CU first to offer new deep brain stimulation treatment for Parkinson’s disease patients

On March 21, the Advanced Therapies in Movement Disorders (ATMD) team at the University of Colorado School of Medicine’s Movement Disorders Center completed the first deep brain stimulation programming using new electrode identifier (EI) and adaptive deep brain stimulation (aDBS) technology now available to patients with Parkinson’s disease.

Deep brain stimulation is a surgical treatment that places electrodes into specific regions of the brain to disrupt diseased networks that cause Parkinson's disease symptoms, such as tremors and stiffness. The electrode is connected to a battery positioned just below the clavicle, similar to the workings of a cardiac pacemaker.

In February, the U.S. Food and Drug Administration (FDA) approved the EI and aDBS applications. EI allows the clinician to use a Parkinson’s disease patient’s own brain signals to quickly localize the area to deliver therapy.

Delivering more personalized care

The new EI technology greatly reduces the time required to program the device and allows the clinician to identify patient-specific biomarkers. The aDBS system will then auto-adjust to the selected biomarker. This allows the device to deliver more stimulation when the biomarker is very high, indicating greater symptoms of Parkinson’s disease, and reduce stimulation when the biomarker is low and the individual does not need much stimulation to control symptoms.  

The ATMD team — led by Drew Kern, MD, MS, FAAN, associate professor of neurology and neurosurgery and John Thompson, PhD, associate professor of neurology, neurosurgery, and psychiatry — played a critical role in trials that evaluated the safety and effectiveness of the EI technology. Twenty-three centers across the U.S., including CU, were selected to roll out these new updates first. Several more across the country will follow.

“This technology has the potential to have important clinical impact in people with Parkinson’s disease,” Kern says.

Thompson adds that the use of EI holds great promise for patients during initial programming and lessens the time required for clinicians to devise more complex symptom specific configurations.

“Additionally, this technology will provide the clinician with a neurophysiological window into disease progression that will allow them to adjust stimulation in a highly patient-specific manner,” Thompson says.

This technology has already demonstrated superior benefit in improving symptoms of Parkinson’s disease.

“It will be exciting to see how this closed-loop system improves many other aspects of Parkinson’s disease and other movement disorders," Thompson says.

Upgrading from traditional DBS systems

While there’s still much unknown about the cause of many cases of Parkinson’s disease, researchers do know that abnormal brain signals are at the root of movement symptoms. Disrupting those signals through implanted electrodes has shown to lessen symptoms, and, for some patients, decrease their need for some medications.

“All DBS systems traditionally have all been an output, meaning all they do is deliver electricity to the brain, but an electrode can also be an input and a recording device,” Kern explains.

“This new system, in conjunction with our efforts, has made this a recording electrode so it can record and better inform the clinician how to program the electrode,” he says. “The clinician can then make the system have an output that directly responds to the needs of brain. It is like we can finally listen to what the brain is telling us to do to improve the person’s symptoms all the while in the outpatient setting.”

The new EI and aDBS technology will be delivered to patients with specific existing deep brain stimulation hardware via a software update.

“There’s still much to learn about how activities of daily living will affect and inform how stimulation is adjusted in these systems,” Thompson says. “The clinician-in-the-loop is critical in defining the signal upon which the system will adjust stimulation.” 

New frontiers for research

Using EI, which is also sometimes called monopolar sensing, means that researchers, including Kern and Thompson, can learn a lot more about the brain signals that are associated with Parkinson’s disease. 

Kern and Thompson, along with medical engineers, were part of sensing studies that tested the identifiers in the new aDBS system. Now, they’re looking to what those recordings might mean for the future of research and future patient care.

“There are many motor and non-motor symptoms, including gait, sleep, and cognition in Parkinson’s disease that are currently being investigated in the context of aDBS – many of which contributed to the recent approval and were supported by NIH BRAIN Initiative funding,” Thompson says.

Ongoing research is trying to identify what factors impact the fluctuations of the brain signals that induce tremors and movement symptoms of Parkinson’s disease.

“There are a lot of open-ended questions we don’t know the answers to yet,” Kern says. “Are there other signals that we should be targeting? What are the ideal settings for adapting? What happens with aDBS during times of stress, walking, and sleep? What are the effects of aDBS on non-motor symptoms such as cognition and fatigue.”

Following the release of the EI and aDBS system to clinics across the country, Kern and Thompson believe there will be a flood of new research studies asking questions that couldn’t be previously answered with the technology available. 

“It’s an exciting time for researchers, clinicians and patients. This moves us forward in treating and learning more about Parkinson’s disease in ways we could only have imaged,” Kern says.