New Study on Deep Brain Stimulation finds big improvement and some risk

Here is the essence of a new study on DBS just released:

ScienceDaily (Jan. 6, 2009) — Patients with advanced Parkinson disease (PD) who received deep brain stimulation treatment had more improvement in movement skills and quality of life after six months than patients who received other medical therapy, but also had a higher risk of a serious adverse events, according to a new study. (To read the entire story, look here)

This was brought to my attention by Roberta Greenberg, who is part of a DBS team in Southern California. I want to share a comment from her about the results:

"What a stunning statistic….71% improvement in motor symptoms and QOL for DBS patients vs. 32% for medical therapy patients. Those of us on the DBS side have been trying to tell the medical community this for the past decade, but have had no verifiable, quantifiable data to back up these claims….just our anecdotal observations of our own patient populations. But now….the data has arrived. WooHoo!!

The risk profile in the study is much higher than what I’ve seen. I think that’s probably because the study started in 2002 and surgical techniques were much more crude then. In my experience, the incidence of infection, bleeds, etc has been less than 2%. I think that’s the norm now. We’re so much better at it now than we were back in 2002/2003. The dark ages of DBS. I wish they had chronologically compared complications in the study…but like I said, I’m grateful that they finally got the darn thing published!"

One unmentioned benefit: After the procedure, friends will call you "Cyber Boy".

It DOES take a brain Surgeon (Part 2)

In our last thrilling installment, the armchair expert parried the question "How does DBS work?" by referring to a helpful diagram, which you can find a couple of posts down. We now resume where we left off...

Q: You call that helpful?

A: Hey, I'm doing my best here. I'd like to give you a better answer, but nobody knows why it works. Here's one theory: As one part of the neural communication network in our brain sends out fewer, fainter signals that say "MOVE" other parts of the brain that specialize in "STOP!" interpret the absence of "GO!" messages as a signal that "Stop!" is the agenda, and steps on the metaphorical brake pedal.

This dutiful but misguided part of the brain is the part targeted by the surgeon when the leads are implanted. The leads, in a sort of tiny replication of the Milgram experiment, zap the offending part of the brain with a jolt of electricity to discourage the hyperactivity. This enables freer movement, and subtly perfumes the air with the delicate odor of fried brain cells, which remind some people of bacon browning.

Q: EW!

A: OK, I made that last part up.

Q: Right. How about another theory?

A: Here's a simpler one from my friend Alec, broadly paraphrased. "The electrical charger creates noise in an overzealous section of the brain, impeding its operation" I think of this as similar to the "Beseiging-The-Bad-Guy-With-rock music-at-Painful-Volume" strategy our military used to force Gen. Noriega out of his diplomatically protected sanctuary back in the previous century.

Q: Are you sure PD is your only problem?

A: I'll overlook that and offer one more explanation in diagram C. (BELOW)


(To be continued.)

It DOES take a brain surgeon ( Part One)

Armchair authority fearlessly takes on questions about DBS

Q: "DBS"? WTF?

A: DBS is the acronym for Deep Brain Stimulation, a surgical procedure that lessens some symptoms of Parkinson's Disease in some patients.

Q: Wouldn't "Shallow Brain Stimulation" be called for with your particular brain?

A: Cheap shot. In this case, "Deep Brain" refers to anatomy, as the target area of the operation lies far inside the the brain. (See diagram A)

Q: "Some symptoms"?

A: An abbreviated list of symptoms that DBS works well for include tremor, rigidity, and slow movement. Among things the surgery does not seem to help with are balance, speech problems (which may increase,) and Parkinson's related dementia.

Q: Well that sucks

A: Tell me about it. As more experience accumulates, some of the early problems are now understood to be related to placement of the apparatus in the brain. Others, such as cognitive impairment may not be as consequential as previously believed. But is not a panacea or a cure for PD.

Q:"Some Patients"?

A: One has to be carefully evaluated by a neurologist to determine whether this expensive and somewhat risky operation will actually benefit the patient or just the surgeon.

Q: Now YOU'RE making with the cheap shots.

A: Sorry, I'll try to behave.

Q: How does DBS work?

A: See diagram B.

This ends part one.