YOUR HEALTH
Advances in Brain Surgery Treatments for Parkinson’s Disease Opens New Approaches to Addiction and Alzheimer’s Disease Joseph C. Maroon MD, FACS
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ery often in the field of medicine when a new medication or surgical treatment is discovered, physicians and researchers begin to wonder if the advancement might help other conditions or illness besides the original intended condition. Perhaps one of the most profound adaptations of a great idea was to modify the cardiac pacemaker, which was approved for human use in 1959, to target very specific areas in the brain. In the 1990s, that is exactly what the Medtronic Co. did. Working with neurosurgeons, a thin electrical lead with image guidance is inserted into a location deep within the brain and connected to a battery under the skin of the chest wall. By programming an adjustable microcurrent of electricity to the lead implanted during brain surgery while the patient was awake, the current would often completely stop disabling tremors of Parkinson’s Disease and other movement disorder conditions. Fast forward to the 2000s, physicians who were treating tremors with Medtronic’s modified pacemaker, called a Deep Brain Stimulator or DBS, began to notice a variety of behavioral changes in patients beyond tremor reduction. Reductions of depression symptoms and decreased appetite with weight loss were being reported. As additional patients with essential tremor
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and other causes of tremor were being treated by DBS, a large patient data base demonstrated other brain targets for stimulation could result in a wide variety of mental health benefits besides tremor reduction. More recently, researchers right here in Western Pennsylvania and northern West Virginia, at UPMC, AHN and WVU Medical Center in Morgantown, have made discoveries demonstrating profound mental health benefits targeting new brain locations using DBS. FDA-approved research, led by neurosurgeons and neurologists, has shown significant improvements in patients with depression, obsessive compulsive disorder and even reduced addiction cravings for opioids. The latest advancement is targeting the brain of Alzheimer’s patients, and it’s being done without requiring any surgery at all. Described as “non-invasive surgery,” modified low intensity ultrasound technology is being used to externally highly focus beams of ultrasound into various areas of the brain with a focal point of less than one millimeter in size. Once focused, these beams can generate heat. For Alzheimer’s patients the focused beam of ultrasound is directed into Alzheimer’s related brain plaques. Changes caused by the heat allow the latest Alzheimer’s drugs to cross the
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blood-brain barrier more easily and allow for a more potent and focused drug delivery. Follow-up MRIs on treated patients have shown significant size and density reductions of the treated Alzheimer’s plaques when co-treated with the focused ultrasound beam and the Alzheimer’s drug compared to areas that were not treated with the ultrasound. What the future holds for a modified brain “pacemaker,” beyond its use for tremors and behavior disorders, or the use of a modified ultrasound device for co-treating Alzheimer’s disease, is still unclear. But it’s clear that researchers, including those right here in our communities, as well as Elon Musk, are pushing technologies and research into areas that would have seemed impossible only several years ago. The brain has always been considered the last frontier in medicine. But despite the many setbacks in treating brain disease and decline, there is hope. I personally believe major breakthroughs will continue and change the lives of many with mood and substance abuse disorders. n Joseph C. Maroon, MD is a Board-Certified Neurosurgeon, Nutritional and Sports Medicine Expert. Dr. Maroon has written and lectured extensively on brain health and healthy life choices. As a competitive Ironman triathlete, Dr. Maroon practices what he preaches and is committed to the promoting healthy choices to his patients and readers.