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Activa Patient Programmer for DBS Therapy Available in US, Medtronic Announces

DBS technology

Medtronic, a medical technology company, announced that its Activa patient programmer technology for deep brain stimulation (DBS) therapy is now available to U.S. patients with Parkinson’s disease (PD) and other movement disorders.

The new programmer, approved by the FDA in July, is used with a customized Samsung mobile device to help patients more easily use DBS treatment and in a home setting. The Ireland-based company said that more than 150,000 people have been implanted with its DBS devices globally to manage disease symptoms, particularly those of Parkinson’s, since 1997.

“It is important for patients to have access to advanced technology for user-friendly therapy management at home,” said Sandeep Thakkar, DO, neurologist and movement disorder specialist at Hoag’s Pickup Family Neurosciences Institute, in a press release.

“The new Medtronic DBS Activa Patient Programmer device is an innovative tool that combines familiar consumer technology with medical devices, which facilitates better control for patients in an easier, more accessible way,” Thakkar said.

DBS is a surgical treatment option for people in advanced stages of Parkinson’s, whose movement problems are not being helped by medications. During surgery, one or more wires are inserted deeply into the brain to reach affected areas. These wires are subsequently connected to a pacemaker-like implantable pulse generator that is typically positioned just under the patient’s skin, in the upper thoracic region.

Able to share patient data directly with clinicians, the Patient programmer includes a programmer handset and communicator. When patients wish to modify prescribed therapy settings, check the battery, or activate or deactivate therapy, they hold the communicator above the implanted device and use the programmer to make adjustments.

Clinicians also have the ability to define settings and work with patients to adjust DBS therapy settings when using the therapy away from the clinic.

The system is managed on a Samsung Galaxy Tab S2 tablet with a customized user interface and five-inch touchscreen, and uses Samsung’s security technology to help protect both the device and patient.

Taher Behbehani, head of the Mobile B2B Division, Samsung Electronics America, said the user-friendly therapy marries safety with data control. Medtronic has partnered with Samsung since 2013, expanding into neuromodulation two years later.

“It’s through our open yet secure mobility platform that we can offer this level of customization on our market-leading devices,” he said.

“Medtronic has been the leader in DBS therapy for over 25 years. This launch continues to serve as further evidence of our dedication to our DBS patients,” said Mike Daly, vice president and general manager of the Brain Modulation business, which is part of Medtronic. “With this device, patients gain confidence, as they are able to discreetly manage their DBS therapy no matter where they are.”

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More Years of Schooling Linked to Better Response to DBS in Small Study

DBS and education

The more years of formal education that people with Parkinson’s disease have, the better they seem to respond to deep-brain stimulation — as seen in a greater ability to “dual-task,” or engage in higher-level thought while walking, a study suggests.

Education level affects dual-task gait after deep brain stimulation in Parkinson’s disease” was published in the journal Parkinsonism & Related Disorders.

Dual-tasking (DT) measures an individual’s ability to carry out a cognitive task (such as counting, or naming words that start with a particular letter) while engaging in a motor skill like walking. As such, it can be a helpful proxy for clinically relevant measures of a patient’s ability to perform everyday life tasks, which rarely come one at a time. Cognitive and motor skills are both impacted by Parkinson’s, and having to move while thinking a bit can increase the risk of falls.

Deep brain stimulation (DBS) is a surgical treatment for Parkinson’s that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator.

Previous studies on DBS have yielded conflicting results about whether this intervention can improve dual-tasking. The researchers behind this study wondered if this conflict exists because DBS improves dual-tasking in some people with Parkinson’s, but not for others.

They recruited 34 people with Parkinson’s (average age 60.5, 44% female) and measured their DT-related gait changes a few months before DBS and again a year after DBS.

Based on these measurements, participants were divided into two groups: 18 were “responders,” meaning they had significant improvements for four dual-task assignments at the second measurement (i.e., forward and backward counting, and phonemic and semantic fluency); the remaining 16 were “non-responders” who showed no such improvement.

