A new paper published in Nature Reviews Neurology suggests that recent advances in deep brain stimulation (DBS) for Parkinson disease could lead to treatments for conditions such as obsessive-compulsive disorder (OCD), Gilles de la Tourette syndrome and depression. The authors of the paper, from the Geneva University Hospitals (HUG), University of Geneva, University of Tübingen and the Wyss Center for Bio and Neuroengineering, argue that bi-directional electrodes which can both stimulate and record from deep brain structures — known as closed-loop DBS — could have applications beyond Parkinson disease.
Other bi-directional brain-computer interfaces (BCIs) have been in development in recent years, notably for the real-time signal processing of neuronal activity to allow control of a robotic arm directly from the brain in people with paralysis.
Professor John Donoghue, Director of the Wyss Center: “Interestingly the fields of brain-computer interfaces for movement restoration and deep brain stimulation for Parkinson disease have developed largely independently. Deep brain stimulation researchers tend to be neurologists or neurosurgeons while brain-computer interface researchers are often neuroscientists, roboticists and engineers. By working together and sharing information we can learn from each other and potentially expand the reach of this technology so that it can help more people.”
Analysis of data from a clinical trial conducted at Vanderbilt suggests that deep brain stimulation (DBS) administered to patients with very early-stage Parkinson’s disease slowed the progression of rest tremor.
The study, published June 29 in Neurology, is significant because it is the first evidence of a treatment that may possibly delay the progression of one of the cardinal features of Parkinson’s disease. However, the study’s authors strongly caution that a larger-scale clinical trial across multiple investigational centers is needed to validate the finding.
“The finding around tremor is truly exceptional,” said David Charles, MD, professor and vice-chair of Neurology and senior author. “What it suggests is that DBS applied in early stage Parkinson’s disease may slow the progression of tremor. Why it is so remarkable is because there are no treatments for Parkinson’s that have been proven to slow the progression of any element of the disease.”
Deep brain stimulation (DBS) of the ventral striatum/anterior limb of the internal capsule is safe and feasible in addressing the affective component of pain in patients with post-stroke pain syndrome.
Cleveland Clinic investigators reported findings from the first prospective, randomized, controlled trial of DBS for neuropathic pain in a presentation at the 2017 annual scientific meeting of the American Association of Neurological Surgeons. The study was also published in the May 2017 issue of Annals of Neurology.
“We showed that active versus sham DBS of the ventral striatum/anterior limb of the internal capsule produced significant improvements in multiple outcome measures associated with the affective sphere of chronic pain,” says lead investigator Andre Machado, MD, PhD, Chairman of Cleveland Clinic’s Neurological Institute. “This trial represents a paradigm shift in chronic pain management in that it targeted neurostimulation to brain structures related to the affective, rather than sensory, sphere of chronic pain.”
Promising, early studies of deep brain stimulation (DBS) for the treatment of Alzheimer’s disease have paved a path for future clinical trials, but there are unique ethical challenges with this vulnerable population regarding decision making and post-study treatment access that need to be addressed as they ramp up, Penn Medicine researchers argue in a new review in the Journal of Alzheimer’s Disease.
Does the patient still have the capacity to make an informed decision half way through the trial? Are there any misconceptions about its therapeutic benefit? Will the device remain after the trial ends, and who will pay for it? posed. These are the questions posed in an ethics review piece that also lays out guidelines for investigators to consider when enrolling Alzheimer’s patients in DBS trials. The article is authored Andrew M. Siegel, MD, an assistant professor of Clinical Psychiatry in the Perelman School of Medicine at the University of Pennsylvania, Marna S. Barrett, PhD, an adjunct associate professor of Psychology in Psychiatry at Penn, and Mahendra T. Bhati, MD, a former assistant professor of Clinical Psychiatry at Penn, who is now at Stanford University, in an ethics review piece that also lays out guidelines for investigators to consider when enrolling Alzheimer’s patients in DBS trials.