Keith Krehbiel battled severe side effects from his Parkinson’s medication for years after being diagnosed with the condition at the age of 42 in 1997. The medications caused intense nausea and, as they wore off, Krehbiel suffered from dyskinesia, which led to uncontrollable head movements. Parkinson’s disease, a progressive neurological disorder, affects about one million people in the United States and is characterized by slow movements, tremors, and issues with balance.
However, Krehbiel’s quality of life took a significant turn for the better following a surgical procedure in 2020 that involved implanting electrodes in specific brain areas. “The tremors almost completely stopped,” shares Krehbiel, now 70 and a retired political science professor from Stanford Graduate School of Business. Originally, his symptoms were wrongly attributed to repetitive strain from computer use at the age of 40. Post-surgery, he has been able to cut down his Parkinson’s medication by over two-thirds. “I no longer feel mentally foggy, nor do I suffer from nausea or dyskinesia,” he adds.
Krehbiel was the inaugural participant in a clinical trial for a novel type of deep-brain stimulation (DBS), which the U.S. Food and Drug Administration first approved for treating Parkinson’s tremors and essential tremors in 1997, and later for other symptoms and conditions. This innovative adaptive system dynamically adjusts stimulation levels based on the patient’s unique brain signals. It received FDA endorsement for Parkinson’s in late February after an extensive international trial involving locations in the U.S., the Netherlands, Canada, and France.
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Dr. Helen Bronte-Stewart, a neurologist specializing in movement disorders at Stanford Medicine and the global lead investigator of the recent trial, explains that this technology could benefit anyone with Parkinson’s, not just trial subjects. “Similar to a heart pacemaker that reacts to heart rhythms, adaptive DBS tunes into an individual’s brain signals to regulate the electric pulses it emits,” she states. This results in a system that is more tailored, accurate, and efficient than previous DBS techniques.
Dr. Todd Herrington, neurologist and director of the deep-brain stimulation program at Massachusetts General Hospital, and another investigator in the trial, notes that traditional DBS provides constant stimulation which may not always align with the varying symptoms of the disease. “Adaptive DBS aims to fine-tune stimulation in real time, enhancing symptom management, reducing side effects, and improving overall patient life quality,” he explains.
Currently, this adaptive system is approved by the FDA only for Parkinson’s, not for treating essential tremor, dystonia (a condition causing involuntary muscle contractions), or epilepsy, which are still managed with conventional, continuous DBS, according to Herrington.
Dr. Ashwini Sharan, chief medical officer at Medtronic’s neuromodulation unit, comments, “Our tailored treatment can significantly manage the tremors associated with Parkinson’s.” The device, which is implanted under the chest skin, sends electrical signals through thin wires to a brain region controlling movement.
Michael S. Okun, national medical advisor to the Parkinson’s Foundation, emphasizes the long scientific journey to decode brain signals for personalized DBS. “We are entering the era of intelligent stimulation for Parkinson’s,” he observes, although he cautions that the effectiveness of these adaptive devices, especially for complex symptoms, remains to be seen over time.
While many may not need adaptive stimulation to manage Parkinson’s symptoms effectively, Okun believes the technology could greatly benefit specific cases. However, Dr. Vibhash Sharma, a neurologist and medical director at UT Southwestern Medical Center’s neuromodulation clinic, notes it’s too early to confirm if this new system outperforms existing ones. “Further studies are necessary to evaluate its effectiveness across a wider patient group,” he adds.
The surgical procedure for implanting a DBS device, whether adaptive or traditional, carries similar risks—low chances of stroke, infection, hemorrhaging, and seizures during electrode placement, warns Sharma. Additionally, individuals might experience stimulation-induced side effects like tingling, tightness, or speech alterations, which might necessitate adjustments to minimize discomfort.
John Lipp, another trial participant, experienced a significant reduction in his Parkinson’s medications—from 15 down to four—after receiving the new system. Diagnosed in June 2015, the 59-year-old CEO of a nonprofit animal shelter in Alameda, California, primarily suffered from dystonia, describing it as “extremely painful muscle spasms and cramping.”
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Cameron Aldridge combines a scientific mind with a knack for storytelling. Passionate about discoveries and breakthroughs, Cameron unravels complex scientific advancements in a way that’s both informative and entertaining.