Grau Enginyeria Biomèdica

Parkinson disease and other

movement disorders
Gary Álvarez Bravo

Unitat de Neuroimmunologia i Esclerosi Múltiple Territorial Girona

Hospital Universitari Dr.Josep Trueta de Girona
Institut d’Investigació Biomèdica de Girona
Universitat de Girona
 Grau Enginyeria Biomèdica

Main aim:

How the knowledge on Parkinson

disease and other movement
disorders from a bioengineer
perspective can help to change the
current understanding?
 What’s a neurodegenerative disease?
Neurodegenerative diseases are a heterogeneous group of disorders
that are characterized by the progressive degeneration of the
structure and function of the central nervous system or peripheral
nervous system.
Parkinson disease
Parkinson disease

Parkinson disease’s pathophysiology

Diagnostic tools

Parkinson disease
DAT-SCAN

Measurement of
presynaptic dopamine
striatal innervation

Very sensitive but not

specific tool: Be
cautious to interpret it
Parkinson disease
DAT-SCAN
Parkinson disease

Parkinson disease’s pathophysiology

Abnormal inhibition

Abnormal excitation

Where could we act on?

nson disease: treatments
Deep brain stimulation

Stimulation or inhibition of
some specific structures in
the CNS to cause a desired
effect
nson disease: treatments
Deep brain stimulation
https://youtu.be/wZZ4Vf3HinA
Stimulation or inhibition of
some specific structures in
the CNS to cause a desired
effect
Parkinson disease: treatments
High intensity
Non-invasive technique to
focused
modulate abnormal responses
ultrasound guided
into the brain
by MRI: HIFU
Parkinson disease: treatments
Other techniques:
gamma knife Non-invasive technique to
modulate abnormal responses
into the brain
Parkinson disease: treatments
HOW DO THESE
TECHNIQUES
WORK?

Perform a Brain MRI

Make a detailed analysis of the brain structures

Identify a specific point to act on the brain

Have a team with experience on the technique

Clinical assessment pre, during and post procedure

Normal Pressure Hydrocephalus
Clinical presentation:

Looks like a Parkinson!

Management approach
 Normal Pressure Hydrocephalus
Look at the brain MRI

Radiological “clues”

Gold standard: enlargement of ventricles

Normal Pressure Hydrocephalus
Shunt ventriculoperitoneal

Gold standard: enlargement of ventricles

Normal Pressure Hydrocephalus
Shunt ventriculoperitoneal

Gold standard: enlargement of ventricles

Orphan diseases
Lewy’s Body Disease

“Close relative” of Parkinson’s disease

Lewy’s Body Disease
Typical finding in functional imaging
Lewy’s Body Disease
Parieto-occipital involvement

Morpho-functional correlation
Progressive Supranuclear Palsy
 Progressive Supranuclear Palsy

Hummingbird sign

Midbrain atrophy in MRI

Multi-system atrophy

Multi-regional involvement Specific but rare radiological findings

 Conclusions
A correct application of
technology based on the biological
insights could help to diagnose or
treating some neurological
conditions

Procedures such as DBS, HiFU are

techniques which emerged a
breakthrough in the treatment for
some disabling movement disorders

There is still a big gap between

biological sciences and exact
sciences