Brains Behind Best Parkinson’s Treatment

Led by the University of Western Australia’s (UWA) School of Psychiatry and Neurosciences, Professor Sergio Starkstein, and School of Surgery, Professor Christopher Lind, the study will focus on understanding the regions of the brain associated with severe tremor and motor fluctuations, as well as the best technique to treat these symptoms in people with Parkinson’s.

Professors’ Lind and Starkstein’s team seek to improve an existing technique, known as Deep Brain Stimulation, to reduce motor symptoms, by targeting a new region of the brain to achieve better results.

“So far, Deep Brain Stimulation of the subthalamic nucleus, is one of the most effective treatments for patients with Parkinson’s who have marked ON-OFF fluctuations, severe tremor or dyskinesia (involuntary movement) resulting from long-term use of medication,” Professor Starkstein says.

“However, the experience collected during the past 10 years shows that some patients may develop emotional and behavioural side-effects after the surgery, such as apathy and depression, as well as cognitive deficits, such as decline in memory and word fluency.

“Therefore, one of the most interesting challenges in Deep Brain Stimulation for people with Parkinson’s is to find brain sites that provide the best motor improvement with the least side effects.”

Professor Starkstein says his group had been studying a new target for Deep Brain Stimulation, known as the posterior subthalamic area, which promised to deliver similar or even better motor responses upon stimulation, with less emotional and cognitive side effects.

“We completed a pilot study of nine patients with Parkinson’s using the new technique, which showed significant motor improvement in the absence of cognitive deficits or psychiatric changes,” he says.

“We have since started a more ambitious study to determine the site within the new target that delivers the best motor response, while providing the greatest safety in terms of cognitive or psychiatric complications.”

Professor Starkstein says 15 patients had already had surgery and been clinically assessed and the funds from the Zrinski Research Grant would allow the team to add an additional 25 patients to complete the study and clinical assessments.

“We are also acquiring sophisticated brain images which will be analysed with state-of-the-art methods, and hopefully identify those individuals who will obtain the greatest benefit from subthalamic area Deep Brain Stimulation,” he says.

According to Professor Starkstein it was the first study to carry out sophisticated brain imaging analysis to identify brain structural and metabolic markers that predict the best motor response.