Ten million people around the world live with Parkinson’s diseasei a progressive neurological condition. Hear from one Boston Scientific leader who is developing technologies to improve lives of these patients, and a patient who has a device that helps him control his Parkinson’s tremors.
Rafael Carbunaru, PhD, is Vice President of Research and Development for Neuromodulation at Boston Scientific. In this role, he leads the development of technologies that help people living with neurological disorders—including Parkinson’s disease.
Rafael, what do you think people need to know about Parkinson’s disease?
I think many people are somewhat familiar with Parkinson’s disease, but probably only on a surface level. It affects about one million Americans,i and it is often characterized by symptoms that affect movement, such as slowness, inability to move, tremors, altered gait and/or muscle rigidity. Over time, these symptoms typically increase and become more severe.
The disease is debilitating, and the symptoms change how people live their lives. One story that really struck me is that of Brendan, a 57-year-old man from Illinois whose tremors caused him a great deal of pain to the point that he was uncomfortable driving and he and his wife considered early medical retirement. Hearing the effect this disease has not only on a patient, but on his family and his future—nearly taking away his ability to do things we rely on like driving to work—is sobering, and reminds me how important our work truly is.
How is Parkinson’s disease treated?
Following a diagnosis, most people with Parkinson’s disease will be treated with medication. But as the disease progresses, more frequent and higher doses of medications are often needed to manage the condition, which can lead to side effects and are not always as effective at managing symptoms. As a result, some physicians will recommend a long-term, adjunctive solution called deep brain stimulation (DBS).
What exactly is deep brain stimulation? How does it work?
Deep brain stimulation works by targeting and stimulating specific regions of the brain with mild electrical impulses. The device is implanted in a person’s chest, directly below the skin, and the mild electrical impulses are sent to the brain via leads.
We know that DBS technologies are effective. Clinical trials for DBS devices have shown improved outcomes for people living with Parkinson’s disease, including better quality of lifeii But at Boston Scientific, we weren’t satisfied with some of the older technologies approved a little more than 20 years ago. So, we set out to develop a DBS system that allows for more flexibility and precision.
What makes the Boston Scientific Vercise™ Directional Systems different?
Throughout my life, I’ve always been inspired to challenge the limitations of healthcare technology. In my work, I challenge myself and my teams to focus on what is best for patients. This approach is truly part of our DNA here, and I believe our DBS devices are an excellent example of that.
The key to the Boston Scientific DBS portfolio, headlined by the Vercise™ DBS Systems, is that it is foundationally different from older DBS technologies available today. Our Vercise DBS Systems adapted cochlear implant technology—devices that were originally designed to stimulate auditory nerves to help people hard of hearing. The precision and sensitivity of these devices is different than other DBS systems, which were based on pacemaker technology that delivered steady streams of energy to stimulate the heart muscle.
Our proprietary multiple independent current control—or MICC, as we call it— enables physicians to deliver to a precise and small target in the brain a desired amount of therapy (electrical stimulation) via the directional leads. This Vercise Directional System with Cartesia™ Lead is designed to enable stimulation only where it will have the greatest benefit, both in terms of symptom control and in reducing side effects. And even as a patient’s brain changes due to aging or disease progression, the system is designed for a physician to be able to ensure the right amount of therapy is being delivered to the right target.
For people like Brendan and his wife, DBS can make a real difference. Brendan and Teri chose the Boston Scientific device because the adaptability gave them a lot of options for the future—something they didn’t have before.
You mentioned your inspiration, what inspired you to pursue a career in healthcare?
I have always been interested in science and technology, but the moment I knew this is the work I wanted to do is a bit of a funny one. When I was 10 years old I saw Star Wars for the first time—and I will never forget the scene when Luke Skywalker gets a new robotic hand. As a kid, I didn’t know if that was possible, but it inspired me into this fulfilling career. Now that I know the great potential of medical devices, what really inspires me are the patients whose lives we touch. I am grateful to our team at Boston Scientific for placing an importance on listening to and sharing patient stories. When I hear stories from people like Brendan and Teri, I know that what we are doing is truly important.
How does the Neuromodulation team at Boston Scientific approach challenges like Parkinson’s disease?
On the most fundamental level, what we are trying to do is to learn to Speak Brainish. We want to understand the language of the nervous system. As we improve our understanding of the signals sent by the nervous system, we can develop technologies that speak that same language and help those living with neurological disorders.
What are you most excited about for the future of Neuromodulation?
Our team is never satisfied. We’ll continue to learn, research and innovate. When you look at the growing burden of neurological disorders, from Parkinson’s disease to chronic pain as well as stroke, Alzheimer’s and even mental health challenges, there are so many opportunities to improve patient care. It is an extremely exciting time to be in this field, and we look forward to doing our part to advance these critical technologies to help patients.
[i] Parkinson’s FOundataion. Statistics. https://parkinson.org/Understanding-Parkinsons/Statistics. Accessed on May 28, 2019.
[ii] Williams, Adrian, Steven Gill, Thelekat Varma, Crispin Jenkinson, Niall Quinn, Rosalind Mitchell, Richard Scott, Natalie Ives, Caroline Rick, Jane Daniels, Smitaa Patel, and Keith Wheatley. "Deep Brain Stimulation plus Best Medical Therapy versus Best Medical Therapy Alone for Advanced Parkinson's Disease (PD SURG Trial): A Randomised, Open-label Trial." The Lancet Neurology 9.6 (2010): 581-91. Web.
Important Safety Information:
Indications for Use: The Vercise™ Deep Brain Stimulation (DBS) Systems are indicated for use in bilateral stimulation of the subthalamic nucleus (STN) as adjunctive therapies in reducing some of the symptoms of moderate to advanced levodopa-responsive Parkinson's disease (PD) that are not adequately controlled with medication.
Contraindications: The Vercise DBS Systems are not recommended for patients who will be exposed to the following procedures: Diathermy as either a treatment for a medical condition or as part of a surgical procedure, Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS). The safety of these therapies in patients implanted with Vercise DBS Systems has not been established. Patients implanted with Vercise DBS Systems should not have Magnetic Resonance Imaging (MRI). Vercise DBS Systems is not recommended for patients who are unable to operate the system or are poor surgical candidates or who experience unsuccessful test stimulation.
Warnings: Unauthorized modification to the medical devices is prohibited. You should not be exposed to high stimulation levels. High level of stimulation may damage brain tissue. Patients implanted with Vercise DBS Systems may be at risk for intracranial hemorrhages (bleeding in the brain) during DBS lead placement. Strong electromagnetic fields, such as power generators, security screeners or theft detections systems, can potentially turn the stimulator off, or cause unpredictable changes in stimulation. The system should not be charged while sleeping. If you notice changes in mood or behavior or have thoughts of suicide contact your physician immediately. Chemical burns may result if the Stimulator housing is ruptured or pierced. The Deep Brain Stimulation System may interfere with the operation of implanted stimulation devices, such as cardiac pacemakers, implanted cardioverter defibrillators, or medication delivery pumps. Patients should operate motorized vehicles or potentially dangerous machinery with caution. It is unknown if the device may hurt an unborn baby. Your doctor may be able to provide additional information on the Boston Scientific Vercise DBS Systems. For complete indications for use, contraindications, warnings, precautions, and side effects, call 833-DBS-INFO or 833-327-4636.
CAUTION: U.S. Federal law restricts this device to sale by or on the order of a physician.
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*Results from this case are not necessarily predictive of results in other cases. Results in other cases may vary.
Safety information for the Vercise™ PC and Vercise Gevia™ Deep Brain Stimulator Systems is available here.