Cognitive reserve — the brain’s ability to improvise and find alternate ways of preforming a task — can account for differences between individuals in “susceptibility to age- or pathology-related brain changes” and has been studied in Alzheimer’s disease. Importantly, in Parkinson’s disease, higher cognitive reserve is associated with milder cognitive and motor deficits.

Education is known to contribute to cognitive reserve. As such, the researchers also divided the participants based on the highest education level they had completed: primary (through 8th grade), secondary (high school), or ‘high level’ (baccalaureate/university studies of up to 12 years).

Among the 16 non-responders, seven had completed a primary education level, four a secondary, and five had a high level. Among the 18 responders, one had completed primary level schooling, eight secondary, and nine had university level.

Responders were more likely to have completed more years of formal education, with further analyses showing that this association was statistically significant.

Other factors analyzed — including levodopa dose, Unified Parkinson Disease Rating Scale (UPDRS) score, and measurements of cognitive function and memory — were not significantly different between the two groups.

“Educational status affects DT-related gait changes one year post-DBS in [Parkinson’s disease],” the researchers concluded, noting that “a high [cognitive reserve] could be considered as a favourable inclusion criterion for future DBS candidates.”

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Deep Brain Stimulation May Ease Some of Common Urinary Problems in Parkinson’s Patients, Study Reports

deep brain stimulation study

Deep brain stimulation (DBS) can help to alleviate some urinary symptoms — such as urinary frequency, urgency, and incontinence — in Parkinson’s patients, and is particularly helpful to women, a large study reports.

The study, “Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson’s disease,” was published in Clinical Intervention in Aging.

DBS involves a surgical procedure in which very fine wires are inserted into the brain to electrically stimulate areas responsible for movement control and, in this way, adjust neuronal activity within those brain regions. This treatment approach is indicated for Parkinson’s patients whose motor symptoms do not respond well to commonly used parkinsonian medications.

“However, the effectiveness of DBS in treating urinary dysfunctions in [Parkinson’s] patients has not been widely investigated,” the researchers noted.

Bladder problems are frequently observed in Parkinson’s patients. Urinary symptoms such as urgency, frequency, nocturia (excessive urination at night), dysuria (pain or discomfort when urinating), and incontinence can also considerably impact patients’ quality of life.

Importantly, the brain region that is stimulated by DBS for proper motor control, called the subthalamic nuclei, is also involved in controlling the bladder.

Researchers at the Capital Medical University in China assessed how deep brain stimulation might affect Parkinson’s-related urinary problems across patients and between the sexes.

Their study enrolled 416 people (307 men and 109 women; average age of about 61), all being treated with lepodova and with urinary symptoms for an average of 5.1 years. Nocturia was the most common, reported by 63.7% of patients; followed by urinary frequency (55.8%); residual urine (43.8%); urinary urgency (38.0%); dysuria (36.1%); and urinary incontinence (17.8%).

Of these participants, 220 (160 men, 60 women) underwent deep brain stimulation for disease symptoms that failed to improve with medication. Quality of life and urinary symptoms were evaluated using a set of validated assessment scales. No specifics were given about the stimulation treatment’s duration and how long after treatment urinary symptoms were assessed.

Bladder storage problems, and symptoms like urinary frequency, urgency, and incontinence all significantly eased in patients given deep brain stimulation compared to those who were not. However, the most common complaint — that of nocturia — feelings of residual urine, and dysuria “were not improved significantly,” the study reported.

Interestingly, the team found sex-related differences in the magnitude of DBS effects.

“The outcomes of DBS treatment in improving urinary dysfunctions in female patients with PD [Parkinson’s disease] are far superior to those in male patients, as symptoms during urination and bladder storage were both significantly improved in the females,” the researchers wrote. These outcomes included maximum urinary flow rate, the ability of bladder muscle to distend to retain urine, and complete bladder emptying.

