Deep Brain Stimulation Treatm... Video Transcript

Participants

Ron Alterman MD, Blair Ford MD, William J. Marks Jr. MD, Philip Starr MD, Shanker Dixit MD

Summary

Among the new treatments for Parkinson's disease, one of the most talked-about is a high-tech device that triggers "deep brain stimulation." Recently approved by the FDA for the treatment of advanced disease, it's not a cure but has already helped a number of Parkinson's patients control their debilitating symptoms. How does this device work? Join experts as they take an in-depth look at this promising technology.

Webcast Transcript

ANNOUNCER: At a hearing before the Labor Health and Human Services Subcommittee, Senators probed this team of panelists on Parkinson's disease.

SENATOR HARKIN: I will pay close attention to NIH's plans for Parkinson's research in the years to come.

ANNOUNCER: A significant fraction of the hearings focused on latest cutting edge therapies. Promising, new strategies to fight Parkinson's: Among them, a device therapy called deep brain stimulation.

RON ALTERMAN, MD: Deep brain stimulation is a recently approved therapy by the Food & Drug Administration for use in the United States for the treatment of advanced Parkinson's disease. Specifically, patients that are not responding to medications as well as they had in the past are getting into severe difficulties with their walking or with complications of medical therapy are appropriate candidates.

PHILIP STARR, MD: The Device consists of a few parts. There is a small electrode or metal contact on the end of a wire; that's the part that goes into the brain. The wire, once implanted then travels under the scalp through a connecting wire to the so-called pulse generator which is the battery unit and control unit, which is located in the chest just where a heart pace maker would be located.

ANNOUNCER:The device is implanted while the patient is awake so doctors can determine the patient's brain function. Routine follow ups are necessary in order to make sure the device is working properly, and the battery needs to be replaced every 3 to 5 years.

BLAIR FORD, MD: The device goes on 24 hours a day and the way it works is not entirely clear, but it seems to work by shutting down some of the abnormal signaling that goes on in Parkinson's disease. It doesn't stimulate cells, it seems to shut them down. And the tremors and rigidity and slowness of movement that arises in Parkinson's disease occurs because of all sorts of signaling problems that go on. The deep brain stimulator seems to jam this signaling and allow more normal, smooth, quick, purposeful movement to occur.

ANNOUNCER: While there's no cure for Parkinson's disease yet, many qualified patients are able to cope better with advanced symptoms with the help of Deep Brain Stimulation.

WILLIAM J. MARKS JR., MD: The best candidate for deep brain stimulation treatment would be a patient with Parkinson's disease who has tried a variety of medications and despite working with a physician to optimize the dosing and the use of the appropriate medications, still is having disability from their symptoms.

PHILLIP STARR, MD: There's number of things we consider in determining whether a patient's a good candidate for deep brain stimulation. The most important is actually their responsiveness to medication. In particular Levodopa, which is the main medication in Sinemet. So the best candidate for surgery is someone who still has improvement in their Parkinsonian signs with taking Sinemet, but where the Sinemet is no longer working for a very long time and where it's onset of action is unpredictable.

ANNOUNCER: In addition to considering overall responsiveness to medication, doctors recommend deep brain stimulation to a select group of patients, based on their general health, lack of cognitive impairment and age.

PHILLIP STARR, MD: It's important to say that we do need to consider a patient's age. That the degree of benefit from DBS surgery does seem to decrease with advancing age. So a patient who is over 80 just doesn't get as much benefit, even for similar symptoms as a patient in their 50s or 60s. The risks tend to be higher in the oldest patients.