At the Center for Neuromodulation, we use the latest neurosurgical technologies to treat a variety of conditions, from chronic pain to refractory psychiatric disorders and collaborative research that looks beyond pharmacological therapies to focuses on understanding and correcting the circuit-based mechanisms. Our goals are to restore lost function or prevent further decline. Below, we outline some of the most common conditions and how we can help.
Dystonia produces sustained, involuntary muscle contractions that can cause repetitive movements and abnormal postures. Primary dystonia has genetic components and often runs in families. Secondary dystonia, also called acquired dystonia, results from a car accident, stroke, or cerebral palsy.
In general, dystonia produces varying degrees of mild to painful spasms, but often the symptoms depend on the part of the body affected. Dystonia is classified according to the body distribution that is affected:
Focal affects a single body region
Segmental affects two or more adjacent body regions
Multifocal affects two or more non-adjacent body regions
Generalized affects the legs, or legs, trunk and one other region
Hemidystonia affects the arm and leg on the same side of the body
DBS is most commonly performed in cases of generalized, hemdystonia, or multifocal dystonia. Some focal dystonias, such as cervical dystonia (affecting the muscles in the neck, causing your head to contort or be pulled forward or backward) can be treated with DBS. Tardive dystonia (dyskineasia) consists of uncontrollable muscle spasms caused by exposure to dopamine blocking medications, such as antipsychotics, certain antidepressants, antiemetics or other medications.
Epilepsy is a chronic brain disorder that affects more than three million Americans of all ages. People with the disorder experience multiple spontaneous seizures, according to the Epilepsy Foundation. Seizures can involve part of the body (called partial) or the entire body (generalized) and often stem from abnormally excited electrical discharges in a group of brain cells. Symptoms can be as simple as a lapse of attention or muscle jerk or as complex as severe and prolonged convulsions. Sometimes you lose consciousness and control of your bowel or bladder function.
Almost 60 percent of people with epilepsy have no known cause for the disorder (called idiopathic epilepsy), according to the World Health Organization. Research suggests there may be a genetic component.
Essential tremor (ET) is a debilitating neurological condition that causes shaking in the hands, voice, and head, making it difficult to complete everyday actions such as holding coffee, grooming, and eating.
People often mistake this condition for Parkinson's disease. According to the National Institute of Neurological Disorders and Stroke, more than 10 million Americans have ET, eight times as many as suffer from Parkinson's disease. ET tends to affect relatively healthy people, both young and old.
ET can affect various extremities of the body, although 95 percent of cases involve the hands. It can cause occasional, temporary, or intermittent symptoms such as rhythmic shaking, difficulty controlling movements and walking, and a poor sense of balance.Often, certain actions (including standing and resting) can trigger the symptoms. We do not know what causes ET but we do know that there is a genetic component, especially among children with the disorder. According to the International Essential Tremor Foundation, children who have a parent with ET have a 50 percent chance of inheriting the gene, LINGO1, associated with the condition.
We work closely with neurologists at the The Robert and John M. Bendheim Parkinson Center and The Tom and Bonnie Strauss Center for Movement Disorders, to create individualized treatment plans, which may include traditional therapies or advanced neurosurgical procedures. We offer an information day for ET patients every three months where we present the latest findings and research trials. You can also meet others who have the same condition.
Parkinson's disease is a neurodegenerative condition of the nervous system affects 1.5 million Americans as well as their families, friends, and loved ones.
You are more likely to get Parkinson’s as you get older. The disease affects your center of gravity and causes soreness, stiffness (rigidity), tremors, and problems with balance or postural stability. It develops gradually. You usually experience symptoms in one extremity at first, but then it spreads throughout your body. In more advanced cases, Parkinson’s affects your walk, memory, and speech, and causes you to move slowly (bradykinesia) and have difficulty swallowing. Often, you become immobile and dependent on your caregivers.
Our experts understand the complicated nature of Parkinson’s. We work with the The Robert and John M. Bendheim Parkinson and Movement Disorders Center, and their neuropsychologists, speech therapists, and physical therapists to recommend the best, most integrated treatment options.
