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November 12, 2001

Deep-brain stimulation holds hope for Parkinson's

By Janet Christenbury


An international, multisite study is showing promising results in treating patients with advanced stages of Parkinson’s disease. Emory was selected as one of 18 institutions to study the effects of a treatment called deep-brain stimulation (DBS) on Parkinson’s patients. The complete findings of the trial were reported in the Sept. 27 issue of The New England Journal of Medicine.

DBS involves surgical implantation of electrodes into specific areas of the brain. These electrodes are connected to a pulse-generator device (similar to a cardiac pacemaker) under the skin near the collarbone.

“The DBS device delivers controlled electrical stimulation to regions of the brain involved in the development of the motor symptoms associated with Parkinson’s disease: the internal segment of the globus pallidus and the subthalamic nucleus,” said neurologist Jerrold Vitek, associate professor of neurology and principal investigator of the Emory arm of the study.

Initial results indicate that stimulating either of these two regions can reduce slowness, stiffness and tremor of Parkinson’s disease, as well as drug-induced involuntary movements.

The study, which concluded in 1999, was carried out in patients whose condition could not be further improved with medication alone. The trial’s duration included enrollment, study time and follow-up phases. The majority of participants were enrolled in Europe; approximately 25 patients were enrolled in the United States.

DBS has been approved by the Food and Drug Administra-tion (FDA) only for use in the thalamus to treat tremor, which consists of stimulating just one side of the brain.

“We hope this study’s positive outcome will encourage the FDA to move toward approving DBS on both sides of the brain, as well as the sites tested in this study, and not just a single side or site,” said Mahlon DeLong, chair of the Department of Neurology and a longtime researcher of Parkinson’s disease.

“Patients who are the best candidates for DBS are those who’ve reached the end of their rope with medication and are constantly plagued with complications of medical therapy,” DeLong said.

This device is promising because, once implanted, benefits can be optimized and side effects minimized by adjusting stimulation parameters. If a side effect develops, the voltage can be lowered or other parameters of stimulation changed.

Vitek and DeLong said this study shows significant potential in treating patients with Parkinson’s disease. Since there is no cure to this degenerative neurological disorder, both doctors believe DBS offers new hope to patients in whom medical therapy is no longer adequate in controlling the symptoms of Parkinson’s.


Back to Emory Report November 12, 2001