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Wearable PKG System Can Help Identify Parkinson’s Patients Eligible for Device-Assisted Therapy, Study Shows

PKG system, DAT scores

Data collected through Global Kinetics Corporation’s wearable device called Personal KinetiGraph (PKG) can help clinicians identify Parkinson’s patients who may benefit from deep-brain stimulation (DBS) or other device-assisted therapies.

This finding was reported in the study, “The Use of Data from the Parkinson’s KinetiGraph to Identify Potential Candidates for Device Assisted Therapies,” published in the journal Sensors.

The PKG system is a wristwatch-like device worn on the side of the body that is most affected by the disease and continuously collects patients’ movement data — such as tremors, slow or involuntary movements, motor skill fluctuations, and immobility.

The device has been cleared by the U.S. Food and Drug Administration and holds CE certification, meaning it meets European safety, health, and environmental protection requirements. Global Kinetics recently announced that its PKG-Watch was recommended by two separate expert panels to improve the clinical management of Parkinson’s disease.

PKG movement data can provide detailed information on the progression of patient’s motor symptoms, as well as on the effectiveness of available therapies to manage them.

Researchers have now evaluated if PKG data could also be used as a screening tool to identify Parkinson’s patients who may benefit from device-assisted therapies (DAT) such as deep-brain stimulation.

“Despite broad consensus as to the criteria for selecting DAT candidates, non-specialists have difficulty in recognizing these criteria. Many [people with Parkinson’s disease] in whom fluctuations are emerging are managed by non-specialists and consequently, suitable DAT candidates are not referred in a timely manner,” the researchers wrote.

The potential for DATs to effectively help manage Parkinson’s symptoms relies mainly on treatment timing, with delays meaning that “suitable candidates may have shorter benefit from DBS or worse still, miss out entirely,” they said.

In fact, “as many as 67% of patients referred for DBS are unsuitable for the procedure yet only 1% of people with Parkinson’s disease receive DBS, even though as many as 20% may, in fact, be eligible,” they added.

“Although there is broad consensus with respect to the criteria for selecting PD patients who will benefit from DBS, these symptoms may be difficult for physicians to identify when relying on patient self-report or in-clinic exam findings that may not reflect the spectrum of the individual’s symptoms and result in treatment delays,” Fatta Nahab MD, associate professor of neurosciences at the University of California San Diego, said in a press release.

Now, researchers at the University of Melbourne in Australia, in collaboration with Global Kinetics, developed a new assessment score, which they call the DAT score. This tool was designed to specifically predict the likelihood that a Parkinson’s patient is a suitable candidate for DAT based on PKG movement data.

An initial group of 172 patients with Parkinson’s was evaluated by a clinical team who identified them as either suitable or not suitable for DBS treatment. Those who were positively selected for DAT were younger and had worse motor symptoms, measured by Unified Parkinson’s Disease Rating Scale (UPDRS) scores.

All patients were asked to use the PKG device, which continuously recorded their movement data. Based on the collected data and according to the initial clinician’s assessment, the researchers selected the most useful parameters that allowed them to differentiate patients who were positively selected for DAT from those who would not be eligible.

The feasibility and accuracy of the DAT score was then tested in a second group of 31 patients with Parkinson’s who had been selected to undergo DBS, 81 patients who were managed in a non-specialist clinic, and 22 patients who had been diagnosed within the past five years.

PKG data was highly sensitive and specific for classifying Parkinson’s patients for DAT eligibility based on the recommendations of specialist clinicians.

Furthermore, the PKG-based DAT score was able to correctly identify 87% of patients who were referred for DAT, namely DBS, in different clinical settings, 92% of patients managed in a non-specialist clinic, and 100% of patients who were within the first five years of diagnosis.

Importantly, DAT scores changed as expected when therapeutic interventions were sufficient to resolve troublesome motor fluctuations or dyskinesia (involuntary movements) that would otherwise have required DAT.

These results demonstrate that “[movement] information from objective measurement [with the PKG device] could improve timely referral for DAT,” the researchers wrote.