We do not know the exact cause of Parkinson’s disease. We do know, however, that the symptoms stem from tissue degeneration within the substantia nigra and other brainstem structures. These parts of your brain use dopamine and related chemicals to communicate with other regions of the brain. Dopamine coordinates movement; when your dopamine levels fall, you become slow and rigid. Other risk factors of Parkinson’s disease include:
- Advanced age can leads to tissue degeneration. At 80 years old, you have a 2 percent chance of acquiring Parkinson’s.
- Environmental influences, such aspesticides, can increase your risk.
- Genetic susceptibility is a concern, especiallyif you have a first degree relative with the disease.
Obsessive-compulsive disorder (OCD) is a mental disorder that affects 3.3 million Americans (1 in 40 adults and 1 in 100 children). People suffering from OCD have unwanted and repeated thoughts, feelings, images (obsessions), and behaviors that drive them to do or think something over and over (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides short-term relief. Not doing the obsessive rituals can cause great anxiety and distress.
Though the cause of OCD is currently unknown, research indicates that neurotransmitters are involved as well as abnormalities in the circuits that connect the basal ganglia and frontal lobes of the brain. There is also a genetic component.
People usually first experience symptoms between childhood and early adulthood. If left untreated, OCD often is a chronic condition. Treatment for OCD consists of behavioral therapy and medication, but for those who living with treatment-resistant OCD, DBS has been shown to be effective in approximately 60 percent of cases. DBS for OCD in Mount Sinai is covered by Medicare, Medicaid and most insurance companies.
DBS may only be considered as a treatment option if there is no response or an insufficient response to therapy and medication, and if the below criteria are met:
- Primary diagnosis of severe OCD (YBOCS-score > 25), > 5 years
- 18-75 years
- No or insufficient response to:
- 2 adequate trials of at least 2 different SSRIs for 12 weeks
- 1 adequate trial of clomipramine 225-300 mg for 12 weeks
- 1 adequate trial of augmentation with antipsychotic drug
- 1 adequate trial of CBT for OCD, defined as 25 hours of documented exposure and response prevention (ERP) by an expert therapist
- No other current unstable medical condition
- No schizophrenia or current psychotic disorder
- No primary axis II personality disorder
- No cerebrovascular risk factors or a previous stroke or major head trauma
- No cardiac pacemaker/defibrillator or other implanted devices
- No alcohol or substance abuse (including benzodiazepines) during last 6 months
- No pregnancy
- No intellectual disabilities or cognitive impairment
Tourette syndrome is a complex neurological disorder that causes motor and vocal tics repeatedly and can interfere with daily activities. These tics can range from simple to complex and include eye blinking, head jerking, jumping, grunting or throat-clearing, and touching an object repeatedly. Some people with the syndrome cannot control saying obscene or socially unacceptable words. If you have Tourette syndrome, you can usually suppress the motor and vocal tics temporarily, but with great stress. Often you feel a great need to reduce the associated anxiety, resulting in the repetition of tics.
We do not know what causes Tourette syndrome, but research indicates that neurotransmitters are involved as well as abnormalities in the circuits that connect the basal ganglia, frontal lobes, and cortex of the brain. There is also a genetic component.
People usually first experience symptoms in childhood, around elementary school years, and it subsides by early adulthood in more than two-thirds of cases. If you have a severe form of the disease, it can last into adulthood.
Most people feel a little sad now and then. Major depression, though, is very different. It is a serious medical condition that upsets your daily life over a long period of time. Major depression affects 16 million Americans each year. People with major depression suffer from depressed mood or loss of interest or pleasure. In addition, they also have other symptoms, such as suicidal thoughts or problems with sleep, eating, energy, concentration, and self-image.
Researchers do not know what causes major depression. Studies suggest neurotransmitters are involved. In addition, depressed people often have abnormalities in the brain circuits that regulate emotions, motivation, and thoughts. Many other factors can also contribute. These include genetics, personality traits, substance misuse, trauma, and loss and other stressful life events. You can develop major depression at any age.