Parkinsons patient "feels cured" with new adaptive deep brain stimulation device
bbc.com
bbc.com
https://www.sciencedirect.com/science/article/abs/pii/S13538...
Here is a meta-analysis of DBS for Parkinson's: https://bmjmedicine.bmj.com/content/3/1/e000705
Principal findings:
"All results had a high risk of bias and the certainty of the evidence was very low for all primary outcomes. The information size was insufficient when assessing all cause mortality. Meta-analysis showed that deep brain stimulation increased the risk of serious adverse events, mainly because of an increased risk of perioperative complications, such as cerebral haemorrhages and postoperative confusion, and events related to hardware, such as infection at the stimulator site, dislocation of the device, or reoperations. Meta-analyses indicated that deep brain stimulation might reduce symptoms specific to Parkinson's disease, but the assessments of disease specific symptoms had several methodological limitations."
So, it's an interesting treatment, but more evidence is needed before we can conclude that it is actually helpful.
The BBC article is about a new device. The evidence base may be slim but the technology looks to be improving. I look forward to seeing new clinical trial results on modern DBS systems.
Has it been contradicted anywhere? I don't see any other studies that have looked into it.
>Most of the included trials in the meta analysis are 10-20 years old as well.
The meta-analysis is from less than 6 months ago, and looked at all the studies available, which cover a range from recent to 10-20 years ago. That is normal for a meta-analysis, so I'm not sure why you're making it sound like it's out of date.
>The BBC article is about a new device.
Yes, there seems to be one study underway, which is still recruiting:
My point is that the available data may not tell us much about the safety and efficacy of this new device.
Somewhat tangentially, and not specific to Parkinson's or DBS, but placebo has been getting stronger for at least some classes of treatment. E.g.:
Tuttle AH, Tohyama S, Ramsay T, Kimmelman J, Schweinhardt P, Bennett GJ, Mogil JS. Increasing placebo responses over time in U.S. clinical trials of neuropathic pain. Pain. 2015 Dec;156(12):2616-2626. doi: 10.1097/j.pain.0000000000000333. PMID: 26307858.
Walsh BT, Seidman SN, Sysko R, Gould M. Placebo Response in Studies of Major Depression: Variable, Substantial, and Growing. JAMA. 2002;287(14):1840–1847. doi:10.1001/jama.287.14.1840
So I would not be surprised if placebo got stronger in this area as well.
So if that meta study finds that generally all evidence related to DBS effects on Parkinsons is low-confidence and old, then why believe that it is even the right direction?
- Studies on the purported mechanism(s) of action
- Preclinical results in vivo
- Anecdotal results like the one in the BBC article
- Mixed effects from older versions of the tech
That’s plenty to motivate further research and trials into this treatment.
Since Parkinsons is for now an incurable and barely treatable disease, it makes sense to try even things that are not very promising. But that doesn't mean we should hold out much hope for them, when all evidence suggests that they are not going to pan out.
Your points are all things that the authors of the meta-study should have looked for, or irrelevancies (anecdotes of people feeling better at some points after they underwent major neuro-surgery are entirely irrelevant to the complexity of a very slow acting degenerative disease).
My mom lost her sight and, to this day, asks me about updates for an electronic eye she once read about. The product existed, yes, but the company abandoned it [1] before it could be even remotely affordable and left existing patients one software bug away from the dark. Still, having no other hope other than a bionic eye, my mom regularly keeps asking me for news.
I also know someone living with Parkinson and I pray they don't see this article - the last they need is an article promising that someone, somewhere has "cured Parkinson" but with a procedure they may never get because it's not available in their country, it's too expensive, and/or they may not qualify for it. In my opinion "there's no cure" is easier to live with than "there is a cure, but you can't have it".
Never heard about it again.
[0] https://www.sciencefocus.com/news/molecular-surgery-gives-pa...
Helps w/ motor symptoms only - does NOT address any dementia/psychosis symptoms.
