Adaptive DBS - a 24/7 surgeon in your head

In the six decades or so since Levodopa came on the scene there has really been only one other innovation that has proved to be a major breakthrough in the treatment of Parkinson’s. It is thirty years since Deep Brain Stimulation (DBS) operations began in the UK and about 400 people for whom drugs are proving less effective or having serious side effects are now treated every year. But now it appears there is going to be another big leap forward with a new advanced treatment called adaptive DBS.

The healthtech company Medtronic, the leading supplier of DBS equipment, put out a press release this week describing its new system as “groundbreaking new technology… that can adjust treatment in real-time based on brain activity to provide personalised care.” The release said a surgeon at Newcastle’s Royal Victoria Infirmary Mohammed Hussain was among those pioneering the new treatment so I got him to explain how it worked.

First, he reminded me that existing DBS systems involve placing two wires in the part of the brain that controls movement and attaching them to a device very similar to a pacemaker which is installed in the patient’s chest. Over the years ever more sophisticated software inside the little box has given surgeons greater visibility over what the electrical stimulation is doing inside the brain, allowing them to modulate the signal accordingly.

Now, says Mr Hussain, adaptive DBS is automating that process: “Give it the parameters, and it'll adjust to optimise your settings to allow you to have the best stimulus for you as as and when you need it throughout the day.”

So instead of having to meet up with their surgeon every few months to have their system tweaked, the new technology will do that job continuously: “It's almost like having me with you 24 hours a day.”

At the very least, he says, adaptive DBS will be more energy efficient meaning the equipment installed in patients should last longer. “But if it is able to stimulate more when the patient needs more, and stimulate less when the patient needs less, hopefully, we'll find that it'll give the patient an overall better experience with the DBS. “

It sounds as though this should rapidly become the standard option for anyone getting DBS - after all why would anyone want a non-adaptive system? But Mr Hussain was surprisingly cautious about this, wanting more data on how patients fitted with adaptive DBS fared and speculating that it might not work for everybody.

And, rather admirably for someone who had been put up to speak by Medtronic’s PR agency, he warned about the dangers of getting carried away by the hype around anything new:

“We have to be a little bit mindful in our practice as clinicians, to make sure that we are making use of all the innovative technologies that are out there, but just not jump on a bandwagon just because it's there, and make sure we are testing it, revising it, looking at the clinical effects of it, before we say this should be there for everybody.”

Nevertheless, I predict that there will be lots of demand for adaptive DBS and a lengthening queue. Although the new system should not come with extra costs - it is after all just a software update - it is still an expensive procedure for which some people are forced to wait for years. But if it lives up to its promise the new technology should increase the productivity of neurosurgeons who no longer have to schedule so many follow up appointments with their DBS patients. Just the kind of innovation the government says the NHS needs…