Overview:

Student: Holly Zheng

Project Title: Comparison Between Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease Performed in an Operating Room versus in a MRI

Location: University of Arizona Medical Center

BASIS Advisor: Mr. Matt Johnston

On Site Advisor: Dr. Willard Kasoff

On Site Advisor Contact Information
            Email: wkasoff@surgery.arizona.edu
            Office Phone: 520-626-2164
Address: Neurosurgery PO Box 245070; Tucson, Arizona 85750-5070
            Arizona Health Science Center: 1501 N. Campbell Ave.
Office Number: 4303A

Mode of Daily Contact: Blog

Course Goals:
Comparison Between Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease Performed in an Operating Room versus in a MRI is part of a six-month clinical trial hosted by the University of Arizona Medical Center.  This SRP has two main objectives: first, I will be comparing the outcomes of deep brain stimulation (DBS) done in the operating room compared to deep brain stimulation done in an MRI to see if there is a benefit in any way, and second, I will gain first hand experience of what a surgery career entails and whether or not I am suited for that lifestyle.  
I will be shadowing Dr. Kasoff for the majority of my SRP.  This includes researching the ClearPoint System, observing the procedures, and following up on patients.  By shadowing Dr. Kasoff and his team of surgeons during the surgery, I will observe if it is easier on the surgeon’s side to place the electrode in the brain while the patient is in the MRI and if the placement of the electrode is accurate.  The patient follow up will mostly consist of questions the effectiveness of DBS.
There will not be a electrode placement surgery done everyday, and on days that Dr. Kasoff is not in the clinic, I will be going through old patient files and gathering data from them.  I will be comparing the position and placement of the electrodes in patients’ who have had their surgery done in the operating room or the MRI by looking at medical imaging scans.  Dr. Kasoff will provide the files from UMC patient archives. 


             

Course Texts:
Bain, Peter G. Deep Brain Stimulation. Oxford: Oxford UP, 2009. Print.

Factor, Stewart, and William Weiner. "Clinical Presentation, Surgery: Deep Brain Stimulation." Parkinson's Disease Diagnosis and Clinical Management. 2nd ed. New York: Demos Medical, 2008. Print.

Hall, Walter A., and Christopher Nimsky. "Implantation of Deep Brain Stimulator Electrodes Using Interventional MRI." Intraoperative MRI-guided Neurosurgery. New York, NY: Thieme, 2011. Print.

Larson, Paul S., and Philip A. Starr. "An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery: Preliminary Evaluation of Targeting Accuracy." Operative Neurosurgery 70.1 (2011): 95-103. Print.

Rodriguez-Oroz, M. C., J. A. Obeso, A. E. Lang, and J. L. Houeto. "Bilateral Deep Brain Stimulation in Parkinson’s Disease: A Multicentre Study with 4 Years Follow-up." Brain, A Journal of Neurology 128 (2005): 2240–2249.PubMed. Web. 18 Nov. 2014. <http://www.ncbi.nlm.nih.gov/pubmed/15975946>.

Willie, Jon T., Nealen G. Laxpati, Daniel L. Drane, Ashok Gowda, Christina Appin, Chunhai Hao, Daniel J. Brat, Sandra L. Helmers, Amit Saindane, Sherif G. Nour, and Robert E. Gross. "Real-Time Magnetic Resonance-Guided Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy." Neurosurgery 74.6 (2014): 569-85. Print.


Project Product Descriptions:
I will write a fifteen-page (minimum) research paper that provides a tentative conclusion to my research question of whether or not there are benefits to performing deep brain stimulation surgery in a MRI scanner compared to the operating room.  The paper will summarize the methods used in this clinical trial, give an analysis of previous case studies of patients who had their surgeries done in the operating room, and contrast those cases with new patients who had their surgeries done in a MRI scanner.  It is possible that I will be working on a publication for a research journal with Dr. Kasoff and the other surgeons on this trial.


