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Communication and Collaboration of Companies for Deep Brain Stimulations in Parkinson’s Disease
Deep brain stimulations (DBS) is a surgical procedure that implants electrodes into the brain. These electrodes generate electrical impulses control the abnormal brain activity. These stimulations of the areas in the brain are controlled by a programmable generator that is placed under the upper chest. This surgical procedure is used to treat several disabling neurological diseases, most commonly Parkinson’s disease’ (PD) debilitating motors symptoms such as slowed movement, stiffness, tremor, rigidity, and walking problems. Throughout this report, the biological concepts, communication and collaboration, and the application and limitations of deep brain stimulations will be discussed.
BIOLOGICAL CONCEPTS:
right278320500right2266950Figure 1: Structure of Deep Brain Stimulation CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018)
0Figure 1: Structure of Deep Brain Stimulation CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018)
right952500In specific regions of the brain, DBS electrodes are placed, depending on the symptoms that is treated. The electrodes are assembled, through small holes at the top of the skull, on the left and right sides of the brain CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). The electrodes are then connected with long wires that travel down the neck and under the skin of the chest to a battery-powered stimulator, as seen in Figure 1 CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). A DBS system contains three parts: Neurostimulator, lead, and an extension. The neurostimulator is a programmable battery-powered pacemaker device that creates electrical pulses CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). This is placed underneath the chest skin, in the abdomen, or below the collarbone, as seen in Figure 1. Lead is a coated wire that contains several electrodes delivering electrical pulses to the brain tissue. This is connected to an extension wire through a small hole in the skull and placed inside the brain and as seen in Figure 1. An extension is an insulated wire that connects the neurostimulator to the lead. This is placed underneath the patient’s skin, running from the scalp, behind the ear, down the neck and all the way to the chest, as seen in Figure 1 CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018).
3893185958215Figure 2: Brain Areas Affected by Deep Brain Stimulation CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018)0Figure 2: Brain Areas Affected by Deep Brain Stimulation CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018)PD is a disorder that progressively degenerates the dopamine-producing nerve cells in the basal ganglia and the substantia nigra. To control body movement, nerve cells produce dopamine neurotransmitters that transfer messages in the substantia nigra CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). In this disease, nerve cells of the substantia nigra that produce dopamine degrade. The normal movement of the individual is affected by tremor, rigidity and stiffness when 80% of dopamine is lost. A complex chain of inter-connected group of nerve cells (the ganglia) control body movement. Movement information is transmitted to the striatum, which utilises the substantia nigra to transmit impulses across the spinal cord and the brain. The cerebellum and the basal ganglia provide movement in a smooth manner CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). Movement impulses are transmitted across neurons, from the brain to the spinal cord and then to the muscles. In PD, part of the basal ganglia are under stimulated or over stimulated due to insufficient dopamine receptor stimulation in the striatum CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). DBS assists in the stabilisation of the feedback loops as it modifies the abnormal electrical circuits, reducing the symptoms of PD CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018). Electrodes of DBS can be placed in several areas of the brain such as the subthalamic nucleus, thalamus, and globus pallidus, as seen in Figure 2 CITATION MAY18 \l 3081 (MAYFIELD Brain & Spine, 2018).
COMMUNICATION AND COLLABORATION:
Aleva Neurotherapeutics (Aleva) (based in Lausanne, Switzerland) announced in 2016 that they have strategically collaborated with Greatbatch Ltd. (Greatbatch) (base in New York, United States) to develop, supply, and manufacture DBS technologies CITATION Glo16 \l 3081 (GlobeNewswire, 2016). Additionally, Greatbatch will invest in Aleva’s current Series C financing round. Aleva is a company that develop next-generation neurostimulation devices and technologies in DBS therapy for major neurological disorders such as PD CITATION Glo16 \l 3081 (GlobeNewswire, 2016). Their aim is to be able to design high precision and efficient DBS approaches than current available treatments that result in less side effects CITATION Glo16 \l 3081 (GlobeNewswire, 2016). Greatbatch Ltd. is currently one of the largest medical devices outsource manufacturers in the globe, serving the cardiac, vascular, orthopaedics, neuromodulations, advanced surgical and portable medical markets, enhancing the lives of patients CITATION Glo16 \l 3081 (GlobeNewswire, 2016). The design and development team QiG of Greatbatch, spun-off as Nuvectra Corporation, will provide Aleva with access to their unique implantable neurostimulation platform, under the development agreement terms CITATION Med16 \l 3081 (Medical Developments, 2016). Additionally, Aleva received a special license to utilise the QiG’s platform in the field in which DBS is used for the treatment of PD and essential tremor CITATION Med16 \l 3081 (Medical Developments, 2016). This allows Aleva to enhance their ability to deliver patients Directional DBS therapy
However, Aleva also incorporated their own microDBS propriety technology platform into a complete system with the QiG’s proprietary 24-channel neurostimulator and paradigm-shifting programmers that included an innovative directSTIM electrode technology for directional DBS, CITATION Med16 \l 3081 (Medical Developments, 2016). This achieves and provides patients and doctors with an unparalleled, next-generation DBS solutions that improve and increase effectiveness of therapy control that may provide improved outcomes for individuals with PD CITATION Med16 \l 3081 (Medical Developments, 2016). QiG continued to work on the development of next-generation DBS technologies with Aleva’s engineering team CITATION Med16 \l 3081 (Medical Developments, 2016). Hence, Greatbatch entered into a private supply and manufacturing agreement for certain devices of the system CITATION Med16 \l 3081 (Medical Developments, 2016).
