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the time course or the progression; it's a purely symptomatic treatment." Since DBS was initially performed approximately 20 years ago, some 100,000 people have been implanted throughout the world. UCLA has performed more than 500 of the surgeries. While most often used for patients with Parkinson's disease or essential tremor, it is also FDA- approved for a third movement disorder, dystonia (characterized by sustained involuntary muscle contractions), as well as for obsessive-compulsive disorder. It is currently being studied for its potential to help in a number of other conditions — including chronic pain, post-traumatic stress disorder, Alzheimer's disease, Tourette's syndrome and depression. In the United States, an estimated 10-million people have essential tremor, and 1 million have Parkinson's disease. Although a large number of these patients could benefit from DBS, many are unaware of the procedure, while some who do know about it are reluctant to undergo a brain operation, Dr. Pouratian says. drugs, experience complications that can't be managed, or have intolerable side effects should be evaluated to determine whether DBS is an option. At UCLA, patients are seen by a multidisciplinary team, led by a neurosurgeon and by neurologist Yvette Bordelon, MD, PhD, who help to determine the best course of action. "We are fortunate in our field to have very good studies — randomized controlled trials — that show DBS to be an excellent therapy," says Dr. Pouratian. "There is significant improvement in quality of life with the surgery, well beyond what patients get from the available medications. It's not a cure, but it's quite clear that they spend much more of their day in a better condition — able to participate in many more activities and to enjoy their lives more. One of the most powerful comments I hear from many patients is that they wish they had done it earlier." UCLA Tweets Surgery Live The world was watching when UCLA's Neurosurgical Movement Disorders Program performed its 500th deep-brain-stimulation surgery earlier this year. UCLA Health invited Twitter followers to observe a surgery-in-progress on social media as a way to educate the public about deep-brain stimulation. In addition to live-tweeting the procedure, UCLA Health posted Instagram photos and short video clips via the new Twitter application Vine. The event went viral, appearing in millions of Twitter news feeds and attracting widespread attention from conventional news media. Adding to the interest, the patient, musician and actor Brad Carter, played guitar during the awake portion of the procedure, helping the neurosurgery team to optimize placement of the electrodes for Carter's brain pacemaker. For more information about UCLA's Deep-Brain-Stimulation Program, go to: dbs.ucla.edu He notes that medications are the first-line therapy for movement disorders, and they can be effective in many patients. But patients who either don't receive satisfactory benefit from their "As a teaching institution, we're used to having medical students, residents, fellows and visitors from other parts of the country and around the world observe our surgeries and learn from us," says Nader Pouratian, MD, who performed the surgery. "We thought this would be a great opportunity to bring the world into the operating room." To read Twitter feeds and see video clips of Brad Carter's surgery, go to: uclahealth.org/uclaorlive 5 UCLA Physicians Update