“The lack of objective measurements for Parkinson’s symptoms has been a barrier to optimizing care and outcomes for Parkinson’s patients across the continuum of disease,” said John Schellhorn, CEO of Global Kinetics Corporation. “Objective, reproducible assessment methods that allow for data-driven clinical decision-making in the treatment of Parkinson’s can help benefit patients, physicians and overall healthcare costs.”

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In the Battle Against Parkinson’s Disease, Are You a Warrior or a Worrier?

warrior

A warrior is not a worrier. A worrier has no peace, is filled with anxiety, and frets over the smallest things. Worriers tend to be lacking in courage and a calm spirit. 

Warriors exude courage. They are brave in the midst of the battle. They are fighters determined to not merely survive but to thrive. Warriors choose to march forward despite the war raging around them.

Parkinson’s warriors have been to the battleground many times. 

They have fought grief over losing pieces of themselves to this disease. 

They have battled depression and struggled for their mental well-being. 

Fear is no stranger in their war, but they muster up the courage to overcome it. 

The enemy of control has gathered its forces against their muscles and nerves, causing them to flail about, become weak, and tremble. They do their best to take charge, using the weapons available: physical therapy, medications, exercising, deep brain stimulation, and more.

The skill with which they once used their fingers to write or paint, garden or fix things, and button and zip their clothes is vanishing, and they realize they may not recover their dexterity.

But they must carry on.

I must not allow this disease to steal my hope that drives me to carry on in the midst of pain and grief. And you mustn’t either. Hope allows us to put one foot in front of the other regardless of our fear of falling — it may even put a cane into our hands. It allows us to focus on the positive things that might be and those that could be. It wears blinders to block out fear and prevent it from taking our joy and peace.

We must not allow it to diminish our courage. 

Our battle is tough, and we may feel that we’re fighting this disease alone. Parkinson’s can leave you feeling isolated, which makes it more difficult to fight.

That’s why it is so important to go out and get involved in the Parkinson’s community. Join an exercise class for those with Parkinson’s. You will meet new people and feel better mentally and physically. Support groups online or in-person will help you to feel connected and provide you with a safe place to share your experiences. 

If you feel like you’re fighting a battle with Parkinson’s and could use some reinforcements, let me know. You can never have too many soldiers around you. We’re not supposed to fight this disease alone. I’ll be with you on the battlefield.

***

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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Abbott Partners with NIH on BRAIN Initiative to Use Neuromodulation Technologies

Abbott BRAIN NIH

Abbott is partnering with the National Institutes of Health (NIH) to explore the use of its neuromodulation technologies for treating chronic pain and progressive movement disorders, including Parkinson’s disease.

The partnership’s goal is to drive forward the Brain Research through Advancing Innovative Neurotechnologies initiative, known as BRAIN, which is working to accelerate neuroscience research.

With this collaboration agreement, Abbott will make its proprietary neuromodulation technologies available for research purposes. These include directional deep brain stimulation (DBS), spinal cord stimulation (SCS), and dorsal root ganglion (DRG) therapy, which have already been shown to be beneficial in treating several conditions affecting the central nervous system.

Researchers will now be able to explore ways to use these technologies to fill knowledge gaps in the field of neuroscience and, at the same time, find new strategies to apply them to treat chronic and progressive neurological disorders.

“The NIH is investigating the application of these devices for the treatment of a wide range of neurological and neuropsychiatric conditions and chronic pain,” Nick B. Langhals, PhD, program director for neural engineering in the division of translational research at the National Institute of Neurological Disorders and Stroke (NINDS), said in a press release.

“The neuromodulation technologies provided by Abbott will help us determine the inner workings of the nervous system to help fill gaps in our current knowledge of the brain and provide opportunities for exploring how the brain interacts with the human body in patients with neurological conditions,” Langhals added.

The  BRAIN initiative, launched in 2013, seeks to understand how the human brain works, especially in a context of disease, by taking advantage of innovative technologies. It also is working to establish new “out-of-the-box” applications for currently available technologies. Its goal is to show how individual cells and complex neural circuits interact in both time and space.

To date, the BRAIN initiative has gathered partners and contributors from diverse backgrounds, including federal agencies, public organizations, Congress, and even the media.

