View Full Version : Electronic Devices
09-12-2006, 09:07 PM
This was brought up at my APDA Chapter meeting tonight..Is there a new electronic device for pd other than DBS?
09-18-2006, 07:20 PM
This probably is not it, but it's interesting:
UW researcher becomes her own Parkinson's 'Guinea pig'
"Lazarus also has used a tongue stimulator called BrainPort, made by the Middleton company Wicab, for people with balance problems. In a study of three Parkinson's patients, including Lazarus, the device improved posture and the speed with which the patients could tap their fingers."
"Wicab, Inc. has developed the BrainPort™ technology to transmit external sensory information to the brain through a substitute sensory channel: electrotactile stimulation of the tongue.
The use of the tongue as a sensory substitution channel has been previously established (see technical papers section of web site). For the brain to correctly interpret information from a sensory substitution device, it is not necessary for the information to be presented in the same form as the natural sensory system.
For example, we do not see with the eyes; the optical image does not go beyond the retina where it is turned into spatio-temporal patterns of action potentials along the optic nerve fibers. The brain then recreates the images from analysis of the impulse patterns.
Thus, for a sensory substitution event to occur, one need only to accurately entrain action potentials in an alternate information channel, which do not differ significantly for the individual senses. With training, the brain learns to appropriately interpret that information and utilize it to function as it would with data from the intact natural sense." More:
09-18-2006, 07:24 PM
The article referenced above:
UW researcher becomes her own Parkinson's 'Guinea pig'
September 16, 2006
Jo-Anne Lazarus was washing her hair when she noticed something odd: Her right hand was moving in circles but her left hand wasn't.
Later, she had trouble getting keys out of her left pocket.
She saw a doctor and got a diagnosis: Parkinson's disease. The condition gradually slows movement, makes muscles rigid and causes tremors, usually leading to severe disability.
Unlike most of the 500,000 to 1 million Americans with Parkinson's, Lazarus didn't need to read up on the disease.
A UW-Madison associate professor of kinesiology, the study of movement, she had been researching Parkinson's long before she learned she had it.
She knew exactly how neurons in her brain were degenerating, creating a shortage of the chemical dopamine that coordinates movement.
She knew that the disease often starts on one side of the body and shifts to the other side.
She knew that drugs and surgeries can ease symptoms, but there is no cure.
Today, eight years after her diagnosis, the 57-year-old's athletic frame is slowly stiffening.
She walks with a slight stoop. Her left arm hangs in near suspension, barely swinging back and forth. If she puts down a coffee cup or cell phone with that arm, her hand freezes in a grasp.
She wears shirts untucked because she can't reach to tuck them in. She talks in a mumble unless she reminds herself to speak up.
But Lazarus isn't accepting her decline from Parkinson's passively. She's studying alternative treatments for the disease with the zeal of a patient and the scrutiny of a scientist.
It's a rare combination that makes her excited yet hesitant to talk about her controversial theory: that increased effort during certain movements might wake up dormant cells in the brain's basal ganglia, where dopamine is produced.
"It's not totally wacko," Lazarus said of the theory. "But it's not totally accepted either."
Her studies on acupuncture, finger tapping, speech therapy and tongue stimulation have shown promising results, which she has presented at conferences.
But Lazarus is quick to point out that the research is preliminary, involving only her and a few other patients. Larger studies would have to be conducted to form conclusions, she said.
"I use myself as a guinea pig," she said. "This is pilot data for now. We still have to work out all the bugs."
With an office in the university's Natatorium, she teaches and researches full time despite fatigue from the disease.
"I keep wondering when I should retire," she said. "But I'm so driven to find things out about Parkinson's."
Athlete to researcher
Growing up in Windsor, Ontario, Lazarus played five sports in high school: badminton, basketball, tennis, volleyball and track and field.
She concentrated on basketball at the University of Windsor, eventually landing in the college's sports hall of fame. She played point guard for Team Ontario in the Canada Games, the country's premier annual sporting event.
Kinesiology, the academic field of physical activity and movement, was a perfect fit. She got her doctorate at the University of Michigan in Ann Arbor, focusing on how children learn to use their hands independently.
