UC San Francisco scientists have discovered a possible mechanism for how deep-brain stimulation (DBS), a widely used treatment for movement disorders, exerts its therapeutic effects.
Few medical treatments show results as rapid and dramatic as those seen with DBS, in which surgically implanted devices deliver electrical pulses to inner brain structures involved in movement. In most Parkinson's disease (PD) patients who receive the treatment, symptoms of slow movement, tremor, and rigidity sharply diminish soon after the stimulation device is activated, and quickly return if the device is turned off.
But surprisingly, there has been very little understanding of precisely why and how DBS works so well--a lack of knowledge that has held back efforts to further improve the therapy. Despite the great success of DBS, some significant problems remain. Customizing the stimulation delivered by DBS devices for each patient to maximally reduce symptoms is challenging and time-consuming. And a minority of patients never obtains the full benefit their physicians expect. With a better understanding of how DBS acts on brain circuits, researchers hope to address these shortcomings and make DBS an even more effective treatment.
The new research, published online April 13, 2015 in Nature Neuroscience, reveals that DBS keeps PD symptoms in check by reducing excessive synchronization of brain activity in the motor cortex, a region on the outer surface of the brain that governs movements of the body.
"This therapy is becoming widespread for many brain disorders aside from movement disorders, including psychiatric conditions such as depression, but no one knows how it works," said UCSF's Philip Starr, MD, PhD, the Dolores Cakebread Chair in Neurological Surgery and senior author of the new study. "This is a significant step in answering this question on the level of brain networks, not just addressing where you're actually applying the stimulation in the brain."
Previous research led by Coralie de Hemptinne, PhD, a postdoctoral fellow in Starr's laboratory, laid the groundwork for the new study. In 2013, de Hemptinne, Starr, and colleagues reported in the Proceedings of the National Academy of Sciences that a measure of synchronized rhythmic activity in the brain, which normally varies with movement or other behaviors, is excessively high in in the cortex in PD.
In that paper, the team hypothesized that this lockstep synchronization of brain circuits in PD thwarts the flexibility the brain requires to plan and execute movements, and that DBS might work by decoupling activity patterns in the motor cortex.
In the new work, "since we had found this excessive synchrony in PD patients, we decided to see if there's a relationship between that synchrony and symptoms, and whether synchrony is lessened when symptoms are improved by DBS," said de Hemptinne, first author of the Nature Neuroscience paper. "We measured synchrony in the motor area of the brain before, during, and after DBS, and while the patient was resting or engaged in a movement task in which they had to reach and touch a computer screen."
During surgery on 23 patients with Parkinson's disease in whom permanent DBS electrodes were being surgically implanted, the UCSF team slid a temporary strip of 6 recording electrodes under the skull and placed it over the motor cortex. As in the prior research, recordings of neural activity showed excessive synchronization of activity rhythms in the patients.
As the name of the therapy implies, the end of the stimulating lead of DBS devices is placed in a structure deep in the brain known as the subthalamic nucleus (STN), which is part of a "loop" of neural circuitry that includes the motor cortex on the brain's surface. When the DBS device was activated and began stimulating the STN, the effect of the stimulation reached the motor cortex, where over-synchronization rapidly diminished. If the device was turned off, excessive synchrony re-emerged, more gradually in some patients than others.