“Researchers at Abbott are continuously striving to better understand how neuromodulation technology can benefit people living with chronic pain or movement disorders,” said Keith Boettiger, vice president of neuromodulation at Abbott. “In addition to our own research efforts, including clinical and real-world studies, working together with world-class scientists at the NIH will help us further validate our neuromodulation therapies and explore new avenues where they may benefit patients affected by devastating neurological conditions.”

With the support of NINDS and the BRAIN initiative, researchers have developed an experimental DBS system that uses brain signals to fine tune its activity in response to signs of dyskinesia, or uncontrolled body movement. This approach may potentially represent a more refined way to ease motor problems in Parkinson’s patients.

During the 5th Annual BRAIN Initiative Investigators Meeting, recently held in Washington, D.C., partners from the BRAIN initiative discussed scientific advancements in the neuroscience field, and identified areas for collaboration and research coordination. 

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NYC Attorney with Parkinson’s Describes Positive Effects of Deep Brain Stimulation

The first time the batteries for his deep brain stimulation (DBS) device were activated, Jim McNasby had the feeling a load burdening his body had been removed.

“It felt like a very gentle posture improvement; I just sat up straighter,” McNasby said in a phone interview, as he described how the technology has helped him.  “It was like a weight was lifted and the shakiness in my limbs disappeared.”

McNasby3
Jim McNasby, an attorney with Marsh & McLennan Companies, with his DBS device at his office in New York. (Photos courtesy of Jim McNasby)

McNasby, 50, a New York lawyer first diagnosed with Parkinson’s disease in 1999 at the age of 30, now wonders why he waited so long to have the DBS mechanism implanted.

“I wanted to be careful with brain surgery,” he said. “At the time it seemed so radical. But now I think: ‘Why didn’t I get it earlier?’”

DBS uses low-voltage electricity to stimulate specific parts of the brain via surgically implanted wires attached to a pacemaker-like neurostimulator placed under the skin on the upper chest. Doctors recommend the device mainly when Parkinson’s patients stop responding to medications designed to reduce motor symptoms, such as tremors, rigidity, involuntary movements, and walking problems.

The technology is not a cure. Research on its long-term effects is still limited, and scientists don’t know exactly how it works. However, a number of studies have shown that electrical stimulation of the subthalamic nucleus can improve symptoms, lower the need for medication, and improve the quality of life for people with Parkinson’s.

Stronger symptoms prompt decision

DBS also can ease symptoms of other diseases, including epilepsy and obsessive-compulsive disorder, and is being studied as a potential treatment for issues as wide-ranging as addiction, chronic pain, headaches, dementia, major depression, Huntington’s disease, multiple sclerosis, stroke, Tourette syndrome, and traumatic brain injury. Some 150,000 Parkinson’s patients had received DBS implants worldwide as of 2018.

In the past, McNasby relied on four medications to keep his symptoms under control. These included Sinemet (carbidopa/levodopa), which he was on for 16 years. In the spring of 2018, however, he started experiencing more tremors, shuffling, and asymmetrical walking. His “off-times,” when the medication wasn’t working optimally and motor symptoms returned, felt stronger and more frequent. Friends commented that he appeared to be struggling.

McNasby2
Jim McNasby, at right, with his husband, Donald Moss, during a July 2018 vacation in Norway.

“I’d feel great, and then I’d fall off a cliff and hardly be able to walk,” he said. “I felt shaky and heavy and like I couldn’t balance. … I’d have to sit on my hands and that kind of stuff to try to stabilize.”

He and his doctor tried tweaking his medications, without much success. Then a friend suggested DBS.

The procedure has reversed his Parkinson’s symptoms by about 15 years, McNasby said, to around where they were when he was initially diagnosed. With round-the-clock electrical stimulation, he wakes up feeling good and no longer has drastic ups and downs during the course of the day.

“All the symptoms have been drastically reduced” and are “well within something that’s manageable,” he said.

“I feel so much better,” he added. “It’s something I unequivocally recommend.”

Voltage is easy to adjust

Several DBS devices are on the market, and different doctors follow different protocols to implant them. While McNasby said some patients have the whole system implanted over a 12-hour period, he and his team at Manhattan’s Mount Sinai Hospital chose a series of three surgeries over the course of about a month. His doctors selected Abbott’s Infinity™ DBS system with batteries that last 5-8 years before needing replacement rather than batteries that need daily recharging.

