The implantation of deep brain stimulation (DBS) devices at an early stage of
Parkinson’s disease – rather than at an advanced one – has been shown, in a
breakthrough study published Thursday, to significantly reduce the tremors and
other symptoms of the widespread neurodegenerative disease that begins mostly
from age 60. The study, which appears in the prestigious New England Journal of
Medicine, is likely to end the global practice up to now of implanting an
electrical stimulating device only as a last resort, when medications are no
The use of DBS devices, implanted under the thalamus in
the brain, for Parkinson’s began in 1993 and was approved by the US Food and
Drug Administration in 2001.
In 2005 the procedure was included in
Israel’s basket of health services covered by the health funds, according to
Zvi Israel, a senior lecturer in neurosurgery at Hadassah University
Medical Center in Jerusalem’s Ein Kerem.
Israel, who is director of its
center for functional and restorative neurosurgery, is a leading Israeli
physician who implants DBS devices into Parkinson’s patients.
until now been reserved for those patients with fairly advanced disease, who
have already developed complications of medical therapy. DBS turns the clock
back on the disease for these patients by many years.
effects are very dramatic. Most patients enjoy a much better quality of life,
often regaining independence and reducing their medication by an average of 50
percent,” he told The Jerusalem Post, in commenting on the new
“Despite the demonstration that DBS is a better option than best
medical therapy for these patients, there has been a certain reluctance to send
them for invasive therapy for many reasons, not all of which were in the
patients’ best interests. Among others, potential complications of surgery would
be stressed,” Israel continued.
The Hadassah neurosurgeon said that
“occasionally, we would see a younger patient referred for surgery who could not
tolerate medication, and these patients would do remarkably well.
has been a trend, certainly in the experienced centers, to offer surgery at an
earlier stage of disease. This is based on the premise that the risks of surgery
are low, and that we have a responsibility to provide a better quality of life
for our patients as soon as possible. This has not been an easy sell, because it
involves something of a paradigm shift in the way that Parkinson’s has been
managed for so many years.”
Thus, publication of the journal article is
very important, as “reputable neurologists [at Christian-Albrechts University in
Kiel, Germany] have compared early DBS to best medical therapy and have shown it
to be significantly better for motor outcome and for multiple measures of
quality of life,” Israel said.
There is no cure for Parkinson’s, which is
a progressive, fatal disease that affects breathing, balance, movement and heart
function and is one of the most common nervous system disorders of the elderly.
Estimates in the US alone are from 500,000 to 1 million cases, while there are
tens of thousands in Israel. Some cases, however, begin as early as age
The disease is caused by the slow deterioration of the nerve cells in
the brain that create the neurotransmitter dopamine, which helps control muscle
movement throughout the body. When dopamine supplies decline, tremors and other
symptoms begin, but after a few years of dopamine-replacement therapy, it loses
its effect. Azilect (rasagiline), a drug developed at the Technion-Israel
Institute of Technology and produced by the Israeli company Teva Neuroscience,
has been found to relieve symptoms, but only in the short-term.
German researchers, in a two-year trial, randomly assigned 251 patients with an
average age of 52 who had the disease for an average of seven-and-a-half years
to undergo the implantation of a DBS plus medical therapy or medical therapy
alone. They concluded that neurostimulation was superior to medical therapy
alone at a relatively early stage of Parkinson, before the appearance of severe
disabling motor complications.
The leading producer of DBS equipment for
Parkinson’s is Medtronic, based in Minnesota and the world’s largest medical
technology company, with branches in 120 countries, including Israel. It is
sure, on the basis of the new study, to apply for addition to Israel’s health