Deep Brain Stimulation for Parkinson’s

Imagine reaching for your morning cup of coffee but feeling like you're swimming through molasses to reach it.  While you extend your arm imagine it trembling, perhaps so violently you can't grasp the cup.  Welcome to the world of someone with Parkinson's disease (PD), where these symptoms are the tip of the iceberg.  As the condition progresses many more, and more debilitating issues arise, along with depression and changes in cognition.  Is deep brain stimulation (DBS) the answer?  Rick and I discuss results of a long-term study on this therapy in this week's podcast, as published online in Archives of Neurology.

DBS involves implanting an electrode deep within the brain of a person with PD.  In this study the electrodes were placed in the subthalamic nucleus on both sides of the brain.  The subthalamic nucleus is located just behind the area of the brain that is destroyed in PD, called the substantia nigra, and has multiple connections to brain areas involved in voluntary movement.

Surgery to implant DBS electrodes is exacting and highly technical, utilizing very sophisticated imaging during surgery, which is often done while the patient is awake.  Because of its highly invasive nature, DBS is reserved for people whose PD has progressed to a point of fairly severe disability, after therapy with medications has been tweaked exhaustively.  In this study 41 patients originally had surgery, with 10 year follow-up available in 18 of them. 

Here's what they found:  DBS was effective in reducing the disability related to movement problems, in medicalese called 'motor symptoms,' over this ten-year period.  Improvement immediately following surgery did diminish over time, however, though presumably not to the point it would have without surgical intervention.  Decline was apparent in speech, gait, and posture.

As Rick and I agree in the podcast, PD is quite debilitating and perhaps with current improvements in both imaging and surgical technique, DBS should be employed earlier in the course of the disease.  As we see more and more often, clearly there is a natural history to the progression of PD, and the question arises as to whether intervening sooner would slow PD's course. There's only one way to answer that, of course, and that is to try it systematically compared to medical treatment alone.

One of the aspects of PD not improved at all by DBS is the constellation of neuropsychiatric problems that also may develop.  These often include sleep disturbance, sexual dysfunction, depression and cognitive dysfunction.  Additionally, many people with PD report being embarrassed by the condition, especially as a loss of facial expression, speech disturbance, and movement difficulties are immediately apparent to others.  We laud Michael J. Fox and others for acknowledging their PD and doing all they can to assist in research efforts.

Other topics this week include variation in use of angiography to assess the heart's blood vessels around the country, soy supplements and menopausal symptoms, and taking blood (phlebotomy) in people who've had a heart attack and anemia, all in Archives of Internal Medicine.  Until next week, y'all live well.

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Rayonna September 3, 2011 at 7:03 pm

You're the one with the brians here. I'm watching for your posts.

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Jym Leonhard August 14, 2011 at 1:47 pm

As symptoms get worse, people with the disease may have trouble walking, talking or doing simple tasks. They may also have problems such as depression, sleep problems or trouble chewing, swallowing or speaking.

Parkinson's usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for Parkinson's disease. A variety of medicines sometimes help symptoms dramatically.
Jym Leonhard
Findyourdrug.com

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