkinson’s disease (PD) and essential tremor. UBNS’ Movement Disorders team has been successfully treating Parkinson’s disease, dystonia, and essential tremor for more than 20 years. Our highly specialized movement disorders team is comprised of fellowship-trained physicians who serve those afflicted with PD as well as other movement disorders.

What is DBS Therapy?

It consists of surgical implantation of one or two leads, with four electrical contacts into specific areas of the brain. The leads are attached by an extension wire to an implanted battery-operated medical device called an impulse generator or neurostimulator. The DBS leads deliver electrical currents to the brain to modulate abnormal nerve signals and thus lessen PD symptoms. The symptoms that respond best to DBS are shaking (tremor), muscle stiffness (rigidity), slowed movement (bradykinesia), and dyskinesia (involuntary movements which is a side effect from medication). For some patients, it can improve walking.

The system can be turned on or off by the patient or by the clinician. The clinician can activate one or more of the four contacts on each brain lead to provide the stimulation and control, to some extent, a variety of electrical parameters or settings to control the amount of stimulation. These adjustments are often referred to as “programming” the DBS system. They allow the ability to maximize benefit and minimize side effects. Because DBS is entirely reversible and can be performed on both sides of the brain, the majority of patients choose DBS over the other surgical treatments.

The DBS System

There are two types of DBS systems: unilateral (placement only on one side of the brain) and bilateral (placement on both sides of the brain). Several pieces make up the DBS system, including:

• Lead—A metal wire that allows for transmission of electricity is surgically implanted into the brain. There are four different contacts at the end of the wire to allow for the delivery of electrical impulses to the brain target site. The wire is just over a millimeter in diameter.
• Extension Wire—A wire runs from the brain electrode to the pulse generator.
• Implantable Pulse Generator (IPG), or Neurostimulator—A battery-powered device supplies electricity through the extension wire to the four contacts on the DBS lead.
• Programmer—A device that communicates with the IPG using radiowaves. This is used to set the electrical stimulation.
• Patient Controller—A remote control device allows the patient to turn on and off the IPG and to check the battery status.

The DBS Protocol

Evaluation of PD, ET, and dystonia begins with our movement disorders neurologist, Dr. Kelly Andrzewski. If PD is suspected, a baseline unified Parkinson’s disease rating scale (UPDRS) should be performed. This scale helps the clinician evaluate the status of your PD. Preoperative tests may include MRI, x-ray, EKG, blood test, and neuro psych evaluation.

Surgery

Once the team has determined that and the patient has decided to move forward with a surgical procedure, a choice is made as to whether the patient will receive Deep Brain Stimulation or an ablative procedure. If DBS is chosen, then an implantation site for the neurostimulator is also necessary.

Before brain surgery, MRI and CT scans are used to locate the target brain structure. Once an internal map is drawn, this map is matched with external landmarks so surgeons can make an accurate incision using a local anesthetic. Surgery is performed by creating a small burr hole in the skull about the size of a nickel. A microelectrode is then guided to the pre-selected target. This customized mapping process helps to fine-tune the exact location individually for each patient, to the desired accuracy of one millimeter or less.

A local anesthetic to numb the skin is administered when the surgeon makes the opening in the skull.

Once the patient has successfully recovered, the extension wire is placed. During this procedure, the patient is placed under general anesthesia. The “pacemaker” is surgically implanted under the skin of the chest, just below the collarbone. The stimulator is turned on for the first time a few weeks post-operation. Programming does not require any further surgery.

As with any surgery, there are risks associated with deep brain stimulation therapy which are explained by your surgeon. The results can be dramatic and life-altering.

The hospital staff will provide you with discharge instructions for care of your incisions. Your DBS staff will provide you with information for follow up appointments for DBS programming and for dosing of your PD medications. This information will include phone numbers to call in case of emergency.

If you have additional questions about DBS and would like to speak to a nurse who specializes in caring for DBS patients, please call Rachel Shepherd, RN at (716) 932-6080, ext 135.

Am I a Candidate for DBS?

When you are first diagnosed with PD, your neurologist or movement disorders specialist will use medications to help reduce the symptoms of PD. Your condition may be well controlled with medication alone and DBS may not be necessary or may be delayed for several years. That said, recent evidence and a revised FDA-approval consideration of DBS earlier in the course of Parkinson’s disease (a minimum of four years after diagnosis) so as to get the best long-term symptom improvement benefit. A movement disorders specialist is the best resource to confirm your diagnosis of PD and help determine if DBS would be a good choice for you.

The best candidates for DBS therapy meet most of the following criteria:

• You have had PD symptoms for at least four years.
• You have “on/off” fluctuations, with or without dyskinesia.
• You continue to have a good response to PD medications, especially carbidopa/levodopa, although the duration of response may be insufficient.
• You have tried different combination of carbidopa/levodopa and dopamine agonists under the supervision of a movement disorders neurologist.
• You have tried other PD medications, such as entacapone, tolcapone, selegiline, or amantadine without beneficial results.
• You have PD symptoms that interfere with daily activities.

DBS is NOT as effective to relieve some symptoms, such as difficulty with balance or walking, freezing episodes, or speech problems. DBS would not be advised if you have severe confusion, depression, anxiety, or another psychiatric illness that is not improved with medication or counseling. If you are not certain about your PD diagnosis, or you have another serious health condition, you may need further evaluation by a movement disorders specialist and/or your primary physician.