Efforts to improve
As the surgeries continue, so do efforts to improve the device and the procedure used to implant it. A year ago, Medtronic switched from the dual controls to a dual-chamber, single-battery device, eliminating the need for two of the incisions originally required to get everything up and running. Research is also under way to find ways to minimize or eliminate the unwanted side effects.
What we're trying to do is perhaps turn back the clock five, six, seven years, and allow Parkinson's patients to be productive, to enjoy activities they're now deprived of. But this is a progressive illness. They're going to continue to progress. There's going to be a need for additional tools to manage, treat, and cure the disease.— Robert Maxwell, M.D., Ph.D.
Maxwell is leading the way to assess the use of MRI technology rather than the patient's motor response to guide electrode placement. Currently patients like Stickney are required to stay awake during the electrode-implanting surgery so that the surgical team can monitor symptoms to gauge when the electrodes are placed correctly. MRI-guided placement would allow the use of general anesthesia during the surgery, a huge benefit for patients whose Parkinson's makes it painful or impossible to lie awake on the operating table for the many hours the surgery currently requires.
"We are finding that the patients we need to do under general anesthesia using anatomical criteria by and large are doing quite well," says Maxwell. "If we find eventually that we can be just as effective doing it in a way that would be much quicker, that would be a really positive thing. It will not only reduce time and stress on the patient, but we should also be able to reduce the cost of the procedure and allow it to be done in more centers."
Maxwell expects demand for the device to continue to grow in the future.
"Parkinsonism is a disease that increases in frequency as we get older, and we have an aging population, so I think Parkinsonism is something we're going to see more and more of," he says. Still, he emphasizes that deep brain stimulation is a treatment, not a cure.
"The majority of patients have had it roughly 10 years and are now reaching a point where they are becoming very disabled. What we're trying to do is perhaps turn back the clock on their illness five, six, seven years, and allow them to be productive, to enjoy activities they're now deprived of. But this is a progressive illness. They're going to continue to progress. There's going to be a need for additional tools to manage, treat, and cure the disease."
To that end, Maxwell looks with hope to other researchers at the University and elsewhere who are doing basic research in stem cell biology and other areas that could lead to novel treatment options — and perhaps even a cure — for Parkinson's disease.
"For the immediate future, deep brain stimulation is going to be the most effective technology available for treating Parkinsonism once proven to be refractory to medical management," he says. "But if we can find a way to replace the tissue and cells and biochemical substrates the brain needs to function normally, that's going to be a major breakthrough."