Deep Brain Stimulation

IMO DBS is still very much a treatment of last resort, and it is likely to remain so.

Videnovic and Metman (2008) indicate that the foundation for meaningful risk/benefit analysis is still lacking.

The need for specialized treatment and management of adverse outcomes means DBS treatments can only be of benefit in a society with an abundance of medical resources. Okun et al (2005) studied DBS patients with unsatisfactory outcomes: note the number of specialists involved in assessing and managing. Read and see how many things can go wrong. Does India have the resources to handle DBS patient needs?

Depression and suicide are reported adverse effects of DBS, not cured by it, as in for example Appleby et al (2007). There is a trade-off in cognitive executive functions as well, as per Witt et al (2008).

It's true I am pessimistic about these treatments and I am biased to look at the risks, whereas another reader might be tempted by the more positive reports. The device industry is a growth area, there's fierce competition to get into it, and big money motives to promote the business and to recruit patients who are, in effect, carrying the burden of research. This is considered an acceptable risk to a patient who is desperate. The promoters who stand to gain financially are expected to be biased when it comes to assessing the risks and costs to others.

My personal feeling is that we need to learn more about the epidemiology and causes of Parkinsons, and that advances will be made through better diagnostic testing technologies, and through technology that allows knowledge-gathering of the environmental factors that contribute to neural disorders.

My experience: A dear friend had a severe case of Parkinson's, and the doctors told him that deep brain stimulation would cure his condition. He went for treatment in a noted U. S. hospital, had the procedure done. During the procedure, his brain hemorrhaged, and as a result, today he is essentially a vegetable, in a long term care nursing home and essentially restrained to keep him from wandering away, or hurting himself.

That is very sad. The adverse events/ side effects of the stimulator treatments are nasty, and very common. Doctors talk about things being "well tolerated": I guess in some cases there is relief in exchange for the bad stuff. But the absolute risk - the possibility of death, or severe disability as in your friend - means that the individual who seeks this treatment must be so desperate as to risk their life for the chance of a benefit.

This research is being done right now by St. Jude Medical Inc. and possibly Medtronic.

I didn't know St. Jude Medical had a DBS prototype. Medtronic is the industry leader - their 'Activa' system has been in use for decades. The other seem to be aiming for lower profile designs as a way to capture market share.

Advanced Bionics has a DBS prototype with a smaller package and extended parameters, which they make available to research interests "for animal research" free of charge, according to the poster published in 2006 NINDS workshop booklet here, poster abstracts page 118.

A DBS Consortium report is also available at the NINDS link above.