Discovery could lead to more precise way to treat symptoms of advanced Parkinson’s disease

Victoria D. Doty

College of Alberta scientists have found a prospective biomarker—the reaction of a distinct reflex in the physique dubbed the Hoffmann reflex—that would help surgeons provide deep brain stimulation (DBS) much more specifically and correctly to people with superior Parkinson’s ailment.

The operate, led by U of A neurosurgeon Tejas Sankar, was recently published in the journal Brain Stimulation. DBS will involve implanting electrodes into the brain and connecting them to a pacemaker-like device in the upper body wall. These electrodes can then be programmed to provide substantial-frequency stimulation that enhances the indications of Parkinson’s ailment.

Sankar, an associate professor of operation in the Faculty of Medication & Dentistry and member of the Neuroscience and Mental Well being Institute, is the only neurosurgeon in Edmonton now doing the process, which can immensely boost the high quality of lifetime for men and women with superior Parkinson’s. It is painstaking operate, owing to the issues involved in placement of the electrodes.

“The wires we implant into the brain are pretty compact, and it takes the much better aspect of quite a few hours with an awake patient in the running area to place these electrodes specifically where by they have to have to go,” claimed Sankar. The surgical group confirms that the placement is proper by a wide range of checks, such as imaging, recording neurophysiological indicators and screening the patient with stimulation when they are on the table, to see irrespective of whether indications this kind of as tremors are lowered.

When in the end productive, the latter method of screening isn’t best, Sankar noted.

“It’s a subjective approach and it’s pretty tiring to the people and to the group as it takes a lot of, a lot of hours,” he claimed. “There’s been a extended-standing intention in deep brain stimulation operation to attempt to discover some type of biomarker that through operation will inform you you’ve put the electrode specifically where by it ought to be to get the very best outcome.”

Checking a reflex for much better results
In the Hoffmann reflex—a examination medical doctors use to examine the reflexes of the higher extremities—Sankar and his group have located a promising applicant for the extended-sought-immediately after biomarker. He was influenced by a collaboration he experienced with the late neuroscientist Richard Stein, who studied spinal reflexes such as the Hoffmann, which has been used for a long time to assess neurological functions for various conditions. The reflex is pretty simply provoked, can be studied in various muscle tissues and doesn’t have to have patient participation, creating it an best applicant for use through deep brain stimulation operation.

Sankar claimed the Hoffmann reflex is related to the acquainted knee reflex examination, where by tapping a tendon in the knee results in other muscle tissues in the leg to contract and the leg to kick in reaction. The Hoffmann reflex generates a attribute response in most individuals, but it is altered in individuals with Parkinson’s. Sankar and his group verified that the electrode placement determined by the Hoffmann reflex examination mirrored the placement verified by the current method of checks and assessments.

Verifying the ideal electrode placement is an ongoing obstacle with deep brain stimulation operation, with suboptimal placement developing in up to 17 per cent of instances. A biomarker that could probably guarantee precise placement would help to minimize prospective stimulation-associated aspect-consequences and provide the biggest attainable profit to people.

“The serious estate is really useful in the brain, so if we provide the electrode to specifically the proper location and we convert on the stimulation and hold it confined to that location, (people) can have spectacular added benefits to their indications of Parkinson’s,” claimed Sankar.

Collaborators on Sankar’s group contain Jennifer Andrews, a post-doctoral fellow who did significantly of the experimental operate inspecting the reflex and Francois Roy, a clinical neurophysiologist who is Sankar’s co-investigator on a Kaye Fund Grant.

Possible programs immediately after operation
The group is also inspecting irrespective of whether the very same reflex can be used to guide the programming of electrical stimulations immediately after operation. Another collaborator, NMHI member and neurologist Fang Ba, fulfills with people about quite a few months next deep brain stimulation operation, choosing various stimulation parameters and hoping to optimize the management of various Parkinson’s indications. The Hoffmann reflex could make this post-surgical approach much more efficient as properly.

Future measures involve searching at what happens to the Hoffmann reflex when a patient is less than typical anaesthesia to determine irrespective of whether the operation could be completed less than individuals parameters and delving even further into the ways it can be used immediately after operation.

In accordance to Sankar, the biomarker could be used to track the development of Parkinson’s, and to seem for other reflexes that may perhaps execute as properly as the Hoffmann reflex, if not much better.

Source: College of Alberta


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