Read more:
How deep-brain stimulation reshapes neural circuits in Parkinson's disease
- Tango Parkinson's Therapy (Washington U. in St. Louis) - May 7th, 2011 [May 7th, 2011]
- Parkinson's Disease Treatment-Exercise Program-Part 2 of 4 - May 14th, 2011 [May 14th, 2011]
- Parkinson's Disease Stem Cell Treatment - Part 2 - May 21st, 2011 [May 21st, 2011]
- Deep Brain Stimulation treatment for Parkinson's disease - May 22nd, 2011 [May 22nd, 2011]
- Parkinson's Disease Treatment-Exercise Program-Part 4 of 4 - May 24th, 2011 [May 24th, 2011]
- James, Parkinson's disease, after stem cell treatment at Tiantan Puhua Hospital Beijing - May 30th, 2011 [May 30th, 2011]
- Parkinson's Disease Stem Cell Treatment - Part 1 - May 30th, 2011 [May 30th, 2011]
- Parkinson's Disease Treatment -- Mayo Clinic - June 2nd, 2011 [June 2nd, 2011]
- When should I start treatment if I have Parkinson's Disease? - June 3rd, 2011 [June 3rd, 2011]
- parkinson-treatment-with-cupping-4.flv - June 3rd, 2011 [June 3rd, 2011]
- New treatment options for Parkinson's Disease feat. Nashville Predators coach Brent Peterson - June 8th, 2011 [June 8th, 2011]
- Speech Treatment in Parkinson disease: Sharon Kha's Story - June 8th, 2011 [June 8th, 2011]
- How you can help cure Parkinson's - June 9th, 2011 [June 9th, 2011]
- TV9 - LADIES CLUB : "PARKINSON DISEASE" - CAUSE, SYMPTOMS - June 9th, 2011 [June 9th, 2011]
- Parkinson's Treatment: Case #1 - June 12th, 2011 [June 12th, 2011]
- parkinsons cure - June 17th, 2011 [June 17th, 2011]
- A Parkinson Patient Finds their Miracle. FCR Treatment helps Parkinson's Disease. - July 3rd, 2011 [July 3rd, 2011]
- Parkinson's Treatment: Case #2 - July 15th, 2011 [July 15th, 2011]
- TMJ Treatment Helping with Parkinson's Symptoms Dr. Gary Demerjian Burbank, California - July 15th, 2011 [July 15th, 2011]
- Parkinson's Treatment at Ta'ir Laser Center testimonial - July 16th, 2011 [July 16th, 2011]
- Parkinson's Disease client pre and post treatment - July 17th, 2011 [July 17th, 2011]
- Parkinson's Disease: Diagnosis, Causes and Treatment. Part 2 - July 18th, 2011 [July 18th, 2011]
- Parkinson's Disease: Diagnosis, Causes and Treatment part4 - July 18th, 2011 [July 18th, 2011]
- Glutathione for Parkinson's Disease. Learn why it helps symtoms - July 18th, 2011 [July 18th, 2011]
- Parkinson's Disease: Diagnosis, Causes and Treatment. - July 19th, 2011 [July 19th, 2011]
- parkinson-treatment-with-cupping-1.flv - July 20th, 2011 [July 20th, 2011]
- 7.30 - a treatment for Parkinson's Disease can cause problem gambling - July 27th, 2011 [July 27th, 2011]
- Parkinson's Disease Symptoms Improve with Non-Surgical TMJ Treatment: Dr. Gary Demerjian - July 29th, 2011 [July 29th, 2011]
- Werth Parkinson Centre, Daniella - Treatment - August 4th, 2011 [August 4th, 2011]
- 6.30 - Parkinson's treatment - August 19th, 2011 [August 19th, 2011]
- MDTV: New Drug Treatments for Parkinson's Disease - September 10th, 2011 [September 10th, 2011]
- Pakistan Parkinson's Disease patient Treatment, in chennai Surgery hospital - DINAMALAR - September 23rd, 2011 [September 23rd, 2011]
- Parkinson's treatment gives life back - October 2nd, 2011 [October 2nd, 2011]
- Parkinson Doctor Sarasota Discusses Parkinson's Disease Treatments - Video - October 15th, 2011 [October 15th, 2011]
- New treatments for Parkinson's disease - pt 1 - Video - October 16th, 2011 [October 16th, 2011]
- Parkinson's Disease Treatment - Year and a Half Later... - Video - October 19th, 2011 [October 19th, 2011]
- Still Life: The Search for a Parkinson's Cure - Video - October 22nd, 2011 [October 22nd, 2011]
- Can Exercise Treat Parkinson's? - Video - October 30th, 2011 [October 30th, 2011]
- Parkinsons Treatments | Symptoms Parkinsons - Video - November 2nd, 2011 [November 2nd, 2011]
- Symptoms - November 3rd, 2011 [November 3rd, 2011]
- Revolutionary Treatment for Parkinson's - Video - November 4th, 2011 [November 4th, 2011]
- Herbal Treatment for Parkinsons disease and recovery - Video - November 7th, 2011 [November 7th, 2011]