McNasby said he was initially nervous about the prospect of the surgery. His doctor explained the potential risks, which include an electrode placed in the wrong spot, stroke, speech complications, and unpredictable effects from the electricity. His first procedure was a magnetic resonance image (MRI) to pinpoint the exact locations in his brain for the implants.

McNasby1
Jim McNasby, 50, says his DBS device has alleviated the worst symptoms of Parkinson’s.

The MRI was followed this past January by robotic surgery to insert a wire in his brain on the left frontal part of his head. The wire comes out through his skull and travels under his skin to a spot behind his left ear, then down his neck to a tiny battery placed on his chest below his collarbone. The stimulation from inserting the wire itself into his brain improved his symptoms for several days, making him more optimistic about the subsequent surgeries, he said.

The second surgery placed a wire and battery on the right side of his head and chest, and the third, on Feb. 11, connected the two sides to each other. After a three-week period of healing, and scaling down his Sinemet, doctors fully activated the device on March 5.

Today McNasby can barely see or feel the implanted wires and batteries. He likes the worry-free ease with which he and his doctor can adjust the voltage: he uses an Apple device the size of an iPhone that synchronizes with his batteries when he sets it on his chest, and his physician uses an iPad to determine the range of changes he can make. The day McNasby spoke to Parkinson’s News Today, one side of his brain was set at 2.5 volts and the other at 2.2 volts.

“You actually can’t hurt yourself with the device,” he said. “You can’t cause any damage that’s irreversible.”

Further improvement possible

And while he can’t feel the electricity while it’s stimulating his brain, he certainly can tell if it has been turned off: his symptoms come back immediately, “my tremors, especially,” he said.

Although McNasby said his case is not typical, he is now completely off the Sinemet. The only medication he uses is Amantadine, which he takes three times a day for tremors. Before his DBS implant, he had to take medication 15 times each day.

Despite developing Parkinson’s at an early age, McNasby says he feels very fortunate: his symptoms haven’t been worse, his disease progressed relatively slowly, and his response to DBS was strong. He never experienced the depression that often accompanies Parkinson’s.

He attributes his “luck” in large part to his one hour of exercise every day. He plays tennis, bikes, lifts weights, and does yoga.

McNasby said he and his doctor are still adjusting his electricity dosage, and it’s possible that he may feel even better in the future. After all, his DBS device has been operating for only two months and it has 44,000 settings.

He doesn’t want to get his hopes up too much. Still, he said, “44,000 [variations] – that’s a lot of options.”

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Parkinson’s Isn’t Always Invisible

invisible

I had breakfast with some friends today. One I hadn’t seen for six months and another for 10 years. Both of them are forever kind of friends, the sort who overlook your flaws. Flaws like Parkinson’s disease (PD).

It is rare for me to have tremors with all of the Sinemet (carbidopa-levodopa) that is in my body. But lately, I have noticed some breakthrough tremors. They don’t happen often or consistently. However, they occur frequently enough to remind me that despite medications to slow it down and a couple of deep brain stimulation surgeries to quieten the disease, it is continuing to progress. I notice it when I wave goodbye, put on my shoes, or try to pull a sweatshirt over my head. I’m aware of it when I stop abruptly during a conversation, having lost my train of thought.

I recognized the progression the other day when I walked 500 feet to a neighbor’s house. We went together to the mailboxes in our mobile home park. Before we left her house, she offered me one of her canes to use. I thought her offer was odd until I got home and realized I had been shuffling as I walked and she had noticed it. Ugh. 

Parkinson’s disease is often referred to as an invisible disease. I wish it would stay hidden.

So today, I had breakfast with friends. The tremors broke through. I was sharing something when I forgot what I was saying. My eyes became blurry and felt gritty. My hands cramped up and my fingers became painfully stiff. I had difficulty getting out of the booth we were sitting in, and when we got back to the house, I had trouble getting out of the car. My friends saw me struggling and came to my side to help.

It is hard to see the progression in yourself sometimes, especially when it happens quietly, gradually, and unassumingly.

But when you have good friends — forever friends — by your side, it makes living with the disease a little more bearable.