When she came to Madison in 1985, she worked with children who had developmental disorders and adults who had traumatic brain injuries.
She also studied Parkinson's disease. In 1992, the journal Movement Disorders published a paper on a study she conducted.
When healthy people in the study flexed one arm, they had more strength and speed when moving a lever with the other arm. Parkinson's patients didn't.
The study suggested that the disease cuts off coordination between the body's two sides.
"Normal subjects utilize bilateral outflow to symmetrical muscle groups to synchronize the two limbs in the bimanual task," Lazarus wrote in a researcher's detached tone, "whereas (Parkinson's) patients dissociate the two limbs."
'On the cutting edge'
Six years later, the scientific pursuit became personal.
Lazarus initially thought the clumsiness in her left hand might be carpal tunnel syndrome. When it persisted, she saw a neurologist. In early 1998, he said it was Parkinson's.
Her familiarity with the disease didn't ease the shock.
"I found myself constantly thinking about it and wondering what was going to become of me," she wrote in her journal at the time.
Soon she realized that her role as a scientist, as well as a patient, put her in a unique position to confront the disease.
"I figured," she said in a recent interview, "I can stay on the cutting edge and benefit from that."
Her drive to learn more about Parkinson's has helped other patients, such as Helen Koberstein of Madison. Lazarus and Koberstein, 46, have started an informal support group. They have early-onset Parkinson's, when the disease strikes before age 50.
"She's always got information it would take me hours to find," Koberstein said. "She's an inspiration in terms of her energy and commitment to search for solutions."
That commitment was recognized last month by the Parkinson's Disease Foundation, which named Lazarus to its 14-member People with Parkinson's Advisory Council.
Though Parkinson's has slowed Lazarus down, she rarely allows the disease to bring her down, said Marilyn Annucci, Lazarus' partner.
"She's brave; she's hopeful," Annucci said. "She keeps trying to figure it out."
Acupuncture a cure?
Lazarus is leery of taking levodopa, the most widely used drug for Parkinson's. It often reduces symptoms, but it can wear off and cause uncontrolled wiggling.
Lazarus takes two newer medications, selegiline and mirepex. She hasn't considered surgery such as deep-brain stimulation, in which electrodes are implanted in the brain and hooked up to battery packs.
She is most excited about acupuncture. Last year, she read about a California acupuncturist who claimed the needle-based treatment could cure Parkinson's by opening the energy channel in the stomach. (Studies have suggested that some cases of the disease might be linked to infection of H. pylori, the bacterium that can cause ulcers.)
"I think she's a little bit off the wall," Lazarus said of the California acupuncturist. "But I also think she's on to something."
Lazarus had acupuncturist David Hassert of Middleton open her stomach channel.
"I was on a high for three days," she said. "I had no symptoms."
Her stiffness and fatigue eventually returned. But Lazarus continues to see Hassert every two weeks and feels better for two to three days afterward, she said.
She recently tested the concept by using functional magnetic resonance imaging, a type of brain scan.
First she stopped taking her regular Parkinson's medications. Then she underwent a scan before and after Hassert gave her acupuncture and some homeopathic remedies. During the imaging, she tapped her index finger to increase blood flow to the motor areas of her brain.
The scans showed more activity in the basal ganglia after the acupuncture and homeopathy, suggesting the treatments might help people with Parkinson's.
Lazarus presented the results in February at the first World Parkinson Congress in Washington, D.C. She wants to try out the idea on more patients.
"I swear by it, even though that's an anecdotal response from a scientist, which we aren't supposed to do," she said.
A developing theory
She has also studied finger tapping by itself. It can be difficult for Parkinson's patients to tap their fingers comfortably, Lazarus said. But it's easier, paradoxically, when they put more effort into it.
Tapping with effort activates the basal ganglia and could help recalibrate the motor system in the brain of Parkinson's patients, suggested a brain- scan study by Lazarus on four patients, including herself.
A speech treatment involving conscious vocal effort triggers similar improvements, she said.