Among possible reasons for this gender difference were men with enlarged prostates. “Hyperplasia in the prostate can also cause urinary dysfunctions, which could not be ruled out in our study,” the team wrote.

Quality of life with the stimulation also improved for both sexes, but only significantly among women.

The researchers stressed that multicenter studies with larger samples are necessary to extend and confirm their findings.

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Initial Results Of PROGRESS Trial Show Promise For Abbott’s Infinity DBS System

DBS

Abbott has announced promising preliminary results from the PROGRESS trial (NCT02989610) evaluating its Infinity Deep Brain Stimulation (DBS) System for the treatment of Parkinson’s disease.

The initial results, detailed in a press release, suggest that the DBS system achieved its primary goal of broadening the “therapeutic window” — the range of stimulation that relieves symptoms without causing adverse effects.

Deep brain stimulation (DBS) is an invasive surgical technique in which thin wires are implanted in the brain to deliver electrical pulses to certain areas and ease motor symptoms in patients for whom standard medications are not effective.

Abbott’s DBS system differs from others in that it’s designed to “steer” electrical current toward specific parts of the brain in order to lessen symptoms such as tremors. This differs from traditional “omnidirectional” systems, which don’t target specific parts of the brain. Because the stimulation is more targeted, the theory is that patients should be able to get meaningful symptom relief with less stimulation. The preliminary results support this idea.

The system also uses a wireless Apple consumer device that allows doctors to perform upgrades and optimize programming settings without the need for surgery.

“We now have the first release of data to confirm the benefits of this technology over traditional omnidirectional lead technology in expanding the therapeutic window for a majority of patients,” said Matthew Brodsky, MD, medical director of the deep brain stimulation program at Oregon Health and Science University and the primary investigator of the PROGRESS trial.

The initial results included data for 66 Parkinson’s patients who were evaluated after three months of using the DBS system. The majority (89.4%) had a wider therapeutic window — an average increase of 35% — accompanied by an average decrease of 30% in the amount of stimulation needed to attain a therapeutic effect compared with patients who were using a conventional “omnidirectional” system.

“In the PROGRESS trial, patients were assessed sequentially, receiving conventional stimulation followed by directional stimulation,” said Keith Boettiger, vice president of neuromodulation at Abbott.

“Despite being blinded to their stimulation type, twice as many patients preferred directional stimulation. Clinicians also preferred directional stimulation in four times as many patients, demonstrating that the Infinity system with our directional lead technology can help people find symptom relief more easily than systems with conventional stimulation,” he said.

The PROGRESS trial is set to include up to 235 patients being treated for Parkinson’s disease with electrical stimulation at 37 sites across seven countries.

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Deep-brain Stimulation Can Reverse Mitochondria Defects Linked to PD, Study Finds

DBS mitochondria

 

Deep brain stimulation therapy can help lessen Parkinson’s symptoms, partly by increasing the number of mitochondria — cells’ powerhouses — in brain nerve cells, a study shows.

The study, “Post mortem examination of Parkinson’s disease brains suggests decline in mitochondrial biomass, reversed by deep brain stimulation of subthalamic nucleus,” was published in The FASEB Journal.

DBS is an invasive technique in which thin wires are surgically implanted into the brain to deliver electric pulses to specific brain areas and ease motor symptoms, such as tremors, in patients for whom standard medications are not effective.

Studies have shown that DBS can effectively reduce motor symptoms and the necessary daily dose of medication, improving quality of life both in patients with advanced Parkinson’s and those  with early-stage disease.

However, despite being the most commonly used surgical treatment for Parkinson’s disease, the exact mechanisms through which DBS may work to help prevent nerve cells’ degeneration remain elusive.

Now, researchers at the Imperial College London analyzed brain cells collected from individuals with Parkinson’s disease who had either received DBS (three patients) or not (four patients), as well as from three healthy individuals. All the tissue samples were collected post mortem and had been stored at the Parkinson’s UK Brain Bank, at the Imperial College London.