***

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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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 System Aimed at More Precise, Safer Targeting in Parkinson’s Patients

deep brain expectations, Versice

A tool called Vercise Cartesia Directional Lead is intended to provide more precise deep brain stimulation (DBS) treatment for people with Parkinson’s disease.

Researchers at UHealth — University of Miami Health System recently became the first in the Eastern U.S. and the second in the country to adopt the system.

DBS is a surgical approach used to treat Parkinson’s motor symptoms, normally in patients who no longer respond effectively to medications and show a reappearance or worsening of symptoms such as tremors and dyskinesia — involuntary, jerky movements.

In DBS, leads, or wires with electrodes at the tips, are implanted in selected regions of the brain. They are connected to a pacemaker-like neurostimulator to provide electrical impulses.

Vercise Cartesia Directional Lead, an implantable pulse generator manufactured by Boston Scientific, contains eight individually controlled electrodes on each lead for more precise control of the shape, range, position, and direction of electrical stimulation to the brain.

The device’s precise stimulation is also key for lessening side effects. The pulse generator has contoured edges designed to minimize erosion and increase patient comfort. It comes with a rechargeable system with a battery longevity of a minimum of 15 years. Compatible with the directional lead, the Vercise PC DBS System offers the same stimulation ability, with a projected battery duration of at least three years with standard settings.

“As technology advances, we are able to further fine tune and enhance DBS for people with Parkinson’s,” Corneliu Luca, MD, PhD, a professor of neurology and director of UHealth’s Deep Brain Stimulation Program, said in a press release.

Software called Neural Navigator 2 was designed for flexible programming, suitable for patients throughout their disease course. In addition, Clinical Effects Mapping software provides a summary of therapeutic benefits and side effects, while keeping track of the patient’s history on the pulse generator.

“Our mission is to offer Parkinson’s patients throughout Florida the latest treatment and most cutting-edge technology to improve their quality of life. It’s always exciting to add new therapies to our comprehensive treatment program.” said Jonathan R. Jagid, MD, a neurosurgeon at UHealth and an associate professor of neurological surgery who has performed more than 1,000 DBS surgeries.

Both Luca and Jagid have played a key role in clinical trials of this DBS system for approval by the U.S. Food and Drug Administration, as part of UHealth’s Center for Parkinson’s Disease and Movement Disorders. Europe and Australia have also already approved the system.

Two trials — one called INTREPID (NCT01839396) conducted in the U.S. and another called VANTAGE (NCT01221948), which took place in Europe — showed that the Vercise system improved movement control in most patients, while also being associated with better quality of life.

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Loud, Startling Sounds Can Decrease Parkinson’s Muscle Stiffness, Study Suggests

loud sounds, muscle stiffness

Loud and alarming sounds can reduce muscle stiffness in Parkinson’s disease patients treated with subthalamic nucleus deep brain stimulation (STN-DBS), a study suggests.

The study, “Influence of alarming auditory cues on viscoelastic stiffness of skeletal muscles in patients with Parkinson’s disease,” was published in Clinical Biomechanics.

Almost 100 years ago, a French neurologist described a phenomenon called paradoxical kinesis (meaning “difficult to understand movement”) consisting of a dramatic but temporary reversal of Parkinson’s motor symptoms in the face of startling situations such as an oncoming car or loud sounds.

“The phenomenon of [paradoxical kinesis] suggests the existence of neural systems that can override parkinsonian impairment in certain conditions,” the researchers wrote in this study.

The association between paradoxical kinesis and muscular rigidity has never been described, probably due to the subjective, observer-dependent scoring methodology while performing clinical assessments of “rigidity during the transitory motor alterations” and also due to the “subjective nature of the examinations according to the Unified Parkinson’s Disease Rating Scale (UPDRS),” according to the researchers.

Increased rigidity has been linked to more viscoelastic stiffness of skeletal muscles. Muscles behave like springs, and while something that is elastic immediately returns to its original shape once a stress has been removed, a tissue that is viscous will deform permanently. Therefore, viscoelasticity refers to the muscle having properties of both, allowing it to slowly recover from being stretched or deformed.

Measurement of muscle tone using a myotonometer — a device that measures viscoelastic characteristics of soft tissues — has proved useful in quantifying the effect of therapeutic interventions on rigidity in Parkinson’s patients.