Moreover, Aleva raised a Series C financing round, that was led by Greatbatch, with existing investors (BioMedPartners, Banexi Ventures, BB Biotech Ventures, and Initiative Capital Romandie) participating CITATION Med16 \l 3081 (Medical Developments, 2016). The Series C was led by Greatbatch, financing round raised $18 million USD with the $5 million USD contribution from the company CITATION Med16 \l 3081 (Medical Developments, 2016). The proceeds were dedicated to the completion of a chronic study in 60 patients who were diagnosed with Parkinson’s disease and obtain the CE mark for their proprietary directSTIM Directional Deep Brain Stimulation System CITATION Med16 \l 3081 (Medical Developments, 2016).
APPLICATION AND LIMITATION:
In DBS there are several application and limitations to the device. One of the application is that, in contrast to previous methods, such as thalamotomy and pallidotomy (surgical procedures that permanently destroy tiny brain areas), on treating disabling neurological diseases, DBS does not damage areas of the brain or remove nerve cells CITATION neu19 \l 3081 (neurologicalsurgery, 2019). With DBS, the use of levodopa, a drug that is used to treat Parkinson’s disease, could decrease the individuals need for this medication, reducing the side effects of levodopa intake and cost issues CITATION neu19 \l 3081 (neurologicalsurgery, 2019). The electrodes implanted into the brain and the stimulation frequency and intensity can be controlled by physician for individuals and can be subjectively altered CITATION neu19 \l 3081 (neurologicalsurgery, 2019).
Although there are several applications of DBS, there various limitations that arise. During the procedure, in which it involves the incision to the scalp in order to access deep parts of the brain, most individuals are awake and may be socially impacted CITATION Par17 \l 3081 (Parkinsonsdisease.net, 2017). One of the major limitations of deep brain stimulation is that it is expensive in which the procedure can cost between $30,000-$100,000 and there is no immediate result CITATION Par17 \l 3081 (Parkinsonsdisease.net, 2017). It can take up to months to determine the exact balance of deep brain stimulation and medications to optimally control symptoms CITATION Par17 \l 3081 (Parkinsonsdisease.net, 2017). As DBS is a machine, malfunction and battery replacement occur. Hardware malfunction, wires disconnecting, and electrodes shifting may occur. As well, the battery life of the devices and controllers need to be monitored frequently CITATION Par17 \l 3081 (Parkinsonsdisease.net, 2017). In relation to the surgical procedure, there may be unexpected consequences of post-surgical side effects including the risk of bleeding, stroke, infection, and accumulating fluid in the brain. Data has shown that DBS has a negative social impact on the behaviour and personality, such as mood changes and anxiety CITATION Ire11 \l 3081 (Rektorova, 2011). Data shows that DBS has increased impulsivity in some PD patients such that 3 out of 19 DBS patients showed impulse control disorders such as compulsive shopping and pathologic gambling compared to 3 out of 37 patients who are medically treated CITATION Ire11 \l 3081 (Rektorova, 2011).
CONCLUSION:
DBS is a surgical procedure in which electrodes are implanted into the brain, generating electrical impulses to control abnormal brain activities. This is used to treat several disabling neurological diseases, most commonly the debilitating motors symptoms of PD such as tremor, stiffness, walking problems, rigidity, and slowed movement. PD is a progressive, degenerative disorder that impacts dopamine-producing nerve cells located the substantia nigra and the basal ganglia.
Aleva Neurotherapeutics collaborated with Greatbatch Ltd. to supply, develop, and manufacture DBS technologies. The Series C financing round, led by Greatbatch, raised $18 million USD, in which was used to obtain CE mark for their proprietary directSTIM directional DBS system and the completion of a chronic study of 60 patients diagnosed with PD.
DBS has various applications and limitation. This procedure does not damage brain areas or remove nerve cells compared to other treatments such as thalamotomy and pallidotomy. DBS decreases the individuals need for medication, reducing cost issues and medicinal side effects. However, the surgical procedure may socially impact the patient as they are not under anaesthesia due to non-existing pain receptors in the brain. DBS procedure costs between $30,000-$100,000 and does not provide immediate results. The device requires frequent monitoring due machine malfunctions and battery replacements. This surgical procedure may cause unexpected consequences of post-surgical side effects such as stroke, infection, bleeding, and accumulation of fluid in the brain. However, DBS may influence future technologies to find better cures of Parkinson’s disease.
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