Weekly Schedule

Week 1:
Introductions and orientation for basic rules in the operating room
Begin reading medical literature on Parkinson’s Disease:
            Parkinson's Disease Diagnosis and Clinical Management
Section II Clinical Presentations: Epidemiology, Cardinal Features of Early Parkinson’s Disease, Autonomic Dysfunction, Sensory Symptoms, Clinical Rating Scales
Section III: Behavior and Psychiatric Manifestations: Dementia, Depression, Anxiety and Panic

Learn how to read an MRI scan and basic brain structures
2 blog posts: Introduce the project and record first week experiences and lessons.

Week 2:
Finish basic training
Learn how to read an MRI scan and advanced brain structures
Medical literature reading assignment:
            Parkinson's Disease Diagnosis and Clinical Management
Section IV: Pathology and Neurochemistry: Neuropathology, Basal Ganglia: Anatomy and Physiology
Patient Archives: 1 case study (provided by Dr. Kasoff)
2 blog posts: Write about background of Parkinson’s Disease and DBS surgery, and record second week experiences and lessons.

Week 3:
Observe procedures if patients are available
Medical literature reading assignment:
            Deep Brain Stimulation
                        DBS Stimulator Programming
                        Selection Appropriate Parkinson’s Patients for DBS
                        Test Stimulation
Patient Archives: 1 case study, most likely same from Week 2 (provided by Dr. Kasoff)
2 blog posts: Write about how to read MRI scans, and record third week experiences and lessons.

Week 4:
Observe procedures if patients are available
Medical literature reading assignment:
            Intraoperative MRI-guided Neurosurgery:
Implantation of Deep Brain Stimulator Electrodes Using Interventional MRI
An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery: Preliminary Evaluation of Targeting Accuracy
Patient Archives: 1 case study, new (provided by Dr. Kasoff)
2 blog posts: Write about the materials and methods for this clinical trial, and record fourth week experiences and lessons.

Week 5:
Observe procedures if patients are available
Medical literature reading assignment:
Parkinson's Disease Diagnosis and Clinical Management
                        Section IX: Surgery: Deep Brain Stimulation
Bilateral Deep Brain Stimulation in Parkinson’s Disease: A Multicentre Study with 4 Years Follow-up
Patient Archives: 1 case study, new or continued from Week 4 (provided by Dr. Kasoff)
2 blog posts: Write about the case studies so far, and record fifth week experiences and lessons.

Week 6:
Observe procedures if patients are available
Medical literature reading assignment:
            Deep Brain Stimulation
                        The Results of DBS for Tremor
Modeling approaches for DBS (Mathematical Modeling)
Patient Archives: 1 case study, new or continued from Week 5 (provided by Dr. Kasoff)
2 blog posts: Write about the deep brain stimulation operation, and record sixth week experiences and lessons.

Week 7:
Observe procedures if patients are available
Medical literature reading assignment:
Parkinson's Disease Diagnosis and Clinical Management
                        Section XI: Other Issues: Outcome measures, The Patient’s Perspective
Patient Archives: 1 case study, new or continued from Week 4 (provided by Dr. Kasoff)
2 blog posts: Write about comparisons so far between OR patients and MRI patients, and record seventh week experiences and lessons.

Week 8:
Rough draft of abstract complete.
Review medical literature so far
Observe procedures if patients are available
2 blog posts: Write about patient care, and record eighth week experiences and lessons.

Week 9:
Submit rough draft of abstract to Dr. Kasoff
Begin working on PowerPoint presentation
2 blog posts: Write about new perspectives on the medical profession, and record ninth week experiences and lessons.

Week 10:
Finalize abstract for the project
Finish PowerPoint presentation rough draft and submit to Dr. Kasoff for revisions.
Begin rehearsal for final presentation.
2 blog posts: Write about the conclusions for this clinical trial, and record tenth week experiences and lessons.

Week 11:
Finalize PowerPoint presentation.
Continue rehearsals for final presentation.
2 blog posts: Give brief outline of the final presentation, and record eleventh week experiences and lessons.

Week 12:
Discuss research paper publication possibility and any post-SRP work to be done.
3 blog posts: Final draft of Abstract, thank yous, and final reflections