Services offered in San Francisco

• Evaluation
• Pre-Op Testing
• Surgical Treatment
• Pallidotomy
• Thalamotomy
• Deep Brain Stimulation
  

Evaluation for Surgical Candidacy

All patients referred to the center receive an extensive neurological and neurosurgical evaluation to determine whether they are appropriate candidates for surgical treatment.  Patients are evaluated by William J. Marks, Jr., M.D., the Medical Director of the SFVA Center; Chadwick Christine, M.D., UCSF Movement Disorders Neurologist; or Michael J. Aminoff, M.D., F.R.C.P., Director of the UCSF Parkinson's Disease Clinic.  Patients also undergo evaluation by Philip A. Starr, M.D., Ph.D., the Surgical Director. Referring physicians will promptly receive a comprehensive consultation report by mail or e-mail detailing treatment options, which may include recommendations for specific medication trials or changes in the present medication regimen. An assessment of the patient's candidacy for surgical treatment will also be provided. Patients who have had surgery elsewhere with sub-optimal results may be referred for reassessment. [Back to Top]
 

Pre-Operative Testing

All patients deemed to be candidates for surgical treatment undergo systematic neurological, neuropsychological, neuroradiological, and functional testing. Many of these evaluations are performed both with the patient on-medication and off-medication. This extensive pre-operative evaluation is focused on determining the surgical treatment best suited for each patient and provides a reference point for intra-operative testing and post-operative follow-up. [Back to Top]
 

Surgical Treatment

All surgical procedures are performed by Philip A. Starr, M.D., Ph.D., Surgical Director of the Center and Chief of Neurosurgery at the San Francisco VA Medical Center. Dr. Starr, fellowship-trained at Emory University, is an internationally recognized expert in the neurosurgical treatment of movement disorders. Dr. Starr employs advanced neurophysiological localization techniques, including microelectrode recording, for all surgical procedures. [Back to Top]
 

Pallidotomy

Pallidotomy involves the precise placement of a small thermolytic lesion in the posteroventral portion of the globus pallidus internus. Correctly performed, the procedure has been shown to significantly improve most cardinal parkinsonian motor signs. Improvement occurs predominantly contralateral to the side of treatment, but some ipsilateral improvement may also be seen.  [Back to Top]
 

Thalamotomy

Thalamotomy consists of the precise placement of a small thermolytic lesion in the ventral intermediate nucleus of the thalamus. The procedure is effective in reducing tremor contralateral to the side of the lesion and may be indicated for patients with essential tremor or patients with Parkinson's disease in whom tremor is the predominant feature and the main cause of functional disability. [Back to Top]
 

Deep Brain Stimulation (DBS)

Chronic high-frequency electrical stimulation of deep brain structures involved in motor control is a means of functionally altering the activity of these structures without producing a permanent, destructive lesion. This is accomplished by implantation of a stimulating lead into the brain structure of interest; the lead is connected by an extension wire to a programmable impulse generator, implanted below the clavicle. The stimulation parameters are programmable using non-invasive radio-telemetry.  Thalamic DBS, in which the stimulating electrode is implanted into the ventral intermediate nucleus of the thalamus, is approved by the U.S. Food and Drug Administration for the treatment of medically refractory essential tremor and tremor associated with Parkinson's disease. The use of deep brain stimulation at other sites, such as the globus pallidus and subthalamic nucleus, is being investigated as a treatment for all cardinal signs of Parkinson's disease. The Center is actively involved in research protocols studying the efficacy and safety of these techniques.  The UCSF/SFVA Center is one of the world's most experienced DBS centers. [Back to Top]