Evaluating Deep Brain Stimulation: earlier is not always better

A group of researchers in Germany and France recently published the results of a clinical trial that examined the benefit of using deep brain stimulation (DBS, Deep Brain Stimulation) on young patients in the early stages of PARKINSON'S disease.
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The organization of the study: young people with recently appeared symptoms

The people considered had had motor complications for not very long, less than three years.

The subjects had not been treated with standard drug therapies but, instead, chose to undergo DBS immediately during the course of their illness. The study followed them for two years and reported significant improvements among subjects in the group with DBS vs. to a control group receiving only drug therapy.

Canadian interest in European Deep Brain Stimulation study.

The study attracted the attention of several Canadian physicians with extensive experience in treating the PARKINSON'S DISEASE, including the Dr. Tony Lang, whose work with movement disorders and also with deep brain stimulation is highly regarded in the medical field.

The Dr. Lang collaborates with the clinic Movement Disorders at Toronto Western Hospital and also with University Health Network, Department of Neurology, University of Toronto, in Toronto, Canada.

Canadian researchers examined the results of the European trial from many perspectives, in addition to the actual clinical improvement of patients.

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CANADIAN RESEARCHERS' CONSIDERATIONS REGARDING THE STUDY

Canadian researchers acknowledged that the results of the intervention on younger subjects led to improved patient quality of life and reduced tremor and stiffness. But the European study also confirmed that the DBS can have serious side effects, including the risk of suicide, which has also been demonstrated in other clinical studies.

In addition, the Canadian group believes that offering DBS to patients who have had motor symptoms for less than 5 years could include people with atypical parkinsonism who would not benefit from the intervention.

CONSIDER THE SEVERITY OF SYMPTOMS IN RELATION TO THE BENEFITS AND CONTRAINDICATIONS OF THE INTERVENTION

If the symptoms are mild, the results of the surgery will also be mild, but the counter indications of the surgery, such as infection, rejection of implanted materials, or response to neurostimulation is the same as patients with more severe symptoms who would see more benefits, however.Given that the symptoms of Parkinson's disease and their severity vary from individual to individual, the decision regarding this treatment must take into consideration the severity of the potential risks of the DBS(Deep Brain Stimulation) and whether there is a team of experienced professionals who are able to follow up with the patient if problems arise.

Deep Brain Stimulation effective on only some Parkinson's symptoms

DBS is not effective on all Parkinson's symptoms; for example, it does not give benefit on bradykinesia or Freezing of gait, symptoms treatable with the AMPS Gondola Therapy. In addition, problems such as walking difficulties and Freezing of the walk could also be worsened or induced by the installation of the DBS device.

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ALSO TAKE INTO ACCOUNT THE PLACEBO AND NOCEBO EFFECT

The Canadian team emphasized that the European study was an open-label study, which means that all participants have received DBS and that there was no control group receiving placebo interventions.

More Parkinson's studies that have included surgical procedures for cell transplantation have shown an extremely high and positive placebo response, the expectation of possible benefit may be very powerful.

Since all participants in the European study voluntarily underwent a series of invasive neurological procedures on their brains, it must be assumed that they had a high expectation of success. This may have created an overly positive response to the intervention.

Similarly, subjects who received only drug therapy may have been negatively influenced, the so-called nocebo effect, thinking that there would not be the same improvement as subjects with Deep Brain Stimulation the benefits shown may have been minor.

This is supported by the fact that after the first blind part of the trial, most of the subjects in the group with traditional drug therapy chose to undergo DBS. Caution should be exercised in interpreting the results in light of these considerations.

More studies to evaluate the results obtained

The results of the European study show some positive responses that are worth reevaluating with further, better-designed clinical trials. This study was done in a younger population with motor symptoms that arose recently and were good candidates for surgery.

In addition, they were followed only for a relatively short period of time, two years. The results may not necessarily hold true even for elderly subjects with other motor or non-motor complications that might make them bad candidates for surgery.

It is not a question of effectiveness but when is the best time to apply it

Deep Brain Stimulation can and has helped many people with Parkinson's disease, there is no questioning its effectiveness.

But there is some question as to what is the best time to apply DBS in order to achieve better results for the individual undergoing the procedure.

Many symptoms of Parkinson's disease can be controlled for a long time with drug therapies and with the help of the GONDOLA device, without the risks associated with serious and invasive brain surgery.

The decision to undergo this surgery must be well thought out by each individual, taking into consideration both the possible benefits and potential counter indications.

An experienced multidisciplinary team of Parkinson's disease and Deep Brain Stimulation must be able to counsel the person and be there to assist them during their decision and after the surgery.