DBS for MSA
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- 28th January 2019 at 8:23 am #14477
DBS is an established treatment for PD.
How successful is the treatment for PD and which symptoms benefit?
Most of the symptoms of MSA are common to PD.
Why is DBS not available for MSA?9th February 2019 at 4:02 pm #14544
Google search has a bunch of trials in which the MSA got worse. Seems the advice is to avoid it.10th February 2019 at 3:16 am #14546
Thanks for your reply. i believe all the negative results are from targeting the globus pallidus or the sub-thalamus region of the brain. There is a proposal to target a different region , the pedunculopontine nucleus (PPN), which has shown some promise when this region has been targeted in PwP, benefiting both the motor and the autonomic functions.11th February 2019 at 10:16 am #14548
Perhaps. Many neuro diseases have overlapping symptoms, movement, autonomic, balance etc stemming from which bit of the brain is damaged. For example MSA-P and PD. While in both cases similar areas are effected, by possibly the same but differently folded protein, the cellular targets and mechanisms of failure are different.
Any trial my have no effect on the patient, but the case of DBS in MSA is made the patients worse. What I have not seem is the analysis of why? What is the effect of DBS on healthy patients? If not as detrimental it implies the problem using it in MSA is not the region being targeted (in which case the effect on MSA and healthy would be similar) but the effect on the mechanism of decay in MSA. In which case changing the region, which has the same decay pathway, will still result in a negative patient outcome, just with different symptoms.
I’m not saying this is the case, more of a devils advocacy argument. I’m just saying if you bash something with a hammer and things get worse, its good idea to have a look why rather than smacking something else. Unless its from IKEA then a repeated bashing has a host of psychological benefits,12th February 2019 at 4:05 am #14554
Thanks for your thoughtful response.
Has anyone any idea how DBS works? I can intuitively sort of understand how it might work for epilepsy disrupting an electical storm in the brain, but how does it work for other brain disorders?12th February 2019 at 12:26 pm #14556
It stimulates cellular pathways but exactly how I don’t know. In PD the nerve cells themselves are killed but in MSA the malign protein also hits the oligodendroglia, a type of cell that makes myelin (a coating on nerve cells that lets them conduct electrical signals rapidly). That’s why I get tremors in a bath, as my nerves are shorting out due he heat and weakened electrical insulation (hot baths were an old school way of spotting MS for this reason and why I was the only person to have hoped he had PPMS at the start!).
Anyway, because this effect on electrical signalling is unique to MSA then it seems to me the worsening with DBS maybe linked. Hence why I worry that changing the region as target for DBS is not enough as its the same MSA and same oligodendroglia pathway.13th February 2019 at 6:19 pm #14560
Thank you for the information. Wold you like to continue the discussion by email?
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