Comparison Between Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease Performed in an Operating Room versus in a MRI

 1. Title of Project

Title: Comparison Between Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease Performed in an Operating Room versus in a MRI
BASIS Advisor: Mr. Matt Johnston
Onsite Advisor: Dr. Willard Kasoff

2. Statement of Purpose

            My research is part of a six-month clinical trial comparing the outcomes of deep brain stimulation (DBS) done in the operating room compared to deep brain stimulation done in an MRI.   DBS is used to treat the motor symptoms of Parkinson’s disease, including tremors, stiffness, slow movement, and walking problems.  An electrode (also known as a lead) is surgically implanted into the brain and targets a specific brain structure to be stimulated.  The placement of the electrode has been previously done in the OR.  Now, both the placement of the electrode will be done in the MRI where the surgeon can see real time images of where the electrode is in the brain.
            The main research question:  Is there an advantage in doing deep brain stimulation in the MRI compared to performing DBS in the operating room?
             
3. Background

I do not have an extensive background on this topic.  In my sophomore year, I took AP Biology and I learned some basic structures of the brain.  These concepts were explored in further detail in my junior year when I took AP Psychology and learned about Parkinson’s Diseases and possible treatments for it.  This past summer, I was a KEYS intern and I studied pathological markers for Amyotropic Lateral Scelrossis (ALS) and did some basic research in the neurology and neuroscience department (nothing clinical was involved).
I attended a public lecture series last year hosted in the University of Arizona called “The Evolving Brain” where professors and practicing physicians discussed new technologies to understand the brain and treat disorders/illnesses.  The talks given by Dr. Michael Lemole about modern brain surgery and Dr. Martin Diego about MRI technologies were the inspiration for this SRP.  They discussed new minimally invasive treatment options that revolve around recent advancements made in the field of medical imaging, specifically the MRI and its derivatives.

4. Significance

            Parkinson’s disease is a progressive neurodegenerative disorder affecting the central nervous system (CNS).  It’s pathogenesis stems from dying dopamine-producing cells in the substantia nigra (mid brain).  There is no known cure for Parkinson’s, nor is there a known cause as to why certain neurons die.  There is some evidence that Parkinson’s disease is genetic and exposure to pesticides can increase the likelihood of an individual being affected.  DBS provides a non-permanent surgical treatment for Parkinson’s patients to ameliorate some motor symptoms.  If the patient does not respond well to DBS, the battery pack (which powers the electrode) can be removed, and therefore DBS is a reversible treatment.  This research project will compare the projected benefits of DBS done in an MRI (increased accuracy in placing the electrode) with the previous surgical method of inserting the electrode in the OR.
          
5. Research Methodology

            The University of Arizona Medical Center will be hosting my research project.  My SRP advisor, Dr. Willard Kasoff is one of the leading surgeons for this study.  I will be shadowing Dr. Kasoff for the majority of my SRP.  This includes researching ClearPoint systems, observing the procedures and following up on patients.  By shadowing Dr. Kasoff and his team of surgeons during the surgery, I will observe if it is easier on the surgeon’s side to place the electrode in the brain while the patient is in the MRI and if the placement of the electrode is accurate.  The patient follow up will mostly consist of questions the effectiveness of DBS.
There will not be a electrode placement surgery done everyday, and on days that Dr. Kasoff is not in the clinic, I will be going through old patient files and gathering data from them.  I will be comparing the position and placement of the electrodes in patients’ who have had their surgery done in the operating room or the MRI by looking at medical imaging scans.  Dr. Kasoff will provide the files from UMC patient archives. 

6. Problems

            There have been certain age limits in the past that restrict who is allowed in the OR, but so far it has not been an issue if I fill out all the paper work.  Dr. Kasoff is currently working on getting me access to previous patient files so I can compare and contrast the current DBS procedure with previous DBS procedures. 
            In the chance that this clinical trial is not a viable SRP, Dr. Kasoff has offered another project involving a comparison between laser surgery for epilepsy versus epilepsy surgery involving standard (non-laser) instruments in which I shadow him and also observe new techniques he will be using in the operating room. 

7. Bibliography

Larson, Paul S., and Philip A. Starr. "An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery: Preliminary Evaluation of Targeting Accuracy." Operative Neurosurgery 70.1 (2011): 95-103. Print.

Rodriguez-Oroz, M. C., J. A. Obeso, A. E. Lang, and J. L. Houeto. "Bilateral Deep Brain Stimulation in Parkinson’s Disease: A Multicentre Study with 4 Years Follow-up." Brain, A Journal of Neurology 128 (2005): 2240–2249.PubMed. Web. 18 Nov. 2014. <http://www.ncbi.nlm.nih.gov/pubmed/15975946>.

Willie, Jon T., Nealen G. Laxpati, Daniel L. Drane, Ashok Gowda, Christina Appin, Chunhai Hao, Daniel J. Brat, Sandra L. Helmers, Amit Saindane, Sherif G. Nour, and Robert E. Gross. "Real-Time Magnetic Resonance-Guided Stereotactic Laser Amygdalohippocampotomy for Mesial Temporal Lobe Epilepsy." Neurosurgery 74.6 (2014): 569-85. Print.