- Early Diagnosis and Treatment of Parkinson's Disease - Video - November 10th, 2011 [November 10th, 2011]
- Parkinson's Disease Treatment (part 1 of 4) at Penn Medicine - Video - November 15th, 2011 [November 15th, 2011]
- Parkinson's Disease Treatment - Video - November 18th, 2011 [November 18th, 2011]
- MDTV: Parkinson's Disease: Treating Off Times - Video - November 20th, 2011 [November 20th, 2011]
- parkinson-treatment-with-hijamah-therapy.3gp - Video - November 24th, 2011 [November 24th, 2011]
- parkinson-treatment-with-cupping-2.flv - Video - December 3rd, 2011 [December 3rd, 2011]
- Parkinsons Antioxident treatment before with Dr. Offutt.MOV - Video - December 7th, 2011 [December 7th, 2011]
- Teva Presenting Data on MS and Parkinson's Disease Treatments - Video - December 7th, 2011 [December 7th, 2011]
- LSVT® LOUD Treatment Benefits Parkinson's Disease Patient -- Hendricks Regional Health - Video - December 14th, 2011 [December 14th, 2011]
- Parkinson's Cure - Dating - Video - December 21st, 2011 [December 21st, 2011]
- Parkinson's Treatment part-2 - Video - December 29th, 2011 [December 29th, 2011]
- Parkinson's Treatment - Video - January 1st, 2012 [January 1st, 2012]
- Parkinson's Treatment - Deep Brain Stimulation - Video - January 2nd, 2012 [January 2nd, 2012]
- Parkinson's cure with out medicine - Video - January 10th, 2012 [January 10th, 2012]
- Parkinson's Disease and The Argentine Tango - Video - January 11th, 2012 [January 11th, 2012]
- Parkinson treatment shows positive results in clinical testing - Video - January 15th, 2012 [January 15th, 2012]
- Parkinson's Disease Treatment - Patient Testimony "Lad" - Video - January 27th, 2012 [January 27th, 2012]
- Parkinson - Video - January 27th, 2012 [January 27th, 2012]
- parkinson-treatment-with-cupping-3.flv - Video - January 28th, 2012 [January 28th, 2012]
- Parkinson's Disease: Balance, Gait (Walk) and Tremors Improve with New Non-Surgical Treatment Part 2 - Video - January 29th, 2012 [January 29th, 2012]
- Researchers visualize the development of Parkinson's cells - January 31st, 2012 [January 31st, 2012]
- NPH diagnosis in San Tan Valley man returns him to normal life - January 31st, 2012 [January 31st, 2012]
- Laser targeting could help fight Parkinson's - February 1st, 2012 [February 1st, 2012]
- Study of live human neurons reveals Parkinson's origins - February 7th, 2012 [February 7th, 2012]
- Lauren Sciences LLC awarded MJFF grant to develop a V-SmartTM therapeutic for Parkinson's disease - February 7th, 2012 [February 7th, 2012]
- "Biochemistry", Advances in Parkinson's Disease Treatment - Video - February 7th, 2012 [February 7th, 2012]
- Parkinson's Disease Symptoms Improve with Non-Surgical TMJ Treatment: Part 2 - Video - February 7th, 2012 [February 7th, 2012]
- Treatment of Parkinson's Disease Symptoms - Video - February 7th, 2012 [February 7th, 2012]
- Parkinson Disease - Surgical Treatment - Video - February 8th, 2012 [February 8th, 2012]
- MediGait Announces: GaitAid Device for Parkinson's Disease Shows Significant Step-initiation Improvement in New Trial ... - February 14th, 2012 [February 14th, 2012]
- Tai Chi Makes Parkinson’s Patients Steadier on Feet, Study Says - February 14th, 2012 [February 14th, 2012]
- Cleveland Clinic Joins 23andMe in the Search for Genetic Clues to Parkinson's Disease - February 14th, 2012 [February 14th, 2012]
- Cleveland Clinic to Recruit Parkinson's Patients for 23andMe - February 14th, 2012 [February 14th, 2012]
- Fairhope Parkinson's patient enters film in contest to awareness of disease - February 15th, 2012 [February 15th, 2012]
- Tai Chi may help Parkinson's patients regain balance - February 16th, 2012 [February 16th, 2012]
- Weight Training May Help Parkinson's Patients Retain Function - February 17th, 2012 [February 17th, 2012]
- Parkinson's Disease and Exercise: How Much Is Beneficial? - February 17th, 2012 [February 17th, 2012]
- Study shows exercise may help Parkinson's patients - February 17th, 2012 [February 17th, 2012]