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When Professor Jens Volkmann, director and chairman of the Department of Neurology at the University Clinic Würzburg, Germany, first started working in neurology 25 years ago, despite being able to make an absolute diagnosis of Parkinson’s disease, there was nothing he could do to help the patient. Watch this in-depth interview with Professor Volkmann below explaining how today’s latest advances in deep brain stimulation can improve symptom control
Deep brain stimulation (DBS) therapy involves mild electrical impulses generated by a stimulator that is implanted around the chest in the similar way to a pacemaker. The electrical stimulation travels along thin wires called leads to specific areas of the brain.
Professor Jens Volkmann says: “When I tell my patients that they have Parkinson’s disease, I tell them that there is both good and bad news. The bad news is that it is a progressive disease that we cannot cure today.
“The good news is, however, that Parkinson’s disease is probably the one neurodegenerative disorder that we can currently treat best. For many years, even decades, patients can have an almost normal life with very little restrictions if they are treated properly.”
Individualised treatments – the key to therapy success
“The best way of treating Parkinson’s disease today is governed by a very individualised approach. Physicians have to titrate medication according to their patient’s specific needs. Patients may participate well in everyday life with medications, still going to work and being professionally active, however, they may eventually come to limits with their medical therapy. Then physicians should seek alternative treatment options such as DBS, for example,” Professor Volkmann recognises.
During the last 25 years, deep brain stimulation has become a well-established treatment for Parkinson’s disease.
Professor Volkmann has been involved in the evolution of DBS since the very beginning. In 1995 the team at the University Hospital Cologne, which included Professor Volkman, was one of the first centres to perform DBS.
“DBS is a great therapy. Twenty years ago, it was a major step forward from pure medical treatment of Parkinson’s disease. When it was first introduced we used systems that were not able to deliver precise electrical signals. In addition, we had to place the electrodes in the so-called ‘sweet spot’ of the subthalamic nucleus, an area with maybe plus or minus one or two millimeters deviation.
“Some target areas for DBS lie immediately next to parts of the brain that control defined and coordinated muscle movements. So, if they are accidently stimulated this causes contractions, slowed or unskilled movements. Only a small deviation used to make the difference between achieving the full benefit of the therapy, or only achieving a small benefit along with side effects. We know today that it’s very important to produce consistent results with DBS.”
Fewer side effects and improved symptom control
The advanced technology of the new DBS systems not only supports physicians in providing personalised therapy, it also changes the risk-benefit relationship of the procedure significantly.
“With the new directional system, uncertainties in the positioning of the electrodes can be compensated through the flexible programming after the surgery,” says Professor Volkmann. “You can think of the new directional system as a lighthouse. In a similar way to directing the beam of light, electrical signals can be steered in certain directions by programming the electrodes, thus avoiding side effects caused by unwanted stimulation of neighbouring brain areas.”
Professor Volkmann implanted three patients living with Parkinson’s disease with the new directional DBS system in cooperation with Professor Cordula Matthies, head of functional neurosurgery at University Clinic Würzburg, in September 2015.
The first implants demonstrated the advantages of the new directional system. Initially, an old DBS system using a conventional way of programming was used but full symptom control wasn’t achieved and side effects were not reduced.
“Only when we started using the new current steering method, were we able to optimise the therapy for our three patients. They are all doing well now,” asserts Professor Volkmann.
Could DBS become the routine treatment for Parkinson’s disease in the future?
According to Professor Volkmann using segmented multi-directional leads to refine the electrical field is only the first step in advancing DBS therapy.
“In the future, DBS has to be made simpler and more adaptive. Programming of the device should be less dependent on physicians’ experience but will be more based on models that can help to predict the effects of stimulations from the electrical field distribution. If the technology is more objective, there can be better quality control and the DBS procedures will be easier to learn, with the result that centres may be able to achieve higher quality and standard of care.
“Only once this stage is reached, will DBS become broadly accepted, similar to a cardiac pacemaker. Today, physicians do not require special skills to provide a patient with a pacemaker – it is the standard of care. For DBS we still struggle to develop these kinds of guidelines so that patients who are in need of DBS can have a broader access to the therapy.”
This article is sponsored by Boston Scientific. The information in this article is given for information purposes only and does not represent an endorsement by the EPDA of any particular treatments, products or companies. This article is not a substitute for advice from your doctor, pharmacist or other healthcare professional. Parkinson’s Life makes no representations or warranties of any kind, express or implied, about the completeness or accuracy of information provided.
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