Innovative development in Parkinson’s therapy with THS
An interdisciplinary team at Duke University, consisting of physicians, brain research experts (neuroscientists) and engineers, has developed two innovative approaches to improve Parkinson’s symptoms through deep brain stimulation.
This new method, which we call self-regulating deep brain stimulation (DBS), offers an important advancement on the previous use of DBS. It utilises advanced technology to monitor brain activity in real time and adjust the stimulation parameters accordingly. This enables more personalised and effective treatment for each individual patient.
Previous therapy with DBS for Parkinson’s disease
Deep brain stimulation (DBS) for Parkinson’s is a surgical procedure in which electrodes are implanted in certain areas of the brain. These electrodes are connected to a pulse generator that is implanted under the skin, usually in the chest area. The generator continuously sends electrical impulses to the brain to control the motor symptoms typical of Parkinson’s, such as tremors, stiffness and slowness of movement.
Benefits of deep brain stimulation for Parkinson’s disease:
- Symptom control: DBS can effectively reduce the motor symptoms of Parkinson’s disease, especially when medication (e.g. levodopa) is no longer sufficiently effective.
- Medication reduction: For many patients, the required dose of medication can be reduced after DBS, leading to a reduction in medication-related side effects.
- Quality of life: Many patients report an improved quality of life due to the reduction in symptoms and the associated restrictions in everyday life.
- Customisable treatment: The pulse generator of DBS can be adjusted individually, albeit manually, to achieve the best symptom control for each patient.
Disadvantages of deep brain stimulation in Parkinson’s disease:
- Surgical risks: As with any surgical procedure, there are risks, including infection, haemorrhage or damage to surrounding brain structures.
- Side effects: Possible side effects of DBS include difficulty speaking, numbness, imbalance or involuntary muscle movement.
- Requires regular adjustments: The pulse generator needs to be checked and readjusted regularly, which requires regular visits to the doctor.
- Not suitable for every patient: DBS is not suitable for all Parkinson’s patients, especially those with advanced cognitive impairment or other health conditions.
- Cost and availability: DBS is a costly treatment and may not be available everywhere.
- Manual control required: However, one of the biggest disadvantages from the patient’s perspective is that our Parkinson’s symptoms fluctuate enormously throughout the day depending on medication intake and stress levels. However, DBS controls the brain with the same intensity throughout the day and night. For this reason, we patients often still have to set the DBS intensity manually using a control device or smartphone.
In summary, deep brain stimulation in Parkinson’s disease offers an effective way to control motor symptoms, but requires careful consideration of the benefits and risks, regular medical follow-up and still many manual interventions by the patient.
Use of adaptive DBS in 2 brain regions
This is precisely where the Duke University development comes in: by simultaneously influencing two key structures of the brain and using a novel, self-adapting device, the team was able to effectively combat the movement disorders of the disease. The team has published the research results in the journal ‘Brain’.
The publication in ‘Brain’ highlights how the team used a combination of advanced imaging, data-driven modelling and innovative engineering to improve the accuracy and efficiency of DBS. Through these techniques, the researchers were able to identify the neural patterns responsible for the motor symptoms of Parkinson’s and develop a more targeted stimulation approach.
From manual to the new self-regulating THS
Deep brain stimulation (DBS) has been used for 20 years to treat advanced Parkinson’s symptoms when medication is not enough. This technique, which is similar to a pacemaker, sends electrical impulses to key areas of the brain and can reduce tremors, stiffness and involuntary movements that develop after prolonged medication. While traditional DBS delivers constant stimulation, adaptive DBS dynamically adjusts its stimulation to the patient’s current needs. This leads to a reduction in side effects and medication use and an increase in the overall effectiveness of the treatment.
The self-regulating THS in action
In collaboration with Medtronic, the team developed a technology that records biomarkers and brain activity and adjusts the stimulation parameters accordingly. In a clinical study at Duke University Medical Centre, they tested their strategies on six patients aged between 55 and 65.
This study was particularly noteworthy because it shows how different patients’ responses to DBS can be. Some patients experienced a significant improvement in their motor function, while others reported improved mood and quality of life. These results highlight the potential of adaptive DBS to address a wide range of Parkinson’s symptoms.
Perspectives of Adaptive Deep Brain Stimulation (aDBS) or “closed-loop” DBS in Parkinson’s disease
The results showed that simultaneous treatment of both brain structures improved motor symptoms more than treatment of a single region. Adaptive DBS was as effective as continuous DBS, but with less stimulation. The team now plans to further optimise adaptive deep brain stimulation and conduct additional tests.
The Duke University researchers are confident that their findings will pave the way for further developments that utilise the full potential of THS.
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References
Stephen L Schmidt et al, At home adaptive dual target deep brain stimulation in Parkinson disease with proportional control, Brain (2023). DOI: 10.1093/brain/awad429
Journal information: Brain