Parkinsons patient "feels cured" with new adaptive deep brain stimulation device

https://www.bbc.com/news/articles/ckgn49r069wo

by ck2 • 1 year ago

272 45 1 year ago

caycep6• 1 year ago

so the short story is - at the moment, the device is basically doing power spectra analysis w/ FFT and such from local field potential recordings, and only turning the device on when it's detecting a strong ~20 hz band.

Helps w/ motor symptoms only - does NOT address any dementia/psychosis symptoms.

ls612• 1 year ago

If the result actually holds up in clinical trials though this is still huge! Parkinson’s is absolutely debilitating and more common than ALS.

piker• 1 year ago

Any idea what a clinical trial to approval roadmap might look like? Vested interest.

valine• 1 year ago

Results of their clinical trial look positive.

https://pubmed.ncbi.nlm.nih.gov/39289373/

rqtwteye2• 1 year ago

DBS devices have been in the market for years already and helping patients. This is just an incremental improvement.

r00fus2• 1 year ago

Aren't the dementia symptoms greatly magnified by the lack of mobility in the first place?

If we could get this kind of treatment early it might alleviate the need for dementia treatment.

caycep6• 1 year ago

I would say, maybe the other way around - gait is very much a cognitive task (think of all the compute power w/ reinforcement learning to get a robot to stand up or balance a stick). but it is probably a self-reinforcing cycle.

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).

hammock• 1 year ago

How does it work that it helps the motor symptoms?

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

caycep6• 1 year ago

our understanding Parkinson's is that it can be described as a control system issue. The part of the brain affected (at least initially) by the disease is part of a network (the basal ganglia/cerebellar network) that evaluates environmental inputs and generates the output necessary for fine/precise motor control, amongst other things. So a Parkinson's patient cannot plan their movements as well and the main symptoms are slowness of movement, abnormal limb tone; yes tremor as well but the 1st 2 are what cause the most issues for most people (keep in mind, not everyone follows the textbook so there are subtypes that have more cognitive issues, i.e. hallucinations, executive dysfunction etc)

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)

rqtwteye2• 1 year ago

My company makes DBS devices. There are a lot of other possible indications like migraine and others where it could help too but progress is very slow. You can't "move fast and break things" with brain implants.

aksss2• 1 year ago

* exempting shrapnel

AbstractH242• 1 year ago

Well, you can, but shouldn't

(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)

fracus2• 1 year ago

My Mom has had the surgery twice now, once for the left side and once for the right. Brain surgery is no joke. It takes a long time just to recover from that. And Parkinsons is a disease that will continue to get worse. The surgery adds quality of life but it will not stop or cure Parkinsons. The surgery is a wonderful option but it isn't a cure.

ryeguy_24• 1 year ago

Same for my mother-in-law. But very little benefit unfortunately. It’s a shame it didn’t add much value for such big surgeries.

MichaelRo• 1 year ago

These deep brain surgical implants are the calomel of today: https://en.wikipedia.org/wiki/Calomel

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.

toast0• 1 year ago

I mean, this feels more like electroshock therapy to me, but that's made a big comeback and is apparently considered relatively safe and somewhat effective.

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.

cpncrunch4• 1 year ago

Bear in mind that the placebo effect from DBS for Parkinson's is 39% of the active treatment, so you can't really tell much from a single unblinded patient report.

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.

directevolve4• 1 year ago

That placebo effect study is 20 years old. Most of the included trials in the meta analysis are 10-20 years old as well.

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.

cpncrunch4• 1 year ago

That placebo effect study is 20 years old.

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:

https://clinicaltrials.gov/study/NCT04681534

tsimionescu3• 1 year ago

If DBS itself is not a viable treatment for Parkinsons, as the study suggests, then no amount of technological improvement of DBS-based devices will change that.

walkingthisquai• 1 year ago

I'm (genuinely) quite surprised by that. A family member had the procedure a year ago and the difference is so immediate and dramatic. Thanks for the links

cpncrunch4• 1 year ago

Parkinsons involves dopamine, which is very amenable to placebo. Surgery and devices like dbs are very effective placebos.

wileydragonfly• 1 year ago

I was in the vicinity of researchers doing this almost 10 years ago in Houston. Was surprised to see this making headlines today. They’re also using DBS to treat depression and other mental illness.

probably_wrong• 1 year ago

I hate articles like these in "regular" newspapers as opposed to specialized journals.

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".

[1] https://spectrum.ieee.org/bionic-eye-obsolete

Tade0• 1 year ago

One time I was really hyped about so-called "molecular surgery"[0] - a technique which promised forming cartilage tissue - so the septum, tendons or even the cornea - with little effort and, crucially, no heating. The research looked as it was in an advanced stage with demonstrations on live specimens and whatnot.

Never heard about it again.

[0] https://www.sciencefocus.com/news/molecular-surgery-gives-pa...

aksss2• 1 year ago

At same time, this has real effects, so I wouldn't be so dismissive of it. I actually know a parent of a friend who had the whole "deep brain, computer in chest, app to adjust it" set up installed somewhat recently (not sure if exactly the same as article), and it's a game changer for her. I mean the difference is huge, and quite striking that it can be activated/deactivated at will and the effect so dramatic.

chiph• 1 year ago

Is this an all-new device, or a new software profile that can be applied to existing DBS controllers?

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.

AbstractH242• 1 year ago

It stings a little every time I hear a story like this on the BBC about the revolutionary new invention being an implanted device to stimulate parts of the brain. This is like the third time.

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.

davidcraven399• 1 year ago

My wife was diagnosed of Parkinson’s Disease at age 61. She had severe calf pain, muscle pain, tremors, slurred speech, frequent falls, loss of balance, difficulty in getting up from sitting position. She was put on Senemet for 6 months and then Siferol was introduced and replaced the Senemet. During this time span she was also diagnosed with dementia. She started having hallucinations and lost touch with reality. Last year, our family doctor started her on Uine Health Centre PD-5 formula, 2 months into treatment she improved dramatically. At the end of the full treatment course, the disease is totally under control. No case of dementia, hallucination, weakness, muscle pain or tremors. My wife is strong again and has gone on with her daily activities as I share this experience. I’m surprised a lot of PWP haven’t heard of PD-5 formula. we got the treatment from uinehealthcentre. com on google

David Craven

Parkinsons patient "feels cured" with new adaptive deep brain stimulation device

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