Lazarus also has used a tongue stimulator called BrainPort, made by the Middleton company Wicab, for people with balance problems. In a study of three Parkinson's patients, including Lazarus, the device improved posture and the speed with which the patients could tap their fingers.
Lazarus gave a talk about the four treatments to scientists this June in Denver.
The researchers were "intrigued but not convinced," she said.
"That's OK," she said. "It's just my theory. I'm early on in my thinking about it."
Lazarus said she intends to keep studying the disease as long as she's able.
Her personal history of resilience suggests that may be a long time.
After Lazarus was thrown off an amusement park ride as a young woman, she rode the ride again. When she broke a bone water skiing, she returned to the same lake and skied behind the same boat. She was bitten by a dog in the face. Yet she and Annucci have a fluffy, white Coton de Tulear.
"I don't give up easily," she said. "I always like to get back on the horse."
09-18-2006, 07:31 PM
Maybe it's repetitive transcranial magnetic stimulation:
Placebo-controlled study of rTMS for the treatment of Parkinson's disease
Mikhail P. Lomarev, PhD, MD 1 *, Sulada Kanchana, MD, PhD 1, William Bara-Jimenez, MD 2, Meena Iyer, PhD 3, Eric M. Wassermann, MD 3, Mark Hallett, MD 1
The objective of this study is to assess the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for gait and bradykinesia in patients with Parkinson's disease (PD). In a double-blind placebo-controlled study, we evaluated the effects of 25 Hz rTMS in 18 PD patients. Eight rTMS sessions were performed over a 4-week period. Four cortical targets (left and right motor and dorsolateral prefrontal cortex) were stimulated in each session, with 300 pulses each, 100% of motor threshold intensity. Left motor cortex (MC) excitability was assessed using motor evoked potentials (MEPs) from the abductor pollicis brevis. During the 4 weeks, times for executing walking and complex hand movements tests gradually decreased. The therapeutic rTMS effect lasted for at least 1 month after treatment ended.
Right-hand bradykinesia improvement correlated with increased MEP amplitude evoked by left MC rTMS after individual sessions, but improvement overall did not correlate with MC excitability.
rTMS sessions appear to have a cumulative benefit for improving gait, as well as reducing upper limb bradykinesia in PD patients.
Although short-term benefit may be due to MC excitability enhancement, the mechanism of cumulative benefit must have another explanation. © 2005 Movement Disorder Society
09-18-2006, 07:34 PM
From Journal Watch
Physician-authored summaries and commentary
from the publishers of the New England Journal
Journal Watch Neurology
August 21, 2003
Repetitive Transcranial Magnetic Stimulation to Treat Parkinson Disease
Repetitive transcranial magnetic stimulation (rTMS) of the brain is a noninvasive, well-tolerated technique that can modify cerebral cortex excitability both locally and at remote, but functionally connected, areas (Lancet Neurology 2003; 2:145). Initial research on rTMS for motor function in Parkinson disease (PD) showed promising results (Neurology 1994; 44:892), but later research failed to confirm initial findings (e.g., Neurology 1999; 52:768) and has yielded mostly conflicting results. Now, two groups of researchers report results with further variations on rTMS in PD.
Okabe and colleagues randomly assigned 85 medically treated PD patients to one of 3 treatments: rTMS to the motor cortex or occipital cortex (0.2 Hz at 110% of the individual's motor threshold intensity) or sham stimulation. Sham stimulation employed low-intensity electric stimuli to the scalp. Sessions of 100 stimuli each occurred weekly for 8 weeks. Participants' Unified PD Rating Scale (UPDRS) scores improved slightly, but to the same degree in all 3 study groups. The authors conclude that, as applied, rTMS is no better than placebo as add-on treatment for medicated PD patients.
Ikeguchi and colleagues targeted the frontal area at 0.2 Hz and 70% of maximal stimulator output intensity. Twelve patients received 6 rTMS stimulation sessions within 2 weeks, to either the frontal lobes (n=10) or the occipital area (controls, n=6). Three of the patients underwent both frontal and occipital stimulation, separated by at least 1 month. Each session consisted of 60 stimuli. After frontal rTMS, activities of daily living and motor scores of UPDRS showed significant but small improvements compared with baseline. Occipital rTMS failed to induce a clinical benefit. On single photon emission CT (SPECT), frontal and occipital stimulation caused significant reductions in regional cerebral blood flow. However, these SPECT findings were not correlated with clinical improvements, and the analysis used uncorrected statistical thresholds and was done without overlaying onto the patients' brain MRI.
