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DBS Effective for the Long Term in Parkinson’s

Deep brain stimulation (DBS) appears to be stable over a period of 3 years for improving motor function in patients with Parkinson’s disease, according to findings from a small investigation. Health-related quality of life improved at 6 months among participants receiving DBS, but the authors noted that improvements diminished over time. Abstract: Neurology, June 21,...

Deep Brain Stimulation & Treatment-Resistant Depression

About 1% to 3% of the United States population has treatment-resistant depression (TRD), a costly and disabling disorder. In recent clinical trials, deep brain stimulation (DBS) has been used on various neuroanatomic targets in the brain in an effort to treat TRD. Helen S. Mayberg, MD, and colleagues in Toronto published a report in 2005 which demonstrated encouraging results when using DBS in the subcallosal cingulate (SCC) matter, an area of the brain that has been dubbed “Area 25.” In this study, patients with TRD who had DBS experienced antidepressant response rates in excess of 50% when assessed 6 and 12 months after the procedure. “Although results were encour­aging, this initial pilot study was limited by being an open-label investigation,” says Dr. Mayberg. In an effort to garner more long-term efficacy and safety data on SCC DBS for TRD and extend experience with the procedure, Dr. Mayberg teamed up with Paul E. Holtzheimer, MD, and colleagues at Emory University and published a study in the February 2012 Archives of General Psychiatry involving 17 TRD patients who received the procedure. The analysis also aimed to address whether there was an antidepressant effect associated with sham SCC DBS and if the procedure was safe and effective in patients with treatment-resistant bipolar depression. (see also, Navigating Patients Through Depression) Analyzing the New Data on DBS In the study by Drs. Holtzheimer and Mayberg, participants received single-blind sham SCC DBS for 4 weeks, in which patients did not know if the DBS system was on or off. This was followed by active stimulation for 24 weeks. Patients were evaluated for up to 2...

Improving Parkinson’s Disease & Tremor With DBS

Medications are effective in about 70% of patients with essential tremor and work well for most with Parkinson’s disease (PD). Many patients with essential tremor, however, are unable to complete activities of daily living with ease even with the use of medications. In people with PD, symptoms worsen over time despite medication. For these patients, successful symptom treatment may be found in deep brain stimulation (DBS). Approved by the FDA in 1998 to treat essential tremor and again in 2002 for PD, DBS involves implanting electrodes in the deep part of the brain. The electrodes are connected to a wire tunneled under the skin to a battery that is implanted just under the skin in the chest. It essentially acts like a pacemaker for the brain. While it’s unclear exactly how DBS works, it appears that electrical stimulation overrides abnormal signals in the brains of patients with PD and essential tremor. Identifying Ideal Candidates for DBS For many individuals with PD, medications may only suppress symptoms for a short time, forcing patients to take their medication more frequently as they wait for the next dose to kick in. In these cases, physicians should consider DBS. Other beneficiaries of DBS include those with PD for whom medications are completely ineffective for reducing tremor. Research shows that only 50% to 70% of patients with essential tremor respond well to medication. Those who don’t respond typically suffer from a poor quality of life and should be considered candidates for DBS. Contraindications to DBS include significant cognitive problems and uncontrolled depression. Getting the Word Out About DBS Despite a decade’s worth of experience,...

DBS for Treatment-Resistant Depression

Chronic subcallosal cingulate deep brain stimulation (DBS) appears to be safe and effective for the long term in individuals with treatment resistant depression (TRD). A team of American researchers found that 2 years of active DBS resulted in remission of TRD in 58% of patients. A response after DBS occurred in 92% of patients with TRD during the study period. The authors added that spontaneous relapse was not experienced by any patients who achieved remission. Abstract: Archives of General Psychiatry, January 2,...

Reviewing DBS for Parkinson’s Disease

In 2002, the FDA approved the use of deep brain stimulation (DBS) for patients with Parkinsons disease. Although it isn’t a cure, DBS has been shown to help manage symptoms of the disease. A workshop of experts was recently convened to create a consensus review of key issues involving DBS surgery. Published in the February 2011 Archives of Neurology, the review is designed to assist patients and physicians who are considering DBS based on clinical research and expert opinion. Patient Selection One of the most important steps toward achieving consistently good outcomes with DBS is careful patient selection. Studies have suggested that more than 30% of failed DBS procedures can be attributed to inappropriate indications for surgery. Patient selection should be based on an individual risk-benefit evaluation for each patient. Good candidates for DBS include patients with Parkinson’s who do not have significant cognitive or psychiatric problems and medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects. DBS has yielded the best results in patients with advanced Parkinson’s and excellent levodopa response, younger age, no or few axial non–levodopa-responsive motor symptoms, no or very mild cognitive impairment, and absence of or well-controlled psychiatric disease. Experience & Teamwork Matter The surgical techniques for implanting DBS devices are continuing to evolve, but few studies directly compare the safety or effectiveness of these methods; the best techniques for DBS require more research. However, the workgroup did reach a consensus on the importance of having Parkinson’s patients receive care in expert centers that deliver DBS. A multidisciplinary team is essential; it should involve a movement disorder neurologist, a neurosurgeon, a neuropsychologist,...
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