[paula_w]

This came into GRC email.....PAN members all know Paul. Look what he has been up to:

http://www.lilafilms.com/shaken_screenings.htm

The emailer said:

I had the opportunity to view "Shaken," a documentary about Parkinson's disease. The film is powerful, touching and heartbreaking. Being a Parkinson's patient and having had the same DBS surgery as Paul in the film, "Shaken" accurately depicts the challenges of living with PD as well as the limitations of this surgery, and at the same time, inspires hope for the future.

Paula

[Stitcher]

Paula, the schedule in Annapolis says 5pm on Sunday the 12th.

http://www.annapolisfilmfestival.com/schedule.htm?

I see Denver already has time schedules in the website you cited.

[paula_w]

More email about 'Shaken'

The Vision Fest Executive Director at the NYC film festival just informed Deborah Fryer that "Shaken" won BEST DOCUMENTARY SHORT last week. That's great news. Congratulations.

For all the night owls in the crowd, a segment of "Shaken" will be shown at 12:05 a.m. mountain time (yes, that's 5 minutes after midnight) tonight on Inside Edition, on Channel 7 in Denver. Check your local listings if you live in a different area.

Thanks again for your support.

[LindaH]

Came across this letter in the November 2006 Lancet Neurology about DBS, reminding that while the results are often good "in carefully selected patients", there's a lot we don't know about it yet and more research is needed to answer the questions.
-------------------------------------------------------------------
FROM:
The Lancet Neurology : Deep-brain stimulation in Parkinson's disease
Volume 5, Issue 11 , November 2006, Pages 900-901

Reflection and Reaction
Deep-brain stimulation in Parkinson's disease
Frances M Weavera, , Matthew B Sternb and Kenneth Follettc

aMidwest Center for Health Services and Policy Research, Hines VA Medical
Center, Hines, Illinois and Northwestern University, Chicago, IL, USA
bUniversity of Pennsylvania Health System and Philadelphia VA Medical Center,
Philadelphia, PA, USA
cUniversity of Nebraska Medical Center, Omaha, Nebraska


Available online 16 October 2006.

Deep-brain stimulation (DBS) for Parkinson's disease (PD) received yet another endorsement with the recent publication of Deuschl and colleagues'1 large, randomised-pairs trial of subthalamic nucleus (STN) stimulation versus standard medical treatment. Despite many published studies of DBS in PD, few have been large, well controlled, or randomised using a medically treated control group for comparison. Furthermore, quality-of-life scales were used as the primary endpoint in Deuschl and colleagues' study in addition to standard motor scales for PD.

Not surprisingly, surgically treated patients had substantially better
outcomes at 6 months than did medically treated patients. In fact, improvements in scores on the Parkinson's disease questionnaire-39 after surgery were far greater than improvements in the scores noted in various clinical trials of antiparkinson drugs in which the questionnaire was used as a secondary response variable. Changes were understandably greatest in the motor aspects of the scale with little difference in the neurobehavioural components.

Of note, in the paired analysis 36% of patients who received medical treatment showed greater improvements than their counterparts assigned DBS. Paired analysis of the off-medication motor component on the unified Parkinson's disease rating scale favoured the medically treated group in 27% of pairs.

Serious adverse effects, although infrequent, occurred more readily in the DBS group. Why did some of the medically treated patients do better than their DBS-treated counterparts and where should DBS now reside in the hierarchy of PD treatments?

First, not every patient benefits from stimulation and patient-selection
criteria are still being refined. Movement disorder specialists lean towards
offering DBS to younger, cognitively intact patients with clear-cut motor
fluctuations and good response to dopaminergic treatment. We still have much to learn about the effects of DBS for other populations of patients and for specific PD symptoms. For instance, the effect of DBS on older patients, who represent most of the PD population, is not known because these patients are commonly excluded from research studies and might be more vulnerable to cognitive decline after surgery.

Second, despite improvements in motor function with DBS that far surpass
measured improvements in most drug studies, there has been little documentation of improved emotional or cognitive status. Furthermore, worsening of non-motor symptoms such as depression, speech difficulties, and cognition have been noted in some patients treated with DBS.2 Clearly, this is an area that needs further study as the neurobehavioural aspects of PD contribute immeasurably to long-term disability.

Third, although the STN is the favoured target for DBS,3 the optimum site for
treatment has not been studied in adequate detail. In a small randomised trial
that compared stimulation of the STN versus the globus pallidus interna (GPi),
there was no difference in motor improvement by surgical target.4 A
meta-analysis of outcomes in patients after DBS of the STN and GPi showed
similar improvements in motor function and activities of daily living for both
targets.5 Although use of dopaminergic drugs was more readily reduced after STN stimulation, the procedure was more likely than GPi DBS to cause
neurobehavioural problems and speech difficulties.2

A large, randomised, double-blind study of GPi versus STN DBS is currently nearing completion (VA Cooperative Study) and will further characterise the effect of each target on motor function and quality of life. Additionally, this study will examine the effect of patients' characteristics, such as age and disease stage, on outcomes.
DBS represents a major advance in the treatment of PD and we applaud the efforts of Deuschl and colleagues1 in undertaking a large randomised trial. These studies are costly, time-consuming, and require the cooperation of many investigators, research personnel, and, most importantly, PD patients.

Although DBS has an established place in the hierarchy of PD treatments, clinicians should remain informed about its limitations and be inquisitive about its potential. They must understand that despite the often impressive results of DBS in some patients, many questions about the treatment are, as yet, unanswered.
The next phase of DBS research will determine whether specific PD symptoms, such as tremor, bradykinesia, gait, balance abnormalities, and dyskinesias, respond more favourably to stimulation of a specific target and whether adverse effects, particularly neurobehavioural symptoms, are more likely to occur with STN or GPi stimulation. DBS is an invasive procedure with inherent risks that must be weighed against the potential for substantial benefit in carefully selected patients.

We have no conflicts of interest.

References
1 G Deuschl, C Schade-Brttinger and P Krack et al., A randomized trial of
deep-brain stimulation for Parkinson's disease, New Engl J Med 355 (2006), pp.
896–908. Abstract-MEDLINE | Abstract-Elsevier BIOBASE | Abstract-EMBASE | Full
Text via CrossRef
2 MC Rodriquez-Oroz, JA Obeso and AE Lang et al., Bilateral deep brain
stimulation in Parkinon's disease: a multicentre study with 4 years follow-up,
Brain 128 (2005), pp. 2240–2249.
3 JL Vitek, Deep brain stimulation for Parkinson's disease: a critical
re-evaluation of STN versus GPi DBS, Sterotact Funct Neurosurg 78 (2002), pp.
119–131. Abstract-EMBASE | Abstract-MEDLINE | Full Text via CrossRef
4 VC Anderson, KJ Burchiel and P Hogarth et al., Pallidal vs subthalamic nucleus
deep brain stimulation in Parkinson disease, Arch Neurol 62 (2005), pp. 554–560.
Abstract-MEDLINE | Abstract-EMBASE | Abstract-Elsevier BIOBASE | Full Text via
CrossRef
5 F Weaver, K Follett, K Hur, D Ippolito and M Stern, Deep brain stimulation in
Parkinson disease: a metaanalysis of patient outcomes, J Neurosurg 103 (2005),
pp. 956–967. Abstract-MEDLINE | Abstract-Elsevier BIOBASE | Abstract-EMBASE