Last Resort Revisited
Vendors and researchers in the implanted neuromodulation device field have long been familiar with the “last resort” nature of neurotechnology interventions. Because of perceived risks, surgical complications, and up-front costs associated with implanted stimulation devices, clinicians generally do not recommend neurostimulation therapy until patients have exhausted all other available interventions. Because of this, neurotech devices approved by regulatory agencies often carry a label restricting their use to refractory, or treatment-resistant patients.
But the availability of deep brain stimulation systems for treatment of Parkinson’s disease may soon challenge this line of reasoning. A number of investigators have put forth the idea that DBS therapy should be used at an earlier stage in the progression of the disease, rather than waiting until the patient stops benefiting from drugs such as L-dopa. Considerable support for this notion emerged after publication of a clinical study in the New England Journal of Medicine earlier this year that showed that patients treated with DBS and conventional medical practice did much better than those treated with conventional medical practice alone [NBR Feb13 p5].
Since that article appeared, several clinicians have chimed in to argue for earlier use of DBS. “This is a terrific study,” said David Charles, professor and vice chairman of neurology and chief medical officer at Vanderbilt Neuroscience Institute in an article in Neurology Today. “It will be transformative for the field.” Michael Okun, administrative director and co-director of the Center for Movement Disorders and Neurorestoration at the University of Florida added, “Potentially, patients could benefit from DBS much sooner in their disease. In the early days, we tried everything to spare the patients surgery. Now, the threshold is starting to move earlier. I think it is a good thing.”
The DBS industry got another boost this month with the publication in Movement Disorders of a German study of the long-term cost-effectiveness of DBS for Parkinson’s disease. “DBS can be considered cost-effective, offering a value-for-money profile comparable to other well accepted health care technologies,” the authors wrote.
While the example of DBS for Parkinson’s disease may not apply to all neuromodulation interventions, it is in our interest to do all we can to educate clinicians, patients, and the public of the economic and therapeutic viability of neurotechnology. Jennifer French, whose book On My Feet Again tells a convincing story of the viability of FES for treating paralysis, is beginning work on a new book titled Last Resort: Short Stories of Becoming Bionic, which will feature individuals using several different types of neurotech therapies. We encourage neurotech vendors to share your success stories with Jennifer.
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