Advances Broaden Treatment Options for Parkinson’s Disease Motor Symptoms
Deep Brain Stimulation
Approved in 2002, the implantable Activa DBS system by Medtronic is indicated for idiopathic Parkinson’s disease of at least four years’ duration in patients who have disabling motor symptoms despite being on an optimized medication regimen but continue, even if briefly, to respond to levodopa, Dr. Fisher said. Used as adjunctive therapy, it provides bilateral stimulation of the internal globus pallidus or the subthalamic nucleus. In one study, patients had significant improvements in on and off time after six months of surgery.
Similar benefits were found for the St. Jude Medical Infinity DBS system, which was approved by the FDA in 2015. The system includes directional lead technology designed to allow physicians to precisely steer current towards the desired structural areas, thereby maximizing symptom management and potentially reducing adverse effects.
The newest DBS system on the market is the Vercise system by Boston Scientific. “This is the only platform that allows independent current delivery to each of the 16 electrodes on the implanted leads,” Dr. Fisher said. “The rechargeable system has a battery life of more than 15 years.” Although the technology has been available in Europe for the last five years, the Vercise system was approved for use in the US in December 2017. Its approval was based on the results of the INTREPID study, the first multicenter, prospective, double-blind, randomized sham-controlled study of DBS for Parkinson’s disease in the US.
“The technology is truly amazing,” Dr. Fisher said. “How the systemperforms in clinical practice remains to be seen.”
—Adriene Marshall
Suggested Reading
Borgohain R, Szasz J, Stanzione P, et al. Randomized trial of safinamide add-on to levodopa in Parkinson’s disease with motor fluctuations. Mov Disord. 2014;29(2):229-237.
Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med. 2004;351(24):2498-2508.
Hely MA, Morris JG, Reid WG, Trafficante R. Sydney Multicenter Study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005;20(2):190-199.
Pahwa R, Tanner CM, Hauser RA, et al. ADS-5102 (Amantadine) extended-release capsules for levodopa-induced dyskinesia in Parkinson disease (EASE LID Study): a randomized clinical trial. JAMA Neurol. 2017;74(8):941-949.
Schuepbach WM, Rau J, Knudsen K, et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med. 2013;368(7):610-622.
