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.

PGATOUR.COM – Interview: Michael J. Fox at Outback Steakhouse Pro-Am

I guess it would take something extraordinary to blast me out of my extraordinary demotivation when it comes to writing. But this interview did it. Not so much the Michael J. Fox bit — although he is an incredible person — but the golfer he played with at this event. 

Tim Simpson is a pro golfer who had to put his clubs away because of his inherited tremor — and who got his game back after having DBS surgery. His account of having the surgery is truly inspiring to someone like me, who is thinking seriously about having the surgery, possibly as soon as later this year.

Thank you Tim, and Michael. It’s time for me to get back on the cart and get serious about this aspect of my life. I’m headed to NYC this week to interview a DBS neurosurgery team. I’m looking forward to it, with much excitement and a bit of dread.

People Understand Risk of Falling, But Not the Risk Factors

For older people, and especially those with Parkinson’s, a fall-related injury is the first event in a chain that leads to ever-worsening problems. I’d say it’s probably the best indicator of how advanced a person’s progression is: the cane, the walker, the wheelchair, and the ability to negotiate even a door jamb or threshold.

A paper in the Journal of Neuroscience Nursing (reprinted at Medscape) describes interviews with 28 people with Parkinson’s. Nearly all of them knew that they were at higher risk for falling. However, many did not understand the factors that might lead to falling, especially the risk posed by medication:

Although our cohort recognized that their probability of falling was substantial, they lacked awareness of specific risk
factors for falling, particularly those associated with medication use. This was a surprising finding, considering that the participants enrolled in this study were taking numerous medications, and many of those medications are known to increase risk for falling. The fact that these individuals attended a movement disorder clinic led us to hypothesize that
their awareness of all risk factors would have been much higher. 

Maybe it’s simple denial, a willful whistle past the graveyard, or maybe there’s some pathological blind spot that leaves those of us with PD in ignorance of even the obvious. Hopefully our friends and partners are more aware of these problems, and are willing to look out for us.