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Research Snapshot: A new approach to programming deep brain stimulation for Parkinson’s

About 100,000 people worldwide undergo deep brain stimulation to treat Parkinson’s disease, dystonia and tremor  when traditional medications or treatments fail to provide symptom improvement or relief. It is also being explored as a treatment for other neurological and psychiatric disorders for which medical therapy has not been effective in alleviating symptoms.

Deep brain stimulation (DBS) involves stimulating portions of the brain through a small implanted device. After the device is implanted, a clinician programs the device to target each patient’s individual symptoms. They establish settings that determine how much stimulation is needed to improve symptoms, a process called programming.

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U of M, St. Jude Medical partner to tackle Parkinson’s disease, depression

Editor’s note: This article originally appeared on Inquiry.

University of Minnesota researchers and St. Jude Medical are collaborating to treat some of the most challenging and debilitating movement and neuropsychiatric disorders using deep brain stimulation (DBS), a treatment which uses electrical current to directly stimulate parts of the brain. The project is part of MnDRIVE (Minnesota’s Discovery, Research and InnoVation Economy), a $36 million biennial investment by the state that aims to solve grand challenges in areas that align with Minnesota’s industries, including discoveries and treatments for brain conditions.

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Research Snapshot: Unmatched insights into deep brain stimulation through MRI

Deep brain stimulation (DBS) is a procedure that is used to treat movement disorders including Parkinson’s disease, tremor and dystonia. To improve symptoms, a DBS lead (insulated wire) is surgically inserted deep within the brain in sites known to control movement.

Electrical impulses are sent from the neurostimulator, also known as a brain pacemaker, to the lead implanted in the brain. The stimulation changes the pattern of electrical activity in the brain into a more normal pattern, thereby improving symptoms and returning more normal movement to patients.

Choosing the target location for the lead is of critical importance. Standard protocol among physicians around the world is to use a brain atlas developed from two French women who donated their brains to science many years ago. From there physicians superimpose the patient’s own brain MRI images and calculate a plan to implant the electrodes in the brain.

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Sen. Jeremy Miller impressed with U and MnDRIVE Neuromodulation research

In late June, the U of M hosted Minnesota Senator Jeremy Miller for an educational visit to learn more about the exciting neuromodulation research and technology taking place as part of the MnDRIVE brain conditions initiative.

During his visit Sen. Miller had the opportunity to tour the campus, meet and welcome new Minnesota men’s basketball coach Richard Pitino and hear from students and faculty about their research.

“I believe it’s extremely important for legislators, especially those on the higher education committee, to see and understand what our higher education institutions are doing,” Miller said.

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25 years later, the Head of Neurology hasn’t lost the thrill that he gets from helping patients

Jerrold L. Vitek, M.D., Ph.D., professor and Head of the Department of Neurology at the University of Minnesota, is an internationally-renowned neurologist and movement disorder specialist. Although Dr.  Vitek has received many professional accolades for his achievements throughout his illustrious career, he still retains the same high level of interest in what led him to medicine in the first place: his love for helping patients.

As a movement disorders specialist, Dr. Vitek regularly diagnoses and treats patients with Parkinson’s disease, a progressive neurological condition that causes tremors, rigidity, slowness of movement and postural changes which can lead to difficulties doing regular activities and even walking.  Some of his patients are affected by a disorder called dystonia, a movement disorder characterized by abnormal muscle contractions which cause involuntary twisting and repetitive movements.

Currently, there are no cures for either condition.  But, there are treatments that can make the conditions more manageable.

In search for the right treatment, Dr. Vitek evaluates the patient and identifies the severity of their symptoms to help determine the best treatment option.  Early on, patients with Parkinson’s disease are prescribed a series of medications to replace dopamine (L-dopa and dopamine agonists).  Most patients with Parkinson’s disease see improvements in their movement when taking these medications, but over a period of 5 to 7 years the medications typically have diminished effectiveness and increased side effects.

For dystonia, patients are typically treated with a combination of medications that block acetycholine or affect other neurotransmitters (chemical messengers) in the brain which help to minimize muscle spasms and relax the muscles.  Unfortunately, these medications aren’t always effective and may have too many side effects for patients with dystonia.

It’s at these points that Dr. Vitek will have a patient evaluated to determine if he/she is a suitable candidate for deep brain stimulation (DBS) surgery.  If the patient is a suitable candidate and decides to go ahead with surgery, a DBS lead (insulated wire) is surgically inserted into a site deep within the brain known to control movement.  A few weeks later, the patient has an insulated wire extension and neurostimulator which is used to provide the power source and make DBS parameter adjustments, implanted in their body under the skin.  Electrical impulses are sent from the neurostimulator at selected DBS settings through the extension wire to the lead implanted in the brain to stimulate this region of the brain and change the pattern of electrical activity into a more normal state, thereby improving their symptoms.

DBS treatments for patients with Parkinson’s disease and dystonia can be very effective, providing some patients with long-lasting results and a sense of normalcy, despite their condition. Dr. Vitek sees the impact that treatment he provides can personally have on a patient.

“One of the many amazing things about working with these patients is that we can see them improve with DBS right before our eyes.” Vitek said. “For example, in patients with Parkinson’s disease, their tremors cease, their posture improves and they are often able to walk normally. It’s remarkable.”

By understanding more about where and how the brain is operating abnormally in each of these conditions as well as how DBS affects activity at the cellular level to improve specific symptoms, Dr. Vitek and his colleagues are better equipped to develop and test new DBS treatment strategies.  Ultimately, this research can translate into changes in clinical treatment options for affected patients, thereby improving patient symptoms, minimizing possible side effects, and improving quality of life.

“I’ve been working with patients for a long time, but I never lose the thrill that comes with helping people. For me, that feeling never gets old.”

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