“Thus, evaluation of viscoelastic stiffness could potentially enable quick and reliable measurements of muscular rigidity during the enhancement of motor performance due to external cues in patients with [Parkinson’s disease],” the researchers wrote.

The team from the University of Tartu in Estonia assessed the effect of alarming auditory signals on viscoelastic stiffness of skeletal muscles in patients treated with STN-DBS — a surgical treatment for Parkinson’s disease that involves implanting a device to stimulate targeted regions of the brain with electrical impulses generated by a battery-operated neurostimulator. Patients can use a handheld controller to turn the DBS system on and off.

The team recruited 10 advanced stage Parkinson’s disease patients (three women and seven men) who had been treated with STN-DBS for approximately 4.5 years prior to the study.

Eight subjects had akinetic-rigid (i.e., slowness of movement accompanied by muscle stiffness), and two had the tremor-dominant subtype of Parkinson’s disease. Ten age- and gender-matched healthy individuals were also recruited to use as controls.

Using a myotonometer, the investigators measured the viscoelastic stiffness of the participants’ wrist skeletal muscles, or in other words, the muscle’s resistance to the force that changes its shape, after one night of Parkinson’s medication withdrawal.

Wrist examinations were performed by two different examiners, 10 times each. Measurements were repeated and compared during the DBS-on and DBS-off periods, with and without auditory alarming signals.

Compared with the DBS-off period, muscular stiffness was significantly reduced in the DBS-on phase, supporting the the effectiveness of the stimulation treatment in lessening one of Parkinson’s motor features.

In addition, wrist stiffness was also significantly decreased during the DBS-off period in the presence of alarming auditory signals.

“The mean values of stiffness during the DBS-on phase were lower than during the DBS-off with [alarming auditory] signals phase but the difference was not significant,” the researchers wrote.

Exposure to loud sounds did not change muscle stiffness in the control sample, suggesting that the paradoxical kinesis phenomenon is more pronounced in Parkinson’s patients.

“According to our data, the changes in muscular rigidity due to [alarming auditory] signals are an exclusive characteristic of the patients with [Parkinson’s disease],” the researchers said.

Further larger-scale research is necessary to confirm this study’s findings and assess the efficacy of auditory cueing in Parkinson’s disease.

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New DBS Method Eases Both Cognitive and Motor Symptoms in Parkinson’s Patient, Study Shows

DBS patient expectations

A new approach to deep brain stimulation (DBS) was able to reduce both motor and cognitive impairments in a patient with Parkinson’s disease, a case study reports.

Described by the researchers in Spain who conducted the study, this alternative to conventional DBS involves a single electrode that is placed in each side of the brain, which is able to stimulate two different regions at the same time.

The study, “Simultaneous Stimulation of the Globus Pallidus Interna and the Nucleus Basalis of Meynert in the Parkinson-Dementia Syndrome,” was published in the journal Dementia and Geriatric Cognitive Disorders.

DBS is a type of surgery recommended for Parkinson’s patients who fail to respond to other medications. The procedure involves implanting a device that sends electrical signals produced by a battery to stimulate specific regions of the patient’s brain.

Although previous studies have shown that DBS can effectively reduce Parkinson’s motor symptoms, the same cannot be said regarding cognitive deficits, which may affect up to 60 percent of recently diagnosed patients.

“In fact, patients with dementia or significant cognitive impairment are often excluded from DBS studies … based on reports of irreversible cognitive worsening after DBS surgery in patients with preexisting cognitive impairment,” the researchers wrote.

Now, these researchers have explored the therapeutic potential of a new type of DBS that is able to target two brain regions simultaneously.

The single-case study focused on a 68-year-old patient with six years of clinical history, showing signs of mild cognitive impairment, who underwent DBS targeting two different regions of the brain with a single electrode placed on each hemisphere (half): the globus pallidus interna (GPi), to treat motor symptoms; and the nucleus basalis of Meynert (NBM), to treat cognitive deficits.

Two months after starting GPi stimulation, the patient started showing signs of motor improvement, reflected by a reduction of 61.37% in the Unified Parkinson’s Disease Rating Scale (UPDRS-III) score and in a performance improvement of 80% during the Up and Go test, compared with before the treatment. The UPDRS-III assesses the severity of motor symptoms, while the Up and Go test assesses mobility according to the time it takes an individual to rise from a chair, walk 3 meters, turn around, walk back to the chair, and sit down.

