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The Parkinson Alliance Presents Speech Data to Medtronic Corporate Leadership

The Parkinson Alliance returned to the Medtronic Neuromodulation Headquarters on October 23, 2012 for their second visit (with the first occurring on January 13, 2010) to receive updates regarding the Neuromodulation Division, and to present some results from The Parkinson Alliance surveys conveying the patient’s perspective about Deep Brain Stimulation (DBS) therapy. This visit was another excellent opportunity to learn about Medtronic and their great contributions to the Parkinson’s disease (PD) community, as well as to educate some of Medtronic’s leadership about our work with DBS patients and those who share their lives.

Medtronic is known for introducing innovative technology and improving the lives of patients who are enduring debilitating medical conditions.  During our visit, Medtronic’s leadership and several researchers/engineers provided a great overview about the advancing technology designed to improve treatments for a variety of medical problems (e.g., Parkinson’s disease, diabetes, chronic pain, and epilepsy, to name a few). The first tenet of their mission statement was apparent with each lecture and with every encounter with Medtronic’s staff: “To contribute to human welfare by application of biomedical engineering in the research, design, manufacture, and sale of instruments or appliances that alleviate pain, restore health, and extend life.” It was evident that these individuals were committed to and passionate about bettering the lives of individuals experiencing a debilitating medical disease.

We were given a tour of the facility, which vividly illustrated the meticulous and remarkably sophisticated means of producing DBS therapy. We were introduced to a variety of facets of their Neuromodulation Division, and participated in talks pertaining to brain infusion technology, the technology behind DBS therapy, the current status of the effectiveness of DBS therapy, and improvements yet to come in DBS therapy. For example, and as it relates to neuroengineering, there was discussion about enhancing a closed feedback loop system for DBS PD patients. Moreover, currently, once DBS settings have been optimized for an individual patient with PD, the system will continuously stimulate using those settings; however, parkinsonian symptoms fluctuate and worsen over time. The fluctuation of symptoms and disease progression suggests that static settings are not ideal for symptom control. Future advancements in the DBS system will likely enable automatic adjustments of DBS output. More specifically, a closed-loop DBS system: 1) will be able to find the best set of parameters for each patient automatically; 2) will save power and enhance battery life; and 3) will apply the minimum current necessary to reduce symptoms, greatly reducing side effects that are caused by overstimulation. Thus, a closed loop system will enable the ability to find the best set of parameters for each patient automatically - resulting in improved management of symptoms in a fluctuating and continuously changing condition.

Patient education and Clinician Training Programs with emphasis on optimal and effective utilization of DBS therapy were also discussed.  There are great efforts placed on educational training programs for clinicians to more effectively monitor and manage symptoms for individuals who have DBS. The curriculum addresses the “comprehensive picture”, including how DBS impacts both motor symptoms and non-motor symptoms associated with PD; with regard to the latter, there is a surging interest related to improving our understanding about the impact of DBS therapy on non-motor symptoms of PD, such as cognition, speech, psychiatric issues, etc.

Furthermore, Carol Walton, CEO of The Parkinson Alliance and Dr. Jeffrey Wertheimer, The Parkinson Alliance’s Chief Research Consultant, led a discussion about non-motor symptoms associated with PD, emphasizing the impact of DBS on speech from the patient’s perspective. Speech disturbance is a serious and debilitating problem for many individuals with PD, and DBS therapy has been found to have an adverse impact on speech. Eighty-six percent of the 758 participants of our study endorsed speech problems, and a significantly larger number of individuals who had DBS reported more speech difficulties and greater severity of speech symptoms (e.g., slurred speech) when compared to PD patients without DBS. Speech difficulties may manifest in either isolated speech symptoms or a constellation of speech disturbances (e.g., low volume, slurred speech, word-finding difficulties, etc.) that commonly results in functional communication deficits, thereby adversely impacting socialization and quality of life. It is of great importance to conduct further research on speech in PD, particularly as it relates to DBS therapy and intervention to improve speech/to alleviate speech disturbance in PD. Medtronic was appreciative of the results and implications, and they supported the notion that it is necessary to develop an action plan to address this matter.

Lastly, it is important to highlight that 94% of the participants in our most recent study indicated that they are satisfied with the outcome of their DBS therapy based on the symptom improvement received from DBS, even in the context of having some side effects. Additionally, in the big picture, 97% of the participants reported that DBS improved their quality of life. (Click here for the detailed report).

In closing, Medtronic continues to enhance neuromodulation with the ultimate goal of improving the quality of life of individuals receiving DBS therapy. The leadership appeared very receptive to The Parkinson Alliance’s feedback, objectives, and contributions. There appears to be some opportunities for Medtronic and The Parkinson Alliance to collaborate in the context of the mutual goal of bettering the lives of individuals with PD.

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