The Next Stage for DBS

Though there are many promising market segments emerging in the neurotechnology industry, the deep brain stimulation market is flush with activity in terms of new indications, new competitors, and new scientific findings bolstering the industry. Much of this activity was evident at the 2008 Neural Interfaces Conference in Cleveland earlier this month [see article, p7].

One of the most profound topics discussed at the conference was the issue of whether or not DBS can have a curative effect on neurodegenerative disorders such as Parkinson’s disease. David Charles from Vanderbilt University, acknowledging that the topic is “explosive” within neurological communities, said that if it is true, then DBS should be applied early in the disease progression. He described some of the early evidence supporting the hypothesis and mentioned that currently, human patients with PD present with 50 to 75 percent loss of dopaminergic cells and that there is no current treatment that slows the progression of the disease.

Caryl Sortwell from the University of Cincinnati described her work with rodent models of PD and noted that STN DBS applied two weeks after lesioning halts neurodegeneration and that stimulation is associated with a threefold increase in brain-derived neurotrophic factor in the striatum. Andreas Kupsch from the University of Berlin in Germany also spoke of work in this area and described a forthcoming European trial of 250 patients who would receive DBS much earlier in the disease progression.

Another session devoted to DBS looked at the effectiveness of STN vs GPi target selection for Parkinson’s DBS. Though the data has not been presented yet, there is early indication that there is not much difference in effectiveness, a finding that could bolster competition. Domenico Servello from the Hospital of Galeazzi in Milan, Italy, described his work with DBS to treat 800 patients with Tourettes Syndrome, just one of many emerging applications for DBS.

In a lunchtime breakout session devoted to DBS, participants discussed issues such as why there is not more application of DBS. The general consensus was that the reason was not lack of capacity. Some participants complained that neurologists were reluctant to refer patients to neurosurgeons for DBS. Others advised that DBS implanters need to make the process simpler for patients and clinicians, particularly programming options.

As the DBS market matures and new players and new indications become viable, events like the Cleveland conference will help shape future directions. It should be interesting to watch this market develop over the next few years.

James Cavuoto
Editor and Publisher