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Max Little describes the remarkable power of interdisciplinary research in the quest to find a cure for, or at least alleviate the debilitating symptoms, of Parkinson's disease (PD). His achievements in using telephone voice recordings from people with and without PD to aid diagnosis and potentially monitor treatment effects are extraordinary. Advances in signal processing analysis, machine-learning methods and human brain stimulation and recording are also being used to advance a therapy for PD called deep brain stimulation (DBS).
During DBS surgery, we now have the ability to watch individual neurons working alone and together in the awake human brains of people with a variety of neurological conditions. We have the opportunity to not only improve brain function in these individuals but, whilst they are awake, record the neurons at rest and during cognitive and sensory motor tasks.
The ability to watch in real-time how individual neurons or clusters of neurons process information in an awake human being has enabled us to look for biological signals in the brain that help define both normal circuits, and abnormal activity that results from brain disease or damage. The significant advances in data capture and analysis techniques allow us to watch the brain thinking directly without the need for additional off-site processing such as in functional magnetic resonance imaging or positron emission tomography.
DBS uses a chronically implantable brain machine interface consisting of electrodes placed in the deep brain that then tunnel under the skin to reach an implantable pulse generator in the chest. The pulse generator then delivers high frequency stimulation back to the target deep brain structure. Recent developments have enabled us to document stimulation activity by extracting data from the pulse generator via its embedded recording system.
Currently, we can adjust these stimulation parameters in the pulse generator using a telephone consultation with the patient. This electronic patient consultation saves time and travel resulting in faster, cheaper and more convenient adjustment of the device. This, in turn, leads to better patient outcomes. In the future, the ability may emerge for patients to have their conditions treated via web-based systems if we can determine the appropriate neurophysiological biomarkers that predict optimum symptom relief. Research at the blurry boundaries of multiple disciples will deliver the future developments we are seeking.
These applications of deep brain stimulation or neuromodulation are now extending beyond movement disorders such as Parkinson's disease and tremor disorders into epilepsy, anxiety conditions such as obsessive compulsive disorder, addiction, body image and intractable pain including phantom limb pain. This direct examination of the brain and its response to simple and complex tasks including higher cognitive function and testing is helping to define brain structure and function and provide a sound basis for neuromodulation that may be achieved remotely.
These issues bring with them major excitement but clear ethical issues remain and will need to be considered as science tackles the modulation of nature's most complex structure.
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