Moreover, the levodopa equivalent dose (a rough technique to compare different medications; LED) score decreased by 16.81% following GPi stimulation.

Motor improvement at two months was accompanied by a general decline in cognitive performance. However, minor cognitive improvements were found three months after the patient began receiving NBM stimulation together with GPi stimulation, namely in the capacity for abstraction, non-verbal memory (our visual memory system), verbal memory retrieval, and speed processing (the time it takes a person to do a mental task).

“The follow-up conducted 1 year after starting the combined GPi + NBM stimulation confirmed the improvement in UPDRS-III scores, along with a 20% reduction in LED compared to baseline. No visual side effects were recorded during the follow-up,” the researchers wrote.

“This approach showed no significant side effects and resulted in improvements in certain cognitive functions in a patient with baseline mild cognitive impairment, which would have excluded this patient from undergoing DBS under most current protocols. Further research is necessary before offering this surgical alternative to a wider range of patients,” they concluded.

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Clinical Improvements From DBS Mostly Meet Parkinson’s Patients’ Expectations, Study Shows

DBS patient expectations

Deep brain stimulation can effectively reduce physical impairment caused by Parkinson’s disease and meets most patients’ expectations for improvements in several domains, a study reports.

However, researchers found that the procedure did fall short of meeting most patients’ expectations concerning the reduction of non-motor symptoms.

The study, “Does the degree of improvement after deep brain stimulation surgery for Parkinson’s disease (PD) meet the patient’s expectations?” was presented at the recent 2018 International Congress of Parkinson’s Disease and Movement Disorders in Hong Kong.

Deep brain stimulation (DBS) is a technique that uses electric stimulus applied to specific areas of the brain to treat people with advanced Parkinson’s disease whose motor symptoms, such as tremors, are not reduced with standard medication.

Thin wires are surgically implanted in the brain to deliver electric pulses to the subthalamic nucleus (STN) or the globus pallidus interna (GPi), areas of the brain involved in motor function.

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

In this exploratory study, researchers identified which symptoms patients expected to improve with DBS and whether the anticipated levels of improvement were met after they had the procedure.

The team assessed expectations prior to surgery and at six months to two years after DBS in 28 patients with advanced Parkinson’s disease, 20 of whom underwent STN-DBS and eight of whom had GPi-DBS. All patients completed a visual analogue scale (VAS) questionnaire — used to measure subjective characteristics or attitudes believed to range across a continuum of values and cannot easily be directly measured.

Significant clinical improvements regarding physical impairment, mobility, ability to perform activities of daily living, and stigma after DBS were observed. In addition, a significant reduction in total levodopa equivalent daily doses (mg/day) of 50.45% was observed in patients treated with STN-DBS.

These objectively determined outcome improvements were in accordance with patients’ self-reported changes after the treatment.

In general, pre-DBS patients’ expectations and the positive changes in Parkinson’s symptoms noted were not significantly different.

“There was no significant difference … between the pre-DBS expectations of general improvement in PD [Parkinson’s disease] symptoms and the perceived general improvement 6 months to 2 years after surgery confirming that general expectations of improvement were met after DBS,” the researchers wrote.

Most patients reported that expectations of improvement after DBS were met, namely 64% for motor symptoms, 71% for quality of life, and 83% for reductions in daily medication dose.

However, only 25% of the expected levels of improvement were met for non-motor symptoms and social domain.

The motivations for DBS were also met after surgery. In the GPi-DBS group, all patients (100%) were satisfied with the final reduction on uncontrolled movements (dyskinesia), 83.3% for motor symptoms, and 66.7% for quality of life.

In the STN-DBS treated group, 84.2% were satisfied with medication reduction, 78.9% with amelioration of motor symptoms, and 73.7% with their quality of life.

These findings demonstrate that DBS clinical outcomes meet the expectations of most patients. However, pre-DBS expectations for improvement of non-motor symptoms and social domain were not met after surgery.

“Overall, both STN-DBS and GPi-DBS patients were satisfied that DBS had met their expectations of surgery,” the researchers concluded.

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