In this case study, a 61 year old man with Parkinson's was treated with a new treatment, deep brain stimulation of the pedunculopontine nucleus, as well as deep brain stimulation of the subthalamic nucleus, which has been in the past. The patient mostly suffered from freezing of gait and instability of posture. After stimulation both areas of the brain, tests were taken to score how well the subject was able to hold his posture and his overall gait. At the end of the study it showed that deep brain stimulation of both areas scored around the same, except for the motor aspect of gait. Stimulation of the pedunculopontine nucleus improved scores of his symptoms of freezing of gait. Although this is just a case study, there seems to be some promise that deep brain stimulation might have some answers for questions about Parkinson's Disease.
DBS electrodes were implanted bilaterally into the STN and PPN. A and B : X-ray imaging. C and D : Transverse sections. E and F : Coronal sections. White arrows indicate PPN (C and E), black arrows indicate STN (D and F). DBS : deep brain stimulation, STN : subthalamic nucleus, PPN : pedunculopontine nucleus.
Huan-Guang Liu, M.D., Kai Zhang, M.D., An-Chao Yang, M.D., and Jian-Guo Zhang, M.D. (2015). Deep Brain
Stimulation of the Subthalamic and Pedunculopontine Nucleus in a Patient with Parkinson's Disease. Journal of Korean Neurosurgical Society. 57(4):303-306. Retrieved from: http://synapse.koreamed.org/search.php?where=aview&id=10.3340/jkns.2015.57.4.303&code=0032JKNS&vmode=FULL
http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/symptoms/con-20028488
This is a very impressive way to decrease the symptoms of Parkinson's disease. At first I wondered why this was being used rather than the common drug treatments such as dopamine agonists and MAO inhibitors. By research further, I found that DBS is used when these types of drugs are not working. Currently DBS is not fully understood, but DBS has been also been seen to decrease addiction (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042315/). I wonder what the connection between DBS, parkinson's, and addiction is? Another treatment that recently has been proposed is spinal stimulation instead of deep brain stimulation in order to treat Parkinson's symptoms. This could be beneficial because it could treat patients that are not able to have brain surgery (https://shakeitup.org.au/leave-brain-spinal-stimulation-offer-alternative-treat-parkinsons-motor-symptoms/).
ReplyDeleteThis is really interesting stuff, Tim. I actually worked at the Colorado Neurological Institute earlier this year under an investigator who is currently carrying out several DBS studies. While the positive effects that have already been observed with DBS are quite amazing, these researchers are investigating ways to make DBS more dynamic as a "smart" customizable DBS system. Their current goal is that a smart DBS will work dynamically so as to adjust the electrical output in the DBS system depending on the patient's tasks, and the corresponding adjustments in brain activity. One common problem that individuals with Parkinson's Disease often encounter is difficulty with speech. Considering this, a major goal of the researchers at CNI is to incorporate into their smart DBS a closed-loop system in which they could target regions of the brain involved with speech and the corresponding motor tasks. Unfortunately during my time at CNI they were in the early stages of carrying out speech tests during the DBS surgery so the development of this system is still very young, but I am thoroughly excited to see the developments of this technology in the near future.
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