This morning, the Lasker Foundation announced that two scientists, one a European Dana Alliance member and the other a Dana Alliance member, will share the 2014 Lasker~DeBakey Clinical Medical Research Award. The award recognizes the work of Alim Louis Benabid and Mahlon R. DeLong to develop deep brain stimulation (DBS) of the subthalamic nucleus, surgically implanting a “brain pacemaker” that can reduce tremors and restore motor functions in people who have advanced Parkinson’s disease.
Dr. DeLong has been a popular guy on our website, as well. He is a generous interview subject, and has explained the science behind DBS for us and for readers as well as writing pieces himself. Here are a few:
In 2007, he joined us at the Dana Center, then in Washington DC, for a panel discussion of how studying brain circuits could hold keys to curing disease [see story and video]. He was excited about the chance patients with epilepsy and other disorders were giving researchers by allowing them to record from their brains during the electrical-stimulation testing before surgery. “We have greater access to the brain, in the course of these procedures that we carry out for sort of routine things like Parkinson’s and other disorders now,” he said. “We’re able to use almost every operation as an experiment, gaining information that would have been impossible before.”
In 2009, colleagues, friends, and grateful patients honored DeLong with a daylong symposium on his work. We wrote a 2-part profile ahead of the event: Part One focuses on his early career and the underappreciated brain parts that make up the basal ganglia; Part Two on targeting Parkinson’s with surgery and electrical stimulation.
When I came into the field, the basal ganglia were viewed as primarily motor—they were thought to be important for transmitting commands from different cortical areas to the motor cortex. A lot of our early work changed the thinking about that. We identified a family of circuits that ran through the basal ganglia involved not only in motor function but cognitive, associative and limbic functions. And that broadened the whole thinking about the basal ganglia as being involved in the whole spectrum of behavior.
With fellow researcher Thomas Wichman, Dr. DeLong wrote a review for our Report on Progress in 2008 on the current state of DBS research and application.
Deep brain stimulation offers truly remarkable benefits to patients with advanced movement disorders and other conditions, but exactly why it works remains unclear. Scientists first believed it simply mimicked the effects of lesioning, but more recent studies of brain activity in animals and patients have suggested that DBS alters patterns of activity in the extended brain networks associated with the stimulated brain region by activating axons that leave or enter the stimulated region of the nucleus.
Already in 2009 he was back, writing a piece for Cerebrum on the promises and perils of using DBS techniques to try to treat psychiatric problems.
We do not know exactly how the future of DBS and the new field of neuromodulation will evolve, but the genie is out of the bottle. Increasing numbers of patients will undergo treatment with DBS for some of the most distressing and disabling disorders known to mankind. Early successes and rapid progress generate both hope and concern.
First, hope: It may soon be possible for patients with the most disabling and resistant forms of depression, OCD and Tourette’s syndrome to find relief. Moreover, progress may spur experimental use of DBS for other psychiatric disorders. Now, concern: Scientists must avoid repeating the mistakes of the past and withstand the pressures to proceed too quickly into uncharted waters. Guidelines are essential to protect patients, and they must include rules for comprehensive evaluation and full discussion of risks, benefits and alternative approaches to ensure that DBS is the appropriate treatment choice. Careful oversight and monitoring by institutional review boards is also essential. Ultimately, physicians and psychiatrists must assure the public that they will do away with the negative associations of psychosurgery by bringing the modern field of neuromodulation to its full potential.
We’re grateful to Dr. DeLong and his fellow Dana Alliance members for their commitment to public outreach.