Author: Boston ScientificPublished:
31 May 2018
Latest Deep Brain Stimulation devices offer a wide range of programming options to help personalise patient treatment. Looking to improve outcomes, Professor Jens Volkmann challenged the status quo and explored promising options
Pharmacological therapy for Parkinson’s disease is aimed at minimising the motor symptoms of the disease, but the side effects of medication can have a significant impact on quality of life. For many people with Parkinson’s – and their carers – motor symptoms are a major burden that can no longer be controlled by medication alone.
For those patients, Deep Brain Stimulation (DBS) therapy could be considered as a safe and effective surgical option. Until recently, DBS was only considered for people who had been living with Parkinson’s for several years. However, recent studies have shown that the sooner suitable subjects undergo DBS surgery, the more they can benefit. Professor Jens Volkmann, Professor and Chairman of the Department of Neurology at the University of Wurzburg, explains: “In younger patients, stimulation can be adjusted a lot easier because they don’t have to regain but rather maintain physical activity which makes a huge difference in the results.”
Motor symptoms such as tremor, rigidity, freezing, slowness of movement or involuntary movements can have a debilitating effect on daily life and social activities. DBS is one of the most effective therapies in reducing these symptoms, with some people able to reduce their medication by more than half.
Beneficial and safe results through personalised DBS therapy
To improve the outcomes of DBS therapy even further, ongoing studies are examining ways of avoiding potential side effects. Professor Volkmann says: “Our brains are all very individual and so is every course of Parkinson’s disease. As a result, every patient responds to DBS differently.”
Today, there are options to individualise and customise each person’s therapy so they can best benefit from it. Professor Volkmann adds: “With personalised stimulation, we can address the individual requirements of a patient’s brain so they can experience the beneficial results from it and also avoid side effects, such as speech disorder, at the same time.”
Shorter stimulation duration is key to fewer side effects
The latest device advancements on the market offer a very wide range of stimulation settings. Trying to identify the ideal setting options, together with a team, Professor Volkmann went against the status quo and found very interesting results. In particular, the team looked at adjusting the “pulse width”, which is one of the stimulation options.
Professor Volkmann says: “Within one second, approximately 130 electrical pulses are repeated to stimulate a specific area in the brain. With this electrical stimulation, we achieve a beneficial effect in a patient. The duration of each of these pulses is called the pulse width. Regulating the pulse width is comparable to dosing a medication. If the dosage of a drug is too low it will not be effective, if it is too high, the patient experiences side effects. With pulse width it is very similar.”
The study found that patients stimulated at a significantly lower pulse width experienced equally good results with even fewer side effects compared to those stimulated at the standard pulse width. He adds: “The newest devices enabled us to respond to the individual requirements of a patient’s brain in a way that was not possible before. This way, patients can receive an equally beneficial and even safer therapy.
“This is a huge step in the right direction. Researchers are continuously looking to improve DBS therapy and its results. I think it will not take long until we can develop a DBS therapy that is auto-adjusting itself based on the individual requirements of a patient’s brain. Technology is evolving incredibly fast and with research like this we are on the right track of finding ways to offer patients a DBS therapy with the best possible results and the fewest side effects at the same time.”
About Deep Brain Stimulation (DBS) therapy
The DBS procedure includes a modest medical device, which sends signals to the brain. The signals help control the motor functions that are affected by movement disorder symptoms such as tremor, slowness and rigidity. The physician will place one or two insulated wires called leads in the brain. The leads are then connected to the stimulator (similar to a pacemaker), which is typically placed under the skin in the chest. The device produces mild electrical impulses that stimulate a specific region of the brain. This may help regulate signalling in the brain, resulting in improvement of symptoms. This stimulation may help improve day-to-day experiences for people living with movement disorders such as Parkinson’s disease, dystonia, or essential tremor.
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Please visit the EPDA website:
https://www.epda.eu.com/living-well/therapies/surgical-treatments/deep-brain-stimulation-dbs/
OR
The Boston Scientific website:
http://www.bostonscientific.com/en-EU/home.html
http://parkinsonslife.eu/better-results-and-fewer-side-effects-with-personalised-dbs-therapy/
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