Repetitive TMS might be beneficial for PD that does not respond satisfactorily to medication, but the conflicting results to date do not provide a clear answer. The parameters of stimulation and the cortical target are critical, a point underscored by previous studies of frontal rTMS (e.g., Mov Disord 2002; 17:528). Studies in animals (Neuropharmacology 2002; 43:101) and healthy humans (J Neurosci 2001; 21:RC157) show that focal rTMS to the frontal cortex can induce dopaminergic release in the striatum. Larger studies are important, but good control conditions are essential. PD patients are particularly sensitive to placebo effects due to abnormal dopamine-dependent reward mechanisms (Trends Neurosci 2002; 25:302), and a better sham-rTMS method will be crucial.
Most important, we still know little about the mechanisms of action of rTMS, how to control for differences between individuals in rTMS effects on cortical excitability, and how to choose suitable stimulation parameters (e.g., frequency of rTMS, intensity, number of stimuli per session, number of sessions per week, length of stimulation course). Many of these questions must be answered before a proper clinical trial can be designed.
-- Felipe Fregni, MD, and Alvaro Pascual-Leone, MD, PhD
Dr. Fregni is Research Fellow in Neurology, Laboratory for Magnetic Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston. Dr. Pascual-Leone is Associate Professor Neurology, Laboratory for Magnetic Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston.
Okabe S et al. for the Effectiveness of rTMS on Parkinson's Disease Study Group. 0.2-Hz repetitive transcranial magnetic stimulation has no add-on effects as compared to a realistic sham stimulation in Parkinson's disease. Mov Disord 2003 Apr; 18:382-8.
Ikeguchi M et al. Effects of successive repetitive transcranial magnetic stimulation on motor performances and brain perfusion in idiopathic Parkinson's disease. J Neurol Sci 2003 May 15; 209:41-6.
09-18-2006, 07:41 PM
rTMS seems to stimulate the dopaminergic system:
Endogenous dopamine release induced by repetitive transcranial magnetic stimulation over the primary motor cortex: an [11C]raclopride positron emission tomography study in anesthetized macaque monkeys
Repetitive transcranial magnetic stimulation (rTMS) has been used as a treatment for neuropsychiatric disorders such as depression and Parkinson's disease (PD). Despite the growing interest in therapeutic application of rTMS, precise mechanisms of its action remain unknown. With respect to PD, activation of the mesostriatal dopaminergic pathway is likely to be a candidate mechanism underlying the therapeutic effects; however, modulating effects of rTMS over the primary motor cortex (M1) on the dopaminergic system have not been studied.
We used [11C]raclopride positron emission tomography to measure changes of extracellular dopamine concentration after 5Hz rTMS over the M1 in eight anesthetized monkeys.
rTMS over the right M1 induced a reduction of [11C]raclopride binding potential (BP) in the bilateral ventral striatum, including the nucleus accumbens, and a significant increase of BP in the right putamen; no significant BP reduction was found in the dorsal striatum. These data indicate that rTMS over the motor cortex induces a release of endogenous dopamine in the ventral striatum.
Our results suggest that therapeutic mechanisms of rTMS may be explained in part by an activation of the mesolimbic dopaminergic pathway, which plays critical roles in rewards, reinforcement, and incentive motivation.
09-18-2006, 11:06 PM
I've been hearing something about an electric cattle prod to the buttocks works wonders.:D :D :D
09-18-2006, 11:12 PM
I've been hearing something about an electric cattle prod to the buttocks works wonders.:D :D :D
I'll bet that would work great for a freezing episode when the old feet are glued to the floor..:D
09-19-2006, 05:55 PM
Maybe we should each have our own stun guns set on low, just high enough to start us up!
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