DBS Draws Consensus Nod for Parkinson’s, But Not Other Conditions

Because snaking tiny stimulating wires into the brain has helped many people with Parkinson’s disease (see ARF related news series), scientists are now considering the same treatment for conditions ranging from Alzheimer’s (see ARF related news story on Laxton et al., 2010) to obesity to obsessive-compulsive disorder (OCD) (see ARF related news story). But while PD claims are well substantiated, other uses require much more careful study before both doctors and patients should rush to adopt DBS, this month’s literature suggests.

In the February 2011 Archives of Neurology, an international panel of research leaders presents its conclusions on deep-brain stimulation (DBS) for PD. In a consensus paper, they write that DBS is an appropriate treatment for people who lack significant cognitive or psychiatric problems but have motor problems that respond poorly to medication. The panel notes that DBS often provides long-lasting relief of dyskinesia and tremor.

At the same time, scientists exploring DBS for other conditions sounded a note of caution in Health Affairs. In 2009, the Food and Drug Administration (FDA) had granted a humanitarian exemption allowing doctors to use DBS to treat obsessive-compulsive disorder. The article’s authors, led by Thomas Schlaepfer at the University of Bonn, Germany, argue that without rigorous clinical trials, the long-term outcomes and side effects of this treatment remain unknown, making it too early for such approval.

Researchers are also arguing the relative merits of single case studies, which some say overhype DBS’s potential (see ARF related news story on Schlaepfer and Fins, 2010 and Hubbeling, 2010). The authors of the current article suggest the FDA revoke the OCD exemption, as scientists continue to examine the therapy in careful trials. In The New York Times, researchers note that practitioners of psychosurgery, burdened by a legacy of lobotomies, must tread especially carefully with new treatments. Other doctors counter that people with severe OCD may contemplate suicide, and it is important to be able to offer DBS as a last-resort treatment.—Amber Dance

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References

News Citations

  1. DBS Update: Attempting to Stimulate Memory in Alzheimer’s
  2. Deep-Brain Stimulation: An Electrode for All Occasions?
  3. DBS Double Update: Call for Trial Registry, Two Targets Work for PD

Paper Citations

  1. Laxton AW, Tang-Wai DF, McAndrews MP, Zumsteg D, Wennberg R, Keren R, Wherrett J, Naglie G, Hamani C, Smith GS, Lozano AM. A phase I trial of deep brain stimulation of memory circuits in Alzheimer's disease. Ann Neurol. 2010 Oct;68(4):521-34. PubMed.
  2. Schlaepfer TE, Fins JJ. Deep brain stimulation and the neuroethics of responsible publishing: when one is not enough. JAMA. 2010 Feb 24;303(8):775-6. PubMed.
  3. Hubbeling D. Registering findings from deep brain stimulation. JAMA. 2010 Jun 2;303(21):2139-40; author reply 2140. PubMed.

Other Citations

  1. ARF related news series

External Citations

  1. Health Affairs
  2. The New York Times

Further Reading

Papers

  1. Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, Marks WJ, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ, . Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med. 2010 Jun 3;362(22):2077-91. PubMed.
  2. Freund HJ, Kuhn J, Lenartz D, Mai JK, Schnell T, Klosterkoetter J, Sturm V. Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation. Arch Neurol. 2009 Jun;66(6):781-5. PubMed.
  3. Fuentes R, Petersson P, Siesser WB, Caron MG, Nicolelis MA. Spinal cord stimulation restores locomotion in animal models of Parkinson's disease. Science. 2009 Mar 20;323(5921):1578-82. PubMed.
  4. Okun MS, Fernandez HH, Wu SS, Kirsch-Darrow L, Bowers D, Bova F, Suelter M, Jacobson CE, Wang X, Gordon CW, Zeilman P, Romrell J, Martin P, Ward H, Rodriguez RL, Foote KD. Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial. Ann Neurol. 2009 May;65(5):586-95. PubMed.
  5. Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD, . Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA. 2009 Jan 7;301(1):63-73. PubMed.
  6. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med. 2003 Nov 13;349(20):1925-34. PubMed.
  7. Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J, . A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med. 2006 Aug 31;355(9):896-908. PubMed.
  8. Drouot X, Oshino S, Jarraya B, Besret L, Kishima H, Remy P, Dauguet J, Lefaucheur JP, Dollé F, Condé F, Bottlaender M, Peschanski M, Kéravel Y, Hantraye P, Palfi S. Functional recovery in a primate model of Parkinson's disease following motor cortex stimulation. Neuron. 2004 Dec 2;44(5):769-78. PubMed.

Primary Papers

  1. Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, Horak FB, Okun MS, Foote KD, Krack P, Pahwa R, Henderson JM, Hariz MI, Bakay RA, Rezai A, Marks WJ, Moro E, Vitek JL, Weaver FM, Gross RE, Delong MR. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol. 2011 Feb;68(2):165. PubMed.
  2. Fins JJ, Mayberg HS, Nuttin B, Kubu CS, Galert T, Sturm V, Stoppenbrink K, Merkel R, Schlaepfer TE. Misuse of the FDA's humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder. Health Aff (Millwood). 2011 Feb;30(2):302-11. PubMed.

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