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.

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.

The Choice Matters: Go With the Specialist

An article in The New York Times makes a point that might seem self-evident: Patients fitted with heart devices had fewer problems when those devices were implanted by doctors who had special training. I think this finding is very relevant for devices implanted in other areas of the body, particularly in the brain. Consider this point:

Most implant procedures, about 70 percent, were performed by electrophysiologists, the study reported. The remaining implants were done by other types of cardiologists or other kinds of doctors including thoracic surgeons. The study found that the highest rate of serious complications about 2.5 percent, occurred among thoracic surgeons, who accounted for only 1.7 percent of the procedures reviewed.

Knowing this, if one had the choice, why would you *not* want to have a brain implant done by anyone except a specialist with a long track record of performing that specific procedure? I suspect that it is on this point that the surgeons with the record of excellent results differ from those that are merely very good.

The article also provides a strong argument for the creation of a national electronic medical records system. The findings were based on filings made to a national database created in 1995 when Medicare and Medicaid agreed to paying for more implanted defibrillators. One can only imagine the other bits of hard science to be gleaned from records based on data from millions of eople.