Christopher Dacanay SYSTEM — Robert Marsh, sales representative for Medtronic, showed an example of the company’s deep brain stimulation system.

STEUBENVILLE — Members of the Our Place Parkinson’s support group learned about a newly approved therapy offering more consistent symptom relief.

A progressive neurological disorder, Parkinson’s occurs when brain cells that create the chemical dopamine stop working. Dopamine is integral to coordinating the body’s movement, and a deficiency can cause various movement-related symptoms, such as tremor, stiffness and trouble walking or balancing.

About a dozen individuals with Parkinson’s or who know someone with the disease listened on Tuesday to a presentation about deep brain stimulation, a therapy that utilizes controlled electrical currents to the brain. Through implanted wires, a pacemaker-like device in the chest transmits electrical stimulation to specific parts of the brain, partly blocking faulty signals that cause Parkinson’s symptoms.

Tuesday’s speaker represented Medtronic, one of three DBS system manufacturers in the U.S. alongside Boston Scientific and Abbott. Earlier this year, Medtronic received FDA approval for an “adaptive” system that automatically adjusts stimulation levels, marking a significant step in the therapy’s continued evolution.

Robert Marsh, who’s been a Medtronic sales representative in the Tri-State Area since 2002, said medication is typically the first treatment method for Parkinson’s. Although dopamine replacement medication can help control symptoms initially, higher doses may become necessary as a person’s disease progresses.

Those on medication may experience distinct “on” and “off” states between doses, meaning motor symptoms fluctuate unpredictably, Marsh said. Additionally, long-term dopaminergic medication use can cause dyskinesia, or uncontrollable over-movement.

The goal of DBS therapy is to provide continuous electrical pulses to the brain, resulting in stabilized motor fluctuations that aren’t dependent on medication usage — more “on” time.

“The primary goal of DBS is to improve quality of life and allow you to be more functional,” Marsh said. “This isn’t a cure. It’s not going to change the progression of the disease. It’s still going to progress. This just helps you control your symptoms better.”

rior to DBS, the standard treatment for tremor was ablation therapy, which meant burning a lesion into specific parts of the brain tied to the condition, stopping it with dramatic effectiveness. While effective, ablation therapy risked damaging surrounding tissue, especially when performed on both brain hemispheres.

BS evolved out of ablative therapy’s framework, according to Dr. Kelly Foote, a neurosurgeon and co-director of the Fixel Institute for Neurological Diseases at the University of Florida — one of the highest-volume DBS centers in the U.S.

Monitoring a patient’s tremor, doctors would use repeated electrical pulses to locate the specific brain sites for ablation, Foote said. Dr. Alim-Louis Benabid, Foote’s mentor, realized that probes could be inserted into those sites and connected to a pacemaker in the chest that constantly delivers stimulation.

“More energy delivery disrupts more brain tissue, and the higher you turn it up, you get better and better tremor suppression,” Foote said. “It started out as a way to treat the other side of the brain more safely, … and then, people realized this works really well and it’s safer than burning a hole in the brain.”

Over the next 40 years, DBS largely replaced ablation therapy and was introduced for various neurological diseases. A reversible procedure, DBS aids Parkinson’s patients, particularly those who experience frustrating motor fluctuations from their medication use, Foote said.

“DBS is a nice solution to help people in that situation because it has a similar effect on the brain circuitry that dopamine does, but it provides direct electrical stimulation instead of chemical, which is dependent on pills. With electricity, it can be turned on and adjusted to be optimized. … (The patients) spend more time at or near their best level of functioning.”

Marsh said DBS can seem frightening to individuals, but 95 percent of patients who underwent the procedure between 1999 and 2007 would recommend DBS and wish they’d done it sooner.

Prospective patients first undergo various evaluations to ensure they’re safe for DBS, Marsh said. An approved patient is scheduled for surgery to implant the system.

Local anesthesia numbs skin over the skull, where doctors will drill dime-sized access holes, Marsh said, noting that patients may be awake or asleep depending on the neurological institute’s common practice. A previous MRI determines where electrodes, known as leads, should be placed on the brain.

With the leads hooked up to an external stimulator, doctors monitor the patient’s brain signals and symptoms to see whether they’ve got the right spot. As stimulation increases, doctors should observe a decrease in symptoms like tremor, Marsh said. Side effects like numbness or tingling would signal the need for a slight placement adjustment.

Following the procedure, patients stay overnight for monitoring, and they return after two weeks for implantation of the battery and extension wire that connects it with the leads — an outpatient procedure. A recovery period precedes the actual treatment’s start, which requires multiple programming sessions with a neurologist to find the right stimulation levels.

BS therapy’s results can be dramatic for some, depending on their disease’s progression and functionality beforehand, Marsh said. The average patient sees a one-third decrease in medication use post-DBS, with some stopping their medication altogether.

The latter outcome occurred for Steubenville resident and two-year Our Place Parkinson’s support group member Becky Salonica, who’s completely off her Parkinson’s medications.

Diagnosed with Parkinson’s in October 2015, Salonica had a Boston Scientific DBS system implanted in April 2022, following extensive evaluations to confirm her as a good candidate. She had been working at Valley Hospice and decided to have the procedure done once the disease began affecting her speech.

Now, she returns every three months for an adjustment to her system, and she can even modify the levels herself using a remote with certain parameters.

Salonica said DBS has “reduced my symptoms like crazy,” allowing her to be more active. She walks every day and has lost 78 pounds since the procedure. She acknowledged that not everyone sees the same level of results and impact on their medication use.

Although Salonica’s system doesn’t offer it, Medtronic’s Percept family of DBS systems offers a closed-loop function. Percept system monitors its patient’s brain activity and automatically adjusts stimulation levels accordingly. For several years, patients have received Medtronic Percept systems with innate closed-loop capabilities, and with the recent FDA approval, those patients can now opt to turn on the function.

This form of adaptive system is a grand step in the advancement of DBS technology, said Foote, who has implanted more than 3,000 DBS lead systems in his practice. Although current adaptive systems are limited to certain “biomarkers” within the brain signals to determine adjustments, Foote believes the technology will eventually expand.

“They’re the fanciest thing available, but you can also imagine something fancier that can do way more,” he said, adding, “I believe eventually we’ll have better and better systems to adjust to fluctuating brain state, and eventually all DBS will be adaptive…”

Marsh encouraged any Parkinson’s patients or caregivers with questions about DBS to contact him at robert.g.marsh@medtronic.com.

Those with Parkinson’s who are interested in DBS have plenty of questions to ask themselves, noted Dr. Michael Okun, executive director of the Fixel Institute and medical adviser to the Parkinson’s Foundation, a non-profit Parkinson’s patient advocacy group.

A neurologist who co-founded the Fixel Institute with Foote, Okun has authored multiple books on neurological disorders and Parkinson’s. His work “The Parkinson’s Plan: A New Path to Prevention and Treatment” — proceeds from which go to Parkinson’s-related charities — recommends a hard look at new drugs and technology in the realm of Parkinson’s treatment. It also advises patients on navigating new treatments and how to make their own plan.

Okun said patients should be wary not to have their expectations inflated by adaptive DBS as a shiny new product. The technology is promising but currently occupies the early adoption and learning curve phase.

Not every patient is an ideal candidate for adaptive or standard DBS, he said, but patients should consult with their neurologist about their goals for symptom management and whether the results will be worth the time, expenses and other commitments.

“If you’re interested in exploring DBS, you should ask: What do you want, what do you seek, what are the symptoms? … Go in eyes wide open and make sure the juice is worth the squeeze.”

More information that may be helpful for patients is available at his blog, www.pdplan.org, Okun noted.