Telemedicine works, but … where are the doctors?

It’s great to hear, via a paper presented at a recent conference, that it’s possible to deliver excellent health care to people with Parkinson’s via video link. Telemedicine might help bridge the accessibility gap that I’ve seen seen here in rural northern New England. People who reside in the Bennington, Vt., area, for example, are about as far away from Boston as they are from Burlington.
This is great news for the patient, but what about the doctors? Caseloads for many motion disorder experts are already high. How would an influx of new cases be managed? 
I could see the MDS assuming more frequently a consulting role, a second-opinion source, to a telemedicine session originating from the office of the patient’s primary care provider. I don’t want to see this technology used to increase bill-able throughput. We risk burning out more doctors that way, and then everyone loses.

The exercise benefit, explained

Exercise just works. I’ve often said that it seems to reset the brain at a fundamental, system-wide level, kind of like re-initializing a computer. 

Now researchers are starting to understand what happens inside the brain when we are pushed to perform at a higher level of exercise than we might normally engage in. From Medscape:

Patients with Parkinson’s disease (PD) who exercise on a stationary tandem bicycle with a healthy partner during a single 40-minute session experience a 35% improvement in motor function and increased brain activation similar to that found with levodopa treatment, new research shows.

The study, by researchers at the Cleveland Clinic in Ohio, found that maintaining a steady rate of 80 to 90 revolutions per minute (rpm) on the bicycle not only improved function in lower extremities but also in upper extremities.

I don’t want to reprint the entire article, but this quote resonated for me:

The researchers surmise that the exercise may facilitate central motor control processes in Parkinson’s patients. “For lack of a better word, we may be ‘overdriving’ the central nervous system by providing an increase in the quantity and quality of sensory information provided to the patient,” said Dr. Alberts.

DBS innovation: Stimulating individual neurons?

This is really quite something to behold: A DBS lead with electrodes small enough to potentially stimulate individual neurons. The genius lies in applying the technology used in semiconductor chip design to create a lead with many tiny electrodes that can then be activated and controlled with an extraordinary level of precision.

Looks like a great buy for one of the major medical device manufacturers.

DBS Surgery: First Person Account

What a terrific article, on the Daily Kos web site. He even answers right up top the unasked question I’ve had for so long: Do you need a catheter, and how exactly is that bit of work performed?

Thank you for writing that article. Very well done. I’ve been trying to conjure the reality of the procedure, the details of what will happen, and this piece takes me there like few others I’ve read.

St. Jude Medical advances Libra PD trial

The public relations team at St. Jude Medical is keeping busy. A press release this week announced that all of the 136 participants in its DBS device trial had received their implants. The release wasn’t clear about the expected length of the trial or what exactly the trial is designed to demonstrate. 

It’s very encouraging to have competition in this market — it seems like St. Jude has spurred Medtronic to accelerate innovation of its line of DBS devices. St. J is claiming its Libra device has the “largest battery capacity” in its class, while Medtronic has received FDA approval for an updated Activa that trumpets, among a number of new features, a battery charge monitor and the ability to recharge batteries without surgery. (I’ll be checking that out in detail soon.)
It’s nice to see Dr. Tagliati and the team at Mt. Sinai in NYC are involved in the Libra trial for PD.

What’s next for DBS? Weight loss, Alzheimer’s

Deep brain stimulation surgery is quickly becoming the hot new treatment for an ever-widening array of ailments. Initially approved for treatment of motion disorders such as essential tremor and Parkinson’s disease, it was exciting to see the technology applied to other problems, such as epilepsy. Discussion then turned to using DBS for obsessive-compulsive disorder. Since then, we’ve seen the buzz building around DBS for depression. Humanitarian exemptions have been granted for DBS to treat severe Tourette’s. 

This morning’s mail brings word of efforts in Canada to extend DBS to people with weight-management problems, and even Alzheimer’s disease. Makes me wonder about how DBS might be used by otherwise normal people seeking a cognitive edge, like those who take the ADD drugs.