2024-08-19 15:13:55
A new method of brain stimulation can improve the quality of life of people with Parkinson’s even more than the traditional method: it not only significantly reduces the symptoms, but also reduces the amount of medication needed. How does the method work – and what are the risks.
A new form of brain injection can better control the symptoms of Parkinson’s disease: The so-called deep brain stimulation (aTHS) can have approximately half the duration of motor problems compared to the usual continuous brain stimulation (cTHS), writes a research group. led by Carina Oehrn von University of California at San Francisco in the journal “Natural Medicine”. However, the team only tested the technique in a proof of concept on four people who each used both forms of DBS for about a month.
The president of the German Society for Neurology (DGN) spoke of a “big part”: “This study opened the field and improved it significantly,” said Lars Timmermann, director of the Department of Neurology at the University Hospital of Marburg said.
What is it about? In Parkinson’s disease, which is estimated to affect between 200,000 and 400,000 people in Germany alone, nerve cells in the brain that produce the neurotransmitter dopamine die. Common symptoms include tremors, muscle stiffness and movement disorders.
Therapy is often based on drugs that aim to replace the neurotransmitter dopamine. In addition, deep brain stimulation – also known as brain stimulation – is used, but usually only when medication does not adequately help with movement disorders. According to Timmermann, the procedure can also be very useful earlier, usually as early as the fourth year of the disease.
In deep brain stimulation, targeted electrodes use electrical impulses in a specific area of the brain, the basal ganglia, to prevent the cell groups there from firing in unison in a pathological manner and thus causing the typical symptoms such as stiffness and tremors. “Deep brain stimulation can improve the quality of life of those involved,” says Timmermann.
However, the releases are always active, so depending on the active level of the respective drug, they can have a strong or weak effect – also because the severity of the symptoms can change a lot.
Controlled by implants in the motor cortex
Timmermann compared the process to a car that is constantly driving at 80 kilometers per hour. “It’s faster in town and a little slower on the highway.” Some kind of cruise control that can increase the speed in the respective area will be useful.
In contrast to traditional brain stimulation, deep brain stimulation aims to ensure that electrical brain stimulation is only used to the extent that it is currently needed – if possible no more and no less. This is ensured by implants placed in the motor cortex at both levels of the brain, which regularly register symptoms there and determine the degree to which stimulation is needed in order to perform this procedure.
The team from San Francisco determined the benefits of the method in a pilot project with four men who had been ill for 10 to 15 years. They were first asked to indicate which of the Parkinson’s symptoms bothered them the most: out of three four patients, these are slow movements, or bradykinesia in technical jargon.
In a blinded procedure, participants used each of the two forms of DBS for one month each. The duration of most disturbing symptoms was roughly halved with exercise compared to continuous brain stimulation, and participants’ self-rating of quality of life increased significantly.
“The big change in deep tissue stimulation is that we can determine in real time where a patient is on the symptom scale and compare this with the exact dose of stimulation needed,” says Simon Little, co-author of the paper. said the research. The team first determined, among other things, where in the brain the severity of symptoms can best be determined – without the constant interference of brain stimuli. The result – the motor cortex – possible transmission to other Parkinson’s patients.
In addition, the team led by the German psychologist Oehrn developed an algorithm for each of the four patients based on artificial intelligence in order to always determine the best stimulation from the signals from the cortex. In the image of a car, this would be a sensor that constantly records the surroundings and tells the cruise control how the car can currently drive.
Less important is the required medication
This step alone – the decision algorithm – takes one to six months for the patient, the team wrote. “At the moment it’s still a real handiwork,” Timmermann said. But he is convinced that the process can be automated. As an analogy, it refers to the development of cochlear implants: auditory receptors that record sound information in the cochlea, convert it into electrical impulses, and thus stimulate nerve cells. directly.
The result is impressive not only in terms of significantly improved symptoms, but the dose of medication required also falls significantly: According to Timmermann, even a normal brainless person can reduce the amount of Parkinson’s medication required by 40 to 50 percent. In the study, deep brain stimulation significantly reduced the required dose compared to conventional stimulation in all four patients, and in three of the four men by roughly half.
However, the team reported that one participant had a serious side effect: an infection occurred when the electrode was inserted into the motor cortex. What we put in has to be replaced. However, Timmermann considers this risk to be manageable – infections only occur in about three percent of DBS operations.
The new technique is currently being tested in the US on a large group of 25 people with Parkinson’s disease and dystonia, a muscle wasting disorder. “This is the future of deep brain stimulation,” said neurosurgeon Philip Starr, one of the study’s leaders. He talks about “a new era of neurostimulating therapies”. Timmermann is more cautious: First, the method needs to be tested on many more patients – especially in periods longer than a month.
If the effect is confirmed and the process is approved quickly, it could come to market in around four to five years, expert estimates. Those affected by Parkinson’s whose symptoms are changing significantly can benefit especially from this; This is the case, among other things, with women. And what about the costs? Traditional deep brain stimulation currently costs an average of around 50,000 euros per patient, Timmermann said. The higher price will pay off for everyone in a few years.
stop/come
#Deep #brain #stimulation #significantly #reduces #Parkinsons #symptoms