Illustration: Deep brain stimulation electrode placement. Wikipedia
This news release summarizes the results of a phase 2 safety trial of a deep brain stimulation device on patients with potential mild Alzheimer’s disease. This is an off-label trial of a device currently used to treat Parkinson’s disease and essential tremor. The device is an implanted neurostimulator that delivers electrical signals to specific areas of the brain, in this case, the fornix which is a memory pathway. The trial was intended to test the 90-day postoperative safety of this particular surgical method. We were disappointed to see that the news release reported only mild side effects and not the serious harms which required several of the study group patients to have corrective surgery.
As the U.S. population ages, Alzheimer’s disease becomes more widespread. About 5 million Americans are currently living with Alzheimer’s, according to the Centers for Disease Control and Prevention. There is a need for more options to treat this disease as well as a need for greater understanding of how to prevent the disease, or stave it off until as late as possible. Current drug treatment methods are not successful in reversing this progressive disease, nor can they stop the progression.
There is