Deep Brain Stimulation (brain pacemakers)

Still seeking the key to Parkinson’s treatment

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The other weekend, I was talking with a friend about Parkinson’s Disease.  One of our synagogue members is succumbing; during the discussion, my friend  mentioned that his mom also suffered from the ailment.  And, when I told him so did my grandfather, he mentioned how he was surprised that L-Dopa was the experimental treatment his mom tried- and that the doctor who was involved was at St. Barnabas in New York.  To which I replied, he meant Dr. Bill Cooper- which blew him away.  Because that was the name he was trying to draw up in his memory.  It was pretty clear that we must have crossed paths some 47 years ago.

L-Dopa was found to NOT be the panacea for which physicians hoped.  The treatment does improve the patient’s status- but only for about 5 years before the drug no longer provides any benefits to the patient.   And, since stem cell therapy is still considered out of bounds (this is a political and not a scientific restriction), we must seek other alternatives.

Deep Brain Stimulation (brain pacemakers)
The pacemaker is inserted below the collarbone (in the chest). From the battery, the charge travels along the wires to the brain. The targeted areas of the brain include the thalamus, the subthalmic nucleus, and/or the globus pallidus internus regions.

Which is why so many companies are considering the use of deep brain stimulation (DBS) to treat patients.   DBS involved inserting a wire into the brain, yielding the brain version of a heart pacemaker.  The problem is finding the perfect spot to insert the electrodes.  (As I wrote some years ago, here.)  Nevertheless, St. Jude, Boston Scientific, and Medtronic are toiling away developing their own versions of DBS systems.  Medtronic has been involved in such research for the longest of the bunch, but that still hasn’t provided them with the golden key.  Nor has it filled Medtronic’s coffers (yielding less than 2% of their gross revenues, although the segment has been expanding by more than 8% per year for a few years).   That’s despite that the cost for the device for each patient ranges between $20K and $ 35K- but with hospital and physician costs that figure rises to $ 100K.  The real issue?  Only about 10% to 15% of the patients will improve (not exhibit symptoms) with DBS treatment.

But, that may change.  Because St. Jude and Boston Scientific are trying a different approach than that used by Medtronic.  Instead of having the current radiate from the end of the wire, these companies are attempting to direct the current, to choose the vector for the electric signal.  Moreover, they are attempting to vary the signal strength, as brain activity modulates.  This should decrease side effects (mood changes, difficulties in speech expression).  [Note:  Medtronic is now adding this approach to its arsenal, as well.]

Even so, this is brain surgery.  And, brain surgery is always considered to be a last resort. So, unless the results are stellar, one should not expect this approach to become the first therapeutic choice for Parkinson’s.

 

 

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