The team found that Parkinson’s-affected brain cells had fewer mitochondria compared to healthy ones. Also, the mitochondria were not located inside the cells where they normally are, such as the synaptic terminals.  Synapses are junctions between two nerve cells that allow them to communicate.

“These results suggest a change in the availability of mitochondria in synaptic terminals as a precursor or a result of Parkinson’s disease,” researchers said.

Samples from patients who had undergone DBS had fewer mitochondria than control samples, but slightly more than Parkinson’s patients not treated with DBS. In addition, the volume of these energy-producing organelles in DBS-treated samples was closer to that observed in healthy brain cells.

“DBS treatment seemed to have inhibited or reversed the reduction in mitochondrial volume and numbers caused by Parkinson’s disease,” researchers wrote. These results suggest “enhanced metabolic plasticity leading to neuroprotection” in the brain areas most affected by the disease as a result of DBS.

Additional studies are still warranted to better understand the effects of DBS therapy on mitochondria and overall nerve cell survival.

“This potentially opens avenues for exploring how to replicate this cell power-up with non-surgical treatments, without the need for implanting electrodes in the brain,” Kambiz Alavian, PhD, lecturer in the department of medicine at the Imperial College London and senior author of the study, said in a news release written by Kate Wighton.

Brain tissue samples are one of the most reliable sources of information on neurological disorders. However, studies using this type of sample can be challenging, as they can only be performed after an individual has died.

“We now hope to carry out larger studies to explore new treatments that may preserve brain cell mitochondria. The ultimate goal would be to keep cells powered up for longer, and Parkinson’s symptoms at bay,” he said.

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Transient Cerebral Swelling a Common Side Effect of Deep Brain Stimulation, Study Suggests

brain edema DBS

Swelling of brain areas close to where the electrodes that deliver deep brain stimulation (DBS) are placed is a common and transient side effect of this treatment in Parkinson’s disease patients, a study suggests.

Long-term impact of this adverse reaction and potential related complications are still unknown and warrant further analysis, researchers say.

The study, “Peri-lead edema after DBS surgery for Parkinson’s disease: a prospective MRI study” was published in the European Journal of Neurology.

DBS is a surgical treatment in which thin wires are implanted in strategic brain areas (those that control complex movements) to deliver electrical impulses generated by a battery-operated device.

Studies have shown that DBS can be beneficial in treating a variety of neurological diseases, particularly Parkinson’s. DBS has been accepted as an effective therapy to reduce motor symptoms such as tremors, lower the necessary daily dose of medication and improve Parkinson’s patients’ quality of life.

The most common adverse events associated with DBS include hemorrhage, infection, and failure of the implant’s components. However, some studies have also reported rare events of cerebral swelling (edema) surrounding DBS electrodes a few days after the surgery.

To gain binsight on the prevalence of this complication, Italian researchers evaluated the progression of 19 Parkinson’s patients who had undergone DBS therapy.

Surgeries were uneventful in all patients, with no complications being reported. However, after surgery, two patients experienced small hemorrhages close to the placed electrodes without any other brain tissue alterations reported.

All patients were evaluated by magnetic resonance imaging (MRI) between days 7 and 20 after surgery.

Researchers found that all patients showed some degree of MRI signal alteration along the placed electrodes, which was consistent with edema. The analysis also revealed small symptomatic hemorrhage in four additional patients, raising the total number of hemorrhagic patients to six (31.57%).

Researchers failed to find any correlation between edema volume and patients’ age, gender, disease duration, or side of the brain in which DBS electrodes had been implanted.

Patients who had hemorrhages also showed tissue swelling on the side of the brain opposite the bleeding.

Most patients were asymptomatic, but six had transient confusional state — disorientation in space and time plus mild signs of frontal lobe dysfunction, which included disinhibition, inattentiveness, and slightly impaired speech with poor word retrieval. Patients did not show any new motor deficits after surgery.

Two symptomatic patients were treated with a short corticosteroid treatment, but no significant effect on symptoms was noted. Still, both patients recovered in two to four weeks.