That being said, there are also reasons at the moment (better imaging support/stimulation programming abilities) to sometimes choose a competitor device over Medtronic (namely Boston Scientific)
Better DSP/ML techniques might make this more effective, but uh...the Parkinson's research community has never been known to be great at math...just saying
The actual clinical results so far shows that the gizmo with recording is not necessarily worse than DBS devices that don't have recording ability. I don't know if they published those results in a paper yet, but it was shown in poster form at MDS congress in Philly.
If we could get this kind of treatment early it might alleviate the need for dementia treatment.
That being said, from DBS clinical series - we know the technology helps w/ limb rigidity, bradykinesia and tremor. It helps initially with gait but sometimes the gait declines despite DBS and meds, say, roughly a decade after implant (even as the upper limb symptoms stay well treated).
He decided early on to never get this treatment and I feel sad to this day that he couldn't have lived a happier last few years.
movement/neuroplasticity/physical stimulation absolutely helps - hence PT, exercise classes, etc have being an important part of treatment
My point is, though - the onset of decline in gait ability typical of Parkinson's patients, is a sign of a decline of cognitive ability because the ability to perform gait and all the inherent brain commands associated with gait, is very much a cognitive function as much as it is motor.
One can argue that good DBS therapy by helping keep patients active and engaged does, at least indirectly, help cognition in that sense. BUT - it is consider not to directly treat Parkinson's dementia if a patient is unfortunate enough to come down with that aspect of disease. i.e. it's not like we can switch the device on or fiddle around w/ the programming and the patient's cognition directly improves from the brain stimulation itself.
And while it’s something if it doesn’t help with dementia it seems like it’s not addressing whatever is the root cause of dopamine deficiency
The stimulators seem to affect the signaling in that circuit (they are targeted by the implanting neurosurgeon to specific nodes in that circuit as best as targeting surgical technology allows) that seem to restore the ability to move well. Exactly why, no one knows. It's just a dumb signal at around 1-4 milliamps at 130-180 hz at those specific spots but presumptively it corrects some aberrant behavior in the whole network. It was observed in the '00s that recordings taken during or right after surgery often showed a strong peak at ~13-35 hz (give or take, but roughtly around 20 hz) during the disease state, and that's what Medtronic has been trying to target w/ these devices.
Of note - there actually isn't a system-wide dopamine "deficiency" - dopamine in general is fine for most of the body, it's just that the particular part of the brain that is affected happens to use dopamine as its signaling neurotransmitter so it's deficient in just that connection within the network.
Dementia is theorized to happen when the abnormal brain process spreads to other parts of the brain other than the substantia nigra (see the Braak hypothesis)
(I have an RNS for epilepsy. After it was implanted, my doctor got impatient waiting for it to record a seizure and reduced my meds too much. Ended up causing me to go into status for the first and only time in my life. My memory has never been the same and I'm not sure it ever will be)
The logic is: we have no idea but must do something, surgical implants are something, let's do brain surgery and implant something!
My father died at the age of 82 from late stage Parkinson's, never got dementia but eventually whatever neurons in the brain control movements, they fail to do so not just for movement but also vegetative processes such as swallowing and gut transit so ... one cannot live without that. Also those neurons die so that can't be good. No amount of waves and vibrations can compensate for dead brain tissue.
Hard pass on the calomel. Come back when you actually got something that works.
Bloodletting has some conditions it's actually appropriate for too.
Not sure mercury poisoning is going to turn out to be safe and effective anytime soon, though.
I'm not advocating for this, but if people are going to do it with informed consent, might as well collect proper data to try to determine if it objectively works. Snake oil that works, if it actually works, is something that works.
David Craven
They treat it like it has never been done before, but in truth, it's something that has been done for decades for Parkinson's, epilepsy, and a handful of other conditions with increasingly precise targeting and triggers.
Got one for my epilepsy two years ago. It reads my brain waves and sends a targeted stimulation deep in my brain to stop the seizure before it spreads.
I know someone getting a DBS next month and the implanted controller gets replaced about every 10-15 years (rechargeable battery replacement), so it would suck to just miss getting this improvement and having to wait a decade.