Could Brain-Stimulation Surgery Be the New Protocol for Parkinson's Patients?

Brain-stimulation surgery has proven to have very positive results for many Parkinson’s patients, but the possibility of serious side effects often prevents many from utilizing this treatment option. Brain stimulation has shown to help patients function for almost five extra hours a day with fewer Parkinson's symptoms, in comparison to the more common drug treatments, with a new study providing additional positive information for this treatment approach.

There is currently almost 1 million American’s suffering from Parkinson’s, a chronic movement disorder that progresses in time as a result of dopamine-producing cells in the brain becoming impaired or destroyed. The disease causes tremors, balance issues, problems with speech, sometimes memory loss, as well as several other symptoms. Parkinson’s tends to effect older adults, but is not limited to only the elderly. According to the Michael J. Fox Foundation for Parkinson’s Research, 1 in every 100 people over sixty suffer from Parkinson's. Those suffering with Parkinson’s often describe it as feeling trapped in a body that is out of control. It can be a very difficult disease to live with and research is ongoing, looking for better treatments to help sufferers regain their quality of life. There are several medications used to treat Parkinson’s and in many cases the medications are helpful, but not all patients benefit from the medication and some medications lose their effectiveness and/or may cause other side effects in the long term.

Recently, the biggest clinical trial ever testing brain stimulation treatment (DBS) on Parkinson’s patients was published in the Journal of the American Medical Association. Based on the study, deep-brain stimulation treatments proved to be much more effective than the best medical treatments but did have some worrisome side effects. The Department of Veteran Affairs, the National Institute of Neurological Disorders and Stroke, and Medtronic Inc. (the company making the deep-brain stimulation system used in the newly released study) funded the project. The study involved implanting a device similar to a pacemaker in a patient’s chest with wires running up deep into their brain, where energy stimulated areas linked to movement issues.

The newly released study was conducted at seven Veterans Affairs hospitals and six University Medical Centers. The study involved 121 patients, who received deep-brain stimulation and 134 patients who only received standard medical treatments, including medications and physical therapy. All the patients involved in the study were in the advanced stages of Parkinson’s. After six months of treatment, the patients who received brain-stimulate therapy reportedly averaged 4.6 hours a day with minimal Parkinson’s symptoms, while the group receiving traditional medical treatment reportedly had no change. Frances Weaver, director of the Center for Management of Complex Chronic Care at the Hines VA hospital said, “(Brain stimulation) patients had significant improvement in their motor function and quality of life after surgery.”

Even though the study had significantly positive results, the study also had its setbacks. The patients who underwent brain-stimulation surgery had 3.8 times higher adverse events. Some of the problems included infection at the surgery site and cognitive decline. The most adverse events had resolved after six months, according to study co-author Claudia May, program director at the National Institute of Neurological Disorders and Stroke. Deep-brain stimulation, which garnered approval in 2002 by the FDA for Parkinson’s treatment, is gaining ground as a more common treatment and is being more widely used in patients no longer benefiting from the drugs. As with many such treatments, there is a high price to pay, with the total cost of an implanted system being around $60,000 dollars.

Dr. William J. Marks Jr., associate professor of neurology at the University of California and study co-author calls the study, “landmark” and said the study, “proved superior for such patients, rather than a tweak-and-adjustment (of medication) approach.” He hopes the new study’s finding will encourage more neurologists to prescribe DBS for appropriate patients. As research develops, and more devices are introduced into the market, the cost for brain-stimulate implants will hopefully become more affordable.

Medtronic Inc. is the only company with an approved deep-brain stimulation system as of now, but St. Jude Medical Inc. plans to seek approval for a similar device to treat multiple disorders.