At a mean time period of 40.64 days after surgery, MRI signs returned to normal values in eight  patients. Superficial edema was still detected in three patients. At follow-up, no patient had detectable bleeding around the DBS electrodes.

To further explore the prevalence of brain edema associated with DBS, the team retrospectively evaluated computed tomography (CT) imaging data of 77 patients who had undergone DBS surgery from January 2013 to February 2017.

Hemorrhage around DBS electrodes was detected in four (5.19%) patients and edema in six (7.78%) patients. In nine patients evaluated by CT scans on days 1, 2, and 3 after surgery, edema was present in two who also had hemorrhage, and another patient.

“Our prospective MRI study confirms that [transient] edema is a common finding in STN-DBS [subthalamic nucleus] implanted patients for Parkinson’s disease and that it is asymptomatic in most patients,” researchers said. “The reason of the extremely high incidence of our finding is likely due to the timing of imaging (average 10 days) from surgery.”

They stated their opinion that edema near the electrode sites “is a normal and constant finding in patients undergoing STN-DBS lead placement. Its recognition is biased mainly because it is mostly asymptomatic and also because of the lack of early routine MRI scans in DBS patients.”

The team suggested that to avoid overtreatment and complications, “no corticosteroid treatment should be administered to patients whose MRI shows … edema in the first 7 to 60 days from surgery.”

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DBS Effectively Reduces Tremor in Parkinson’s Patients, Regardless of Stimulated Brain Area, Study Shows

Parkinson's tremor

Deep brain stimulation (DBS) can effectively reduce tremor in people with Parkinson’s disease, regardless of the brain region stimulated, according to a recent review study.

The review, “STN vs. GPi deep brain stimulation for tremor suppression in Parkinson disease: A systematic review and meta-analysis,” was published in the journal Parkinsonism & Related Disorders.

Tremor is a main symptom of Parkinson’s disease, strongly affecting patients’ quality of life. It is estimated that 47-90% of Parkinson’s patients have an action tremor and 76-100% have a resting tremor.

Reduction of tremors is an important goal in Parkinson’s treatment, and could have a significant impact in patients’ well-being and everyday life. However, tremor is difficult to treat and often does not respond to anti-tremor medications.

Deep brain stimulation — electric stimulation in strategic brain areas through surgically implanted thin wires in the brain — is used to treat people with advanced Parkinson’s disease whose motor symptoms, such as tremors, are not reduced with medication.

Several studies have shown that DBS eases motor symptoms, reduces the necessary daily dose of medication, and improves patients’ quality of life.

Currently, the main approved targets for DBS in Parkinson disease are the subthalamic nucleus (STN) and the globus pallidus interna (GPi), areas of the brain involved in motor function.

While recent studies have found no significant differences between the therapeutic effects of the stimulation of both targets, many clinicians maintain an older preference for STN over GPi, due to a supposedly greater reduction in tremors and in medication.

However, evidence supporting STN-DBS superiority in tremor suppression is limited.

Researchers have conducted a systematic review of all randomized clinical studies comparing the therapeutic effects of STN-DBS and GPi-DBS on tremors in Parkinson’s patients, published before March 2017.

Their search identified five suitable longitudinal randomized control trials with five years follow-up data. The data included the two DBS targets, STN and GPi, and tremor sub-scores of the Unified Parkinson’s Disease Rating Scale (UPDRS) before and after DBS, and with or without dopaminergic medication.

Their analysis showed that deep brain stimulation significantly reduced tremor symptoms in Parkinson’s patients, and that these effects were observed regardless of medication status.

When looking at the two targets of deep brain stimulation, researchers found that both methods reduced tremor severity in Parkinson’s patients, with no significant differences between them. These results support that DBS of each target promotes similar long-term benefits on tremor.

However, analysis of therapeutic effects on tremor over the course of five years showed that STN-DBS was more effective to reduce tremors after two and five years than at the first six months. In turn, GPi-DBS showed a more stable degree of effectiveness on tremors over time.

