April is Parkinson’s Disease (PD) Awareness Month, commemorating the prevalence of this extremely stubborn, debilitating and difficult to treat chronic degenerative neurological disease.
What is Parkinson’s disease?
Ever since Dr. James Parkinson described trembling movements and descent in some individuals as “paralyzed agitans” in his famous “Trembling Paralysis Essay” in 1817, Parkinson’s disease has remained the source of great intrigue. among patients and physicians, primarily due to his resolutely progressive nature and tenacity. Parkinson’s disease is mainly characterized by tremors in the hands and legs, stiffness, slowness in activities, difficulty in walking, reduced facial expression, softening of the voice, among other symptoms. Contrary to popular belief, it is rarely genetic and is usually sporadic in the majority of cases.
Conventional management of Parkinson’s disease
A person with any or all of the above symptoms should be initially evaluated by a neurologist who specializes in movement disorders and the diagnosis is primarily clinical. A combination of progressively increasing antiparkinsonian drugs with structured neuro-rehabilitation tides in the early years. However, with the progression of the disease, the effectiveness of drugs gradually decreases and becomes unpredictable. Eventually, the patient tends to become dependent on his caregivers to a large extent even for his routine activities of daily living, thus becoming a source of great economic and psychosocial burden for the caregivers.
Is there a place for surgery?
Surgery for a cohort of these patients who suffer from advanced Parkinson’s disease is advised to improve their quality of life as well as to significantly reduce the need for anti-Parkinson’s drugs.
Historically, “ablative” surgeries targeting certain specific brain areas (depending on symptoms) were in vogue. However, the problem with such a surgical approach (causing permanent tissue damage) was its irreversibility and lack of adjustment to counter the progressive nature of the disease.
Thus, the need arose for a reversible and adjustable surgical therapy commensurate with the progressive nature of the disease, known as Brain-Pacemaker surgery or Deep Brain Stimulation (DBS) surgery. It is an esoteric therapy by which a neurosurgeon implants a device which sends electrical signals to specific brain areas, depending on the disease being treated and which can be “programmed” or modulated over time in synchronization with the progression of the disease so that long-term symptom control can be achieved.
Since the clinical elucidations of Dr. Benabid, who was a pioneering figure in the popularization of deep brain stimulation therapy beginning in the late 1980s, advanced Parkinson’s disease is by far the most commonly treated abnormality for the brain pacemaker surgery.
The sine qua non of successful brain stimulator surgery is precision and sub-millimeter accuracy. To this end, the inculcation of cutting-edge technological advancements in the conduct of deep brain stimulation surgery goes without saying.
One of the main innovations used in the clinical practice of brain stimulator surgery is the direct patient-specific targeting of neural circuits (comprising white matter pathways interspersed with gray matter relay stations), which is an emerging approach for refractory patients with Parkinson’s disease. as the next step. Since the effectiveness of deep brain stimulation surgery likely depends on precise and precise targeting of these brain circuits, better surgical planning using information obtained from advanced brain imaging MRI technologies such as fiber tracking methods (e.g. DTI: Diffusion Tensor Imaging), has shown consistent improvement in surgical outcomes.
Recently, we performed the first successful robotic brain stimulator awake neurosurgery procedure in India in an incurable patient with Parkinson’s disease. Robotic deep brain stimulation (R-DBS) surgery offers the benefit of not only reducing reliance on manual adjustments, but also improving overall surgical efficiency.
The application of artificial intelligence (AI) via machine learning holds great promise in some salient aspects of brain pacemaker surgery, such as patient selection, surgical targeting, and eventual optimization of pacemaker programming. cerebral.
Another ingenious technological aspect being explored is a real-time feedback analysis of local field potentials by the brain stimulator’s pulse generator itself, which would then automatically trigger a closed-loop feedforward stimulation response, at the as needed, to the brain to mitigate any unpredictable manifestation of PD symptoms as much as possible. This technology promises to obviate the need for frequent doctor-dependent manual brain stimulator programming sessions that have until now been mandatory after ‘conventional’ brain stimulator surgery.
Remote-controlled satellite-assisted modulation of the brain stimulator directly from the doctor’s office, enabling fine-tuning of the DBS device of patients seated at remote locations in the comfort of their living room, without the need to travel long-distances for sessions. follow-up programming, has also proven to be a game-changing innovation, improving overall patient adherence to this therapy.
In conclusion, a harmonious blend of cutting-edge technological innovations with the epitome of “Human-Touch” (including proper case selection, adequate target planning, detailed intraoperative electrophysiological and neurological assessments) is required for successful surgery. of the brain stimulator and, consequently, improve the quality of life of thousands of patients with Parkinson’s disease who are severely disabled and resistant to advanced drugs. A balanced holistic approach, including minimal medication, regular exercise as well as appropriate brain pacemaker neuromodulation, serves best to bring these socially ostracized patients back into the productive mainstream.
The opinions expressed above are those of the author.
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