in the field of neurology across five continents as well as a current interest “in the space where you can create new therapies, new projects, new protocols for helping the patients”. This background enables Dr Sweta to offer brilliant insight into why she thinks a device offering peripheral stimulation is “a great idea” for people with Parkinson’s.
Peripheral Stimulation and Parkinson’s
Speaking eloquently, with a dizzying speed that betrays her fierce intelligence and a deep understanding of the condition, Dr Sweta explained why she is “a great fan” of using any strategy which can help people with Parkinson’s overcome their hypokinesia (slow movement), rigidity and freezing episodes (a sudden, temporary, inability to move).
The CUE1 (a vibrotactile stimulation device) uses the concept of peripheral stimulation to help “boost” the neuromotor circuitry and bypass movement problems caused by a lack of dopamine (a neurotransmitter in the brain). Dr Sweta deftly explains the process as “stimulation at the periphery – which can be anywhere (as she indicates her whole body) – and that is where the impulses go back to the brain. They hit the basal ganglia circuit and the motor cortex and again, with that stimulus, give a central boost.”
Parkinson’s Disease (PD) is a progressive disorder that affects nerve cells in the brain responsible for body movement. When dopamine-producing neurons die, symptoms such as tremor, slowness, stiffness, and balance problems can occur.
What other treatment strategies are there?
One treatment option which has been explored is Deep Brain Stimulation (DBS) – an invasive procedure which involves inserting thin metal wires in the brain to modulate the motor circuitry. Exactly how DBS works is not fully understood, but many experts believe it regulates abnormal electrical signaling patterns in the brain. This is not a cure and experts believe those eligible make up just 1-10% of all people with Parkinson’s. Dr Sweta also cautions that “trials suggest that it does not work very well for everyone” and that “it does not help all the symptoms of Parkinson’s Disease”.
Two other treatment strategies include either pushing the existing dopamine cells to work harder (“but they cannot beyond a certain point” Dr Sweta states) or – more commonly – supplementing existing levels of dopamine. Whilst medication works in the latter case, it can lose its effectiveness over time which leads to significant side effects such as the ‘on-off’ phenomena and erratic dose responses.
CUE1 and peripheral stimulation a “great idea” for People with Parkinson’s
Dr Sweta confirms that it is during the early- to mid- stages of Parkinson’s that the peripheral stimulation could be most effective in helping people manage some of their symptoms. She explains that “the main impact would be in the motor aspect of it…making the movement smoother and progressive”, thus helping with slowness of movement and potentially overcoming freezing episodes.
She shares her knowledge of older trials, as well as more recent research describing the successful use of alternative strategies – including cues. These studies have shown that the use of sensory stimulation to ‘bridge’ the circuit is securely founded in science “because you are trying to ignite that same circuit which is a part of the problem”.
During our discussion, it is obvious that it is the lack of risk which is particularly important to Dr Sweta’s support of the use of sensory stimulation as part of a management plan. “I think it’s a great idea” she states. “There is no pharmacological intervention whatsoever – there is no additional harm that you are doing by stimulating the periphery”. She goes on to add that “the chances of working (whatever they may be) would definitely help the patient rather than do any harm”.
Helping people with Parkinson’s overcome mobility symptoms
It may not make a huge difference to appendicular rigidity (stiffness in arms and legs), postural symptoms, balance or tremors. However, Dr Sweta explains how intermittent stimulation could help those who struggle with walking difficulty (slowness) and intermittent freezing. The vibrotactile stimulation, in theory, should reduce hypokinesia and boost the effect of levodopa.
Devices such as bent sticks, laser light devices and more are already being used for facilitating walking in patients of Parkinson’s Disease, although they do not employ sensory stimulation. The CUE1 Device utilises this component well.
Dr Sweta concludes that any clinical trials that are carried out that “prudently monitor” the akinesia (inability to move), hypokinesia and freezing aspects (with reference to both the ‘on’ and ‘off’ phases); trialled with and without stimulation from the CUE1 Device – would be “highly valuable”.
Buoyed by these affirming comments we continue to develop CUE1 to be as effective and user-friendly as possible with plans to take the technology to clinical trials in the coming months.
We strive for its success – to help people suffering from the disease and to provide a ray of hope to their families equally struggling to care for them. Thank you to Dr Sweta for lending her expertise and support, further adding to the fantastic knowledge base behind CUE1.