Dr. Fasano & Dr. Kalia
Neurologist Dr. Alfonso Fasano, (L), and neurosurgeon Dr. Suneil Kalia, with Krembil Brain Institute, are using a new device to track the brain activity of patients with Parkinson's disease. (Photo: Courtesy CBC)

Six years ago, 66-year-old Gord Luke was shoveling the driveway of his Wawa, Ont. home when he fell, breaking his hip and his hand. Soon after, Gord noticed a consistent shaking in his hand, but chalked it up to the injury.

It was Parkinson's disease, a progressive degenerative neurological condition that can impact a person's mobility, movement and cognition.

"My wife said, 'you don't smile like you used to,'" Gord remembers. "But I never thought it was Parkinson's."

A candidate for deep brain stimulation (DBS) surgery, Gord was referred to Dr. Suneil Kalia, a neurosurgeon and scientist, and Drs. Alfonso Fasano and Renato Munhoz, neurologists and Clinician Investigators, with UHN's Krembil Brain Institute, at Toronto Western Hospital.

In October of this year, Gord received surgical implantation of electrodes to stimulate his brain, and a new device that can monitor his brain activity in real time.

"This is the first time we can chronically record brain activity," says Dr. Fasano. "It's especially helpful for patients with Parkinson's, because they experience a lot of fluctuations.

"Sometimes they move well, other times they have excessive movement. The condition really changes by the minute, so knowing why the brain behaves the way it does will give us greater insight into more effective treatments and therapies."

Gord Luke looking at his hands
Gord Luke, 66, is the first Canadian patient to receive the new implant. "I feel great," he says. (Photo: UHN)

The only way a patient's medical team would have had access to a patient's brain activity prior to this is during the implantation procedure, where electrodes are surgically delivered to targeted areas during awake brain surgery. Now, doctors have the ability to "listen" to the brain, in addition to using electrodes to stimulate those areas to decrease symptoms.

"It's kind of like a brain diary," says Dr. Kalia. "With this technology, we can record brain activity anytime, whether it's a day after surgery, or whether it's two to five years after surgery.

"And that provides clinicians a lot of data that we can react to and optimize the therapy, and potentially further improve the quality of life of our patients."

When Dr. Fasano turns on the device and increases the amount of stimulation, Gord experiences an improvement of movement with the induction of some dyskinesia, or involuntary movements, in his hands and feet. When he decreases the stimulation the right amount, dyskinesia disappears while the beneficial effect on movement remains. At the same time, Dr. Fasano is correlating Gord's brain waves on a monitor to what he is seeing, in real time.

"It's pretty incredible," says Dr. Fasano. "I've never been able to see this before."

The goal is for Gord to keep a log of activity using a handset, which is connected to the pacemaker-like device in his chest, including when his symptoms are at their most intense and when he takes his medications. Dr. Kalia and Dr. Fasano can use these crucial data to make adjustments, or improve his therapy.

Allows patients to have a greater role and more autonomy in their care

Krembil Brain Institute is one of the top centres for neuromodulation, or brain stimulation, in North America. The team, comprising more than 100 brain-focused clinicians, researchers, Allied Health Professionals and support staff, does more neuromodulation procedures each year than anywhere else in Canada.

"We have many patients like Gord, who come from far distances for appointments," says Dr. Kalia. "This device will allow our patients to have an even greater role in their care, and more autonomy in their care.

"Having access to a patient's brain activity while we're not with them is a huge benefit for the team and for the patient, when we do see them."

"The brain is very mysterious," says Dr. Fasano. "We always wonder what's happening in someone's brain, more so in a patient with a neurological condition."

"This device gives us a full picture of brain activity, which will lead to better outcomes," he adds. "for us, it's very exciting."

'The potential is vast and the field is wide open'

Right now, the device is being used in patients with Parkinson's to better understand how abnormal brain signals change over time as the disease progresses. The next generation device will be able to sense a patient's brain state and automatically make adjustments to therapy.

Both Dr. Fasano and Dr. Kalia see huge potential for future applications of this technology with other neurological disorders.

"For epilepsy, we would have the capability of detecting seizures before they happen, and potentially, stopping seizures," Dr. Kalia says. "With other more difficult to treat conditions like depression and OCD (obsessive-compulsive disorder), we would have the ability to potentially monitor patients' mood and changes in their mood, and adjust the therapy accordingly.

"So the potential is vast and the field is wide open."

Gord is hoping this new technology will help him get back to the wood carving and painting that keeps him busy in retirement.

"I'm a little nervous, but excited," he says. "I'm looking forward to getting back to my life."

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