Deep Brain Stimulation for MSA
Research type
Research Study
Full title
Deep Brain Stimulation for Autonomic and Gait Symptoms in Multiple System Atrophy
IRAS ID
241831
Contact name
Alexander Green
Contact email
Sponsor organisation
Clinical Trials and Research Governance
Duration of Study in the UK
3 years, 8 months, 0 days
Research summary
Research Summary
Patients referred to our department routinely and safely undergo deep brain stimulation (DBS) for treatment of symptoms related to neurodegenerative conditions, most commonly Parkinson’s disease.
In our experience, and published evidence shows, that stimulation has effects on the autonomic nervous system. In patients undergoing therapeutic DBS for a particular subtype of Parkinsonism, Multiple System Atrophy, we would like to investigate further the effects on autonomic parameters such as blood pressure and bladder symptoms as well as the originally intended indications (gait and movement disorder). We would also like to investigate the mechanisms of any effects by using a number of techniques such as magnetoencephalography (MEG) and Muscle Sympathetic Nerve Activity (MSNA) recording.
Our key goals are to:
a) Demonstrate that stimulation of the peduculopontine nucleus (PPN) improves autonomic function and has an attendant improvement on patients’ quality of life
b) Investigate the role of the PPN and how it interacts with other brain areas.We hope that this translational strategy leads to a larger efficacy study of DBS for MSA as well as revolutionizing neural-based treatments in other autonomic disorders such as orthostatic hypotension and pure autonomic failure.
Summary of Results
This study aimed to show whether or not deep brain stimulation (of a particular region in the brain) could be used to alleviate some of the symptoms of multiple system atrophy, in order to improve quality of life for these patients.
The major symptoms that we looked at were: balance when walking, bladder control and emptying, and drop in blood pressure when standing.
In the 5 patients that we studied, we were able to show that electrical stimulation of this part of the brain is safe to undertake in the first place - we did not see significant excess morbidity related to surgical intervention beyond that expected of this type of procedure.
A major difficulty we encountered was that patients with this disease can deteriorate very quickly - surgery does not halt the progression of the disease, but is only aimed at symptom control. In some of our patients (2 out of 5), the disease itself progressed between surgery and outcome measures, such that measurement of some of our measure - eg. patients had become wheelchair bound or catheter dependent. This is partly because the SARS-CoV2 pandemic delayed outcome measurement.
In the patients that were able to study more fully, we showed that walking can be modified and improved, and that balance and walking fluency is positively affected by stimulation. We also showed that urinary bladder capacity and emptying were improved by stimulation - with the additional benefit of allowing for better rest at night due to minimised interruptions to urinate (both for patient and for bed partners!). We also showed that blood pressure postural change could be affected, and improved by stimulation, but while this improved, it did not improve so much that it reversed the threshhold of orthostatic hypotension.
In terms of overall quality of life, most of our participants improved in some way after surgery. However, disease progression in MSA is rapid and relentless, and as only a symptom modifier, did not reverse neurodegeneration such that survival was impacted. At study end, 2 out of 5 patients have died - this is in line with life-expectancy at diagnosis of MSA.
REC name
North West - Preston Research Ethics Committee
REC reference
18/NW/0403
Date of REC Opinion
5 Jul 2018
REC opinion
Further Information Favourable Opinion