Shortening the path to a successful treatment
Demystifying neuromodulation of dysfunctional brain circuits in Parkinson's disease patients with deep brain stimulation using high-resolution functional magnetic resonance imaging.
For many people with Parkinson’s disease who undergo deep brain stimulation, the treatment can appear nothing short of miraculous. The procedure involves surgically implanting a transmitter within the brain, to allow the application of electrical impulses that reduce or eliminate tremors and restore motor control.
Achieving good results, though, calls for a great deal of fine-tuning. Alexandre Boutet, who is currently completing his doctorate in neuroscience at the University of Toronto, has seen some individuals take as long as a year to adjust to the implant. That’s because it needs to be tuned to emit just the right amount of electricity to achieve the desired result in a patient’s brain. For people who often travel across the country to gain access to this specialized treatment, the challenge is frustrating and expensive
“The post-op period is often not as easy as patients hope it will be, because of all those logistical issues,” he explains.
Boutet is addressing this problem with another powerful technology, the imaging system known as functional magnetic resonance imaging (fMRI). This specialized MRI technique allows a strong magnetic field to compose a useful picture of blood flow, which also reveals those brain cells that are activated at any given moment. Depending on the type of stimulus — such as when an individual is reading, speaking, or listening to music — different parts of the brain “light up” accordingly in an fMRI image.
This same strategy makes it possible to map out which parts of the brain DBS will activate as the DBS is turned on. If doctors could identify the optimal settings for the device with an MRI after surgery, it could reduce a patient’s adjustment period – maybe even to a single day.
“If we can cut down that first year to a one-day MRI, that would be great,” Boutet says.
The imaging technique also provides patients with highly accessible images so they can see exactly how DBS will help them. “It’s very intuitive to understand,” he says.
Boutet also believes fMRI, combined with DBS, will have the potential to treat mental illness, the field where his research began. His original interest in the use of DBS for mental ailments drew him into the study of Parkinson’s disease, which is in fact the most common reason for the use of this technology. He finds it satisfying that the innovation he is exploring could benefit patients facing all these different types of problems.
“The whole goal of this research is very patient-oriented,” he says. “It’s to make their lives much better.”