Surgeons implant first brain ‘pacemaker’ for Alzheimer’s disease in US Reply

Researchers at Johns Hopkins Medicine have surgically implanted a pacemaker-like device into the brain of a patient in the early stages of Alzheimer’s disease, the first such operation in the United States.

The device, which provides deep brain stimulation and has been used in thousands of people with Parkinson’s disease, is seen as a possible means of boosting memory and reversing cognitive decline. Instead of focusing on drug treatments, many of which have failed in recent clinical trials, the research focuses on the use of the low-voltage electrical charges delivered directly to the brain. There is no cure for Alzheimer’s disease yet.

 

The surgery is part of a federally funded, multicenter clinical trial marking a new direction in clinical research designed to slow or halt the ravages of the disease, which slowly robs its mostly elderly victims of a lifetime of memories and the ability to perform the simplest of daily tasks, researchers at Johns Hopkins say. Some 40 patients are expected to receive the deep brain stimulation implant over the next year or so at Johns Hopkins and four other institutions in North America as part of the Advance Study led by Constantine G. Lyketsos, M.D., M.H.S., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, and Andres Lozano, M.D., Ph.D., chairman of the neurology department at the University of Toronto. Only patients whose cognitive impairment is mild enough that they can decide on their own to participate will be included in the trial. Other sites performing the operation, supported by the National Institutes of Health’s National Institute on Aging (R01AG042165), are the University of Toronto, the University of Pennsylvania, the University of Florida, and Banner Health System in Phoenix, Ariz. The medical device company, Functional Neuromodulation Ltd., is also supporting the trial.

 

While experimental for Alzheimer’s patients, more than 80,000 people with the neurodegenerative disorder Parkinson’s disease have undergone the procedure over the past 15 years, with many reporting fewer tremors and requiring lower doses of medication afterward, Lyketsos says. Other researchers are testing deep brain stimulation to control depression and obsessive-compulsive disorder resistant to other therapies. The surgery involves drilling holes into the skull to implant wires into the fornix on either side of the brain. The fornix is a brain pathway instrumental in bringing information to the hippocampus, the portion of the brain where learning begins and memories are made, and where the earliest symptoms of Alzheimer’s appear to arise. The wires are attached to a pacemaker-like device, the “stimulator,” which generates tiny electrical impulses into the brain 130 times a second. The patients don’t feel the current, Rosenberg says. “Deep brain stimulation might prove to be a useful mechanism for treating Alzheimer’s disease, or it might help us develop less invasive treatments based on the same mechanism,” Rosenberg says. By 2050, the number of people age 65 and older with Alzheimer’s disease may triple, experts say, from 5.2 million to a projected 11 million to 16 million, unless effective treatments are found.

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