Brain pacemaker can help Parkinson's patients

Parkinson's disease: brain pacemaker keeps impulsive behavior in check

Parkinson's disease is an incurable chronic progressive disease of the central nervous system. However, there are treatment options that make life with Parkinson more bearable. Among other things, patients can benefit from a brain pacemaker.

Second most common neurodegenerative disease in Germany

According to the German Society of Neurology (DGN), Parkinson's disease is one of the most common diseases of the central nervous system. According to estimates, more than 400,000 people are affected in Germany. Parkinson's is the second most common neurodegenerative disease after Alzheimer's disease. The nervous disease is still incurable, but there are treatment options that make life more bearable for those affected. Deep brain stimulation (THS) not only relieves movement disorders in advanced Parkinson's disease, it also stabilizes mood, researchers have now discovered.

Parkinson's disease is one of the most common neurological diseases in Germany. Researchers have now discovered that a brain pacemaker not only relieves movement disorders but also stabilizes patient mood. (Image: Astrid Gast / fotolia.com)

Deep brain stimulation improves the condition

As the DGN and the German Parkinson Society (DPG) report in a joint press release, the published in the journal "Lancet Neurology" additional analysis of a Franco-German study (EARLYSTIM) refutes the fear that the surgical procedure emotional fluctuations and impulse control disorders Parkinson's patients could reinforce.

"On the contrary, the evaluation of the EARLYSTIM study shows that fluctuations under the stimulation treatment even decrease. The THS improves the condition significantly and to a degree that can not be achieved with medication alone, "says Professor Dr. med. Günter Deuschl of the DGN.

"The study provides good arguments for recommending THS to selected patients with neuropsychiatric fluctuations or impulse control disorders," comments Professor Rüdiger Hilker-Roggendorf, chief physician at the Department of Neurology at Klinikum Vest (Recklinghausen) and member of the DPG's Executive Board.

Already 150,000 patients successfully treated

Parkinson's disease is a chronic progressive disease in which, among other things cells in the so-called black substance (Substantia nigra) die in the brain. These cells produce the messenger dopamine, which is e.g. important for the control of motor skills.

If dopamine is lacking, the typical motor symptoms such as slowing down the speed of movement, pacing, speech impediments, tremors and stiffness in the arms and legs.

Deep brain stimulation (THS) - sometimes referred to as a "brain pacemaker" - can help if movement disorders can not be adequately controlled by medication.

In an operation microelectrodes are then implanted into the brain, which inhibit weak brain waves with weak surges. More than 150,000 patients worldwide have been successfully treated with this method.

Pulse control disorders are common

However, some experts feared that the process could increase the risk of unrestrained behaviors such as gambling addiction and spending spree or unrestrained sexuality.

Whether the cause of these so-called hyperdopaminergic disorders lies in the disease itself or in the electrical stimulation, was indistinguishable without detailed investigation.

However, a recent study with 251 Italian Parkinson's patients already suffering from motor complications of drug therapy (dyskinesia) revealed that impulse control disorders are common:

The proportion of those with impulse control disorder was 55 percent, and in 36 percent of cases, this was considered clinically meaningful.

"The present sub-analysis of the EARLYSTIM study shows with great scientific evidence that disorders of behavior and mood regulation can improve if the patients receive a THS early and then the dosage of the drug treatment can be reduced," says Professor Hilker-Roggendorf.

Improved quality of life

Initial results from the 251 patients study funded by the German Ministry of Health and the manufacturer of the brain pacemaker were published five years ago.

At that time, the researchers led by co-director of studies, Professor Deuschl, had made quality of life a central goal of the study.

Parkinson's patients who were also treated with deep brain stimulation had a higher quality of life than those who had received only medications.

Lower mood swings, better impulse control

The follow-up analysis shows that under a THS the emotional fluctuations of the patients are also improved. In patients who received only medication, the neuropsychiatric fluctuations remained unchanged.

With an additional THS, the corresponding score on the Ardouin Scale (Parkinson's Disease Ardouin Scale) decreased by 0.65 points.

The difference was also very large in the case of hyperdopaminergic behavioral disorders (impulse control disorders, hypomania, leapiness): With THS, the value decreased by 1.26 points - compared to an increase of 1.12 points, if the patients only received medication.

On the other hand, no difference was found in so-called hypodopaminergic behavioral disorders such as apathy and depression, regardless of whether the patients received exclusively medication or THS.

"The study answers important questions about the treatment of Parkinson's patients who suffer from unstable disease with mood swings and behavioral disorders," said Professor Hilker-Roggendorf.

"Medication-induced impulse control disorders can improve with THS, and apathy and depression do not increase with THS. The THS can be used in appropriate patients already in the middle disease stage with good efficacy and sufficient safety. "(Ad)