“Although both targets were effective, practitioners should be aware that it is possible one target could appear superior in studies depending on the duration of follow-up,” researchers wrote.

They also noted that when Parkinson’s patients present with tremor as the primary complaint, or as an issue adversely affecting quality of life, selection of deep brain stimulation target should focus on the presence of other problems “such as cognitive impairment, speech difficulties, presence of mood disorders, and presence of impulse control disorders.”

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Source: Parkinson's News Today

Deep Brain Stimulation Seen to Ease Tremors in Patients with Early-stage Disease in Pilot Study

DBS and tremors

Deep brain stimulation (DBS) was seen to slow the progression of “rest tremors”  in patients with early-stage Parkinson’s disease, a pilot study reports.

The study, “Effects of deep brain stimulation on rest tremor progression in early stage Parkinson disease,” was published in Neurology.

“The finding around tremor is truly exceptional,” David Charles, MD,  professor and vice-chair of neurology at Vanderbilt University, in Tennessee, and the study’s senior author, said in a university news article. “Why it is so remarkable is because there are no treatments for Parkinson’s that have been proven to slow the progression of any element of the disease.”

Vanderbilt has been approved to conduct a large-scale, Phase 3 clinical trial looking at the effectiveness of deep brain stimulation in early-stage patients by the U.S. Food and Drug Administration based on this pilot study. It plans to start enrolling about 280 such patients when it opens next year.

This study’s findings point to DBS easing tremors associated with periods of rest — tremors very common in Parkinson’s patients and particularly distressing at early disease stages — but was too small to measure effectiveness or benefit with any significance.

DBS is commonly used to treat patients with advanced Parkinson’s who no longer respond to available medications and are unable to adequately manage their symptoms. The FDA also recently expanded use of DBS — which requires surgery to implant a device to stimulate targeted regions of the brain — to patients with mid-stage disease who also respond poorly to standard medications.

The pilot trial (NCT00282152), which took place at Vanderbilt’s medical center, looked at whether DBS might be safe and tolerable for early-stage patients. It included 28 people, ages 50 to 75, who had been taking Parkinson’s medications for at least six months and up to four years. They had no history of dyskinesia (uncontrolled movement) and stable motor symptoms.

Patients were randomized to receive DBS plus Parkinson’s medication, or medication alone. At baseline (study start) and 6, 12, 18, and 24 months, all agreed to stop all Parkinson’s therapy for one week (medication and/or stimulation). This allowed researchers to evaluate symptom changes and progression.

Results found that patients on medication alone were seven times more likely to again develop rest tremor two years post-treatment, compared to those patients given both DBS and standard therapy.

Analysis also revealed that 86% of the medication-only group developed new motor symptoms in limbs that were initially unaffected. This occurred in 46% of patients in the DBS treatment group.

Seven DBS-treated patients did not develop rest tremors in previously unaffected limbs, and four of these patients showed a lack of tremors in an initially affected limb at the study’s.

“The field of DBS therapy for Parkinson’s disease is moving toward earlier stages of treatment,” Charles said.  The planned Phase 3 study will both  “ensure patient safety and provide the Parkinson’s community with the best possible medical evidence to guide treatment.”

This large-scale trial — expected to begin in 2019 — will likely take place at Vanderbilt’s Nashville campus and at other 17 medical centers across the United States, according to the article.

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Source: Parkinson's News Today

What Exactly Is Deep Brain Stimulation?

deep brain stimulation

Sherri Journeying Through

If I were to ask someone “What is DBS?”, they might reply something like: “Deep brain stimulation. Yeah, that’s it. DBS … Deep brain stimulation.” That’s good, but not the definition.

And another interviewee: “Well, it’s a surgical procedure that involves cutting into the brain and putting some wires in there to help reduce tremors. Something like that.” Yeah, it is something like that.

OK. So, I ask a third person and they reply, “DBS,” (they begin, as they were taught to answer in complete sentences), “is a medical procedure that involves surgically inserting an electrode into the brain, specifically in the area referred to as the basal ganglia, which controls complex movements.” Ohh, now that’s really good.

If you asked yet another person, the likelihood of them answering with an, “I dunno,” would be quite probable. The fact is, the three responses would be correct. Of the first three, one is quite simplistic in its response, the second a tad more filled with slightly more information, and the last is the most informative.

Other answers may include, “Brain surgery for people with Parkinson’s disease.” Or, “Uh, I don’t know. Maybe Department of … I don’t know.”

If you want to know what DBS (deep brain stimulation) really is, I have the nitty-gritty answer for you, for today I received my bill from the neurosurgeon for the last DBS procedure he performed on my brain.

Here is the definition of DBS, in neurosurgeon-ese (which I paid a boatload of money to learn): “A craniotomy with electrodes involving an incision and subcutaneous placement of a cranial neurostimulator pulse generator or receiver, with direct or inductive coupling, inconjunction with a connection to a single electrode array.”

Whoa. Try and say that five times without getting tongue-tied. I dare you.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Source: Parkinson's News Today

What Deep Brain Stimulation Can and Can’t Do

DBS

 

We sometimes don’t get all of our facts straight when it comes to pursuing what we want. As Parkinson’s patients, we only want one thing: a cure. Since we know that a cure is being researched but we don’t know when it will come about, we are grateful for anything that comes along in the meantime.

While that “anything” may not cure us, we’re glad for any way that it helps to make the day-to-day reality of living with Parkinson’s disease easier and more comfortable. This includes things like Sinemet (carbidopa levodopa), a medication that serves as a type of replacement for the missing dopamine in our brains. Or Lexapro (escitalopram), one of those wonder drugs that helps keep us on an even keel, knowing that depression can play a large, often hidden role in Parkinson’s disease, more than most realize.

And then there’s deep brain stimulation (DBS). The National Institute of Neurological Disorders and Stroke describes the treatment as follows:

DBS “is a surgical procedure used to treat a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.”

It “uses a surgically implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.”

DBS has proven to do more than someone with Parkinson’s disease could have hoped for. But sometimes we forget the facts and hope for so much more. We may forget that DBS isn’t a cure as we come away from the surgery. We’re feeling great after our stimulator has been activated. The tremors have ceased or at least eased. We are getting by with lower amounts of medication. We may not be as stiff or rigid. We can move with less struggle and walk with more confidence.

However, perhaps we seem to be feeling slightly more depressed. Perhaps we’re having trouble finding our “words,” and when we do find them, we struggle to get them out. If only one side of our brain was “stimulated,” perhaps we’re now noticing how the disease seems to have progressed to the other side. But perhaps that side just wasn’t as noticeable prior to the surgery because we were distracted while trying to control the more pronounced side.

There may be more controllable symptoms. There may be less. DBS is not a fix-all. You will still have Parkinson’s when you wake up after surgery, but now it may be an even more “invisible” disease. DBS can control the symptoms. It can give you back so much of what you’ve missed. It seemingly works miracles but it isn’t a cure. Exercise is still vital. Proper medication for the symptoms that DBS doesn’t control (such as depression) need to be monitored regularly.

If you are thinking about having deep brain stimulation, talk to others who have been through it. Read about it. Talk to your doctor and ask every question you can think of. Talk to some more people. If you feel it’s right for you and your doctor supports and recommends the procedure, get the prep work done. If all is a go, then set a date.

However, remember that DBS isn’t a replacement for treatment — it is an extension of well-managed treatment that can enhance your life. If your treatment is not well-managed — medications don’t work well, ons and offs are hit-and-miss, dosages haven’t been updated in a while, etc. — then you probably need to get on track there first.

DBS isn’t a cure, no. But it can make you feel and move a whole lot better. However, you need to remember that what works for one person may not work for another. Parkinson’s disease presents itself differently in each individual, and so each person will respond to treatments differently.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Source: Parkinson's News Today