Two new strategies using deep brain stimulation can improve symptoms of Parkinson’s disease, Duke University researchers have found.
Doctors can efficiently improve symptoms of Parkinson’s by simultaneously targeting to key brain structures using a newly developed self-adjusting device, researchers recently reported in the journal Brain.
For the past two decades, doctors have used deep brain stimulation (DBS) to treat symptoms of advanced Parkinson’s, which can include tremors, stiffness, and involuntary writhing movements.
The technique involves electrodes inserted into a targeted area of the brain. The electrodes act similarly to a heart pacemaker, delivering electrical pulses that help quell symptoms.
The two key brain regions targeted by deep brain stimulation are the subthalamic nucleus and the globus pallidus, “which are two structures in the brain closely associated with movement,” said senior author Dr. Dennis Turner, professor of neurosurgery, neurobiology, and biomedical engineering at the Duke University School of Medicine in Durham, N.C.
“There are benefits to both locations on their own depending on the patient’s symptoms,” Turner said in a Duke news release, “but we believed placing the electrodes at both locations could be complementary and help reduce medication doses and side effects, as well as implement a completely new approach to adaptive DBS.”
Beside targeting both regions at once, researchers also decided to include a technique called “adaptive DBS.”
Traditional DBS involves a doctor setting up parameters in advance for the electrical pulses delivered to the brain, to best treat symptoms while minimizing side effects. Those parameters may not change for months or years, depending on the patient’s response.
Researchers thought more flexibility in delivering the pulses could provide even better results.
“The amount of stimulation a person living with Parkinson’s needs changes, depending on their medications or activity levels,” researcher Warren Grill, a professor of biomedical engineering at Duke University, said in a news release. “A patient will need more stimulation if they are walking their daughter down the aisle at her wedding than if they are just watching TV.”
An adaptive system is “like a smart thermostat in your office that makes adjustments based on the temperature outside,” Grill said.
To test this, the Duke team worked with experimental technology provided by medical device company Medtronic to create an adaptive DBS system.
The device tracks a patient’s brain activity and other biomarkers, and adjusts stimulation to provide the best symptom relief throughout the day.
Duke researchers tested these strategies in a group of six Parkinson’s patients between 55 and 65 years of age.
They spent two years observing what happens when both regions of the brain are stimulated at the same time, using traditional and adaptive DBS.
They found that targeting the subthalamic nucleus and the globus pallidus at the same time improved motor symptoms more than targeting either region alone.
Further, they found that the adaptive DBS applied less stimulation but was just as effective as traditional DBS targeting both brain regions.
“Clinically, the patients are doing phenomenally. Looking at their rating scales, they are doing better than the average DBS patient when both target areas are stimulated,” researcher Dr. Kyle Mitchell, an assistant professor of neurology at Duke University.
“We’re not only seeing excellent clinical responses to dual target stimulation, but we’re also able to integrate this adaptive, smart tool into the brain that can at least match this clinical response. It’s very exciting,” Mitchell added.
Based on these results, the research team is planning the next stage of clinical trials for adaptive DBS.
The Parkinson’s Foundation has more on deep brain stimulation.
SOURCE: Duke University, news release, Jan. 18, 2024
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