Natalie Focha 7 November 2013 Dr.

Nadar Pouration NRB Auditorium Clinical Correlation #1 Movement Disorders and Neurosurgical Treatments Dr. Nadar Pouratian, the Assistant Professor in Neurosurgery presented our first clinical correlation about movement disorders (e.g. Parkinson s disease) and neurosurgical treatment of these disorders. In addition to Dr. Pouratian, Richard (Richie) Rothenburg, a Parkinsons patient of Dr. Pouratians, accompanied the doctor in his seminar. Parkinson s disease (PD) is the second most common degenerative disorder, after Alzheimers Disease. It affects 1-2% of the population and is commonly observed in people ages sixty-five and up. Some of the major symptoms of PD are tremor, rigidity, slowness of movement, and postural instability. Although it is not common, PD can have a young onset, as was the case for Richie and Michael J. Fox. Richie described his first symptoms of PD as asymmetrical rigidity in his knee which was diagnosed as tendentious and treated orthopedically. His treatment continued in the orthopedic vein until one day, during an outing with members of his family, his cousin convinced him that he should visit a neurologist. Richie was diagnosed with PD when asymmetrical rigidity, slight tremors, and affected gait were observed during his examination with a neurologist. This diagnosis took time for Richie to accept, but after the same diagnosis from the fifth neurologist he visited, he finally accepted his condition. Fast forward seven years later and Richie is dramatically affected and almost catatonic. During the seminar, Richie said that when younger, PD has greater affect than if you get PD when you are older because you want the drugs they give you to treat your symptoms to work so you can function because you have so much to do when you are young. The further you progress with the disease, the more motor fluctuations (going from a very rigid state to a functional state) becomes. In addition, since the neurotransmitter that is affected by Parkinsons is dopamine, and dopamine affects multiple systems, depression and compulsive behaviors are very common in those affected with PD. As Richies symptoms were steadily increasing, neurologists recommended deep brain stimulation. Deep brain stimulation is advantageous because it is both modulatory and reversible. The surgery was successful and although Richie still has tremors, he can spend more time in a functional condition (on condition) and less time in a catatonic state due to his increased efficacy of drug delivery that is adjusted every few months.