Movement Disorders
- Preliminary results from an open-label study of Gamma Knife subthalamotomy for Parkinson’s disease were reported by Regis et al. at WSSFN. Patients experienced a 66 percent reduction in dyskinesia, but UPDRS motor score benefit and motor fluctuation benefit were modest.
- A small, open-label study of spinal cord stimulation in Parkinson’s disease patients with postural instability and gait disturbance showed a marked benefit in timed-walking tests. Larger trials are underway to confirm this finding (Pinto de Souza et al., Mov Dis 2017).
- DBS for MS tremor has been controversial. A small, randomized trial demonstrated an approximately 30 percent benefit in severity score (Oliveria et al., Lancet Neurol 2017).
- Boston Scientific received EU permission to market its Vercise Gevia deep brain stimulation system. The Gevia system features directional, constant-current stimulation with independent current control for each segment and is MRI conditional and rechargeable. It is not yet available in the U.S.
Epilepsy
- The first large, randomized, controlled study of a component of medical marijuana for refractory epilepsy was published. Patients with Dravet syndrome, a hard-to-control seizure disorder, experienced a significant decrease in seizure frequency (Devinsky et al., NEJM 2017).
- The Neuropace responsive neurostimulation (RNS) device was the subject of several recent studies. Two subgroup analyses of the largest prospective RNS study were published, describing 70 percent seizure reduction in mesial temporal onsets (Geller et al., Epilepsia 2017) and 58 percent seizure reduction with neocortical onsets (Jobst et al., Epilepsia 2017).
Chronic pain
- Medtronic has released its Intellis platform for spinal cord stimulation. The Intellis platform features much longerdistance wireless programing than any prior Medtronic device, as well as improved recharging capabilities. The trial electrodes are also programmable in a wireless fashion.
- Nevro has initiated the SENZA-PDN study to evaluate the efficacy of high-dose stimulation to treat painful diabetic neuropathy. The original SENZA randomized controlled trial was selected as the top pain paper of 2016-2017 by Neurosurgery (Kapural et al., Neurosurg 2016).
New Directions
- While results from the BROADEN trial of DBS for depression (halted at interim futility analysis) are not yet available, recent data suggests that individualized targeting strategies may improve outcomes. The Emory group has refined their targeting approach using DTI to prospectively identify key white matter structures and reported an 82 percent one-year response rate (Riva-Posse et al., Mol Psych 2017).
- A relatively large (19 patients) randomized trial of pallidal stimulation for Tourette’s did not show a benefit at three months of blinded stimulation, which was the primary endpoint (Welter et al., Lancet Neurol 2017).
- Cerebellar deep brain stimulation may help with recovery after stroke. Preliminary human results presented by Baker et al. were described at the WSSFN meeting, and a larger trial is ongoing.
- For the first time, a fully implanted visual prosthetic was implanted in a human being with blindness. Phosphenes were reliably produced using the Neuropace RNS device, as reported by Pouratian et al. at WSSFN.
- The medial forebrain bundle has emerged as a promising therapeutic target in major depression. Promising results from Europe have recently been published (Bewernick et al., Brain Stim 2017), and similar results were also reported by Fenoy et al. at WSSFN.
- A novel technique for noninvasive deep brain stimulation was demonstrated by a group at MIT and shown to affect neural activity (Grossman et al. Cell 2017). Multiple interfering electrical fields influenced spiking activity in rodents. Of course, many years of further work will be needed before any such device is trialed in humans.
Chuck Mikell, MD
Stony Brook, NY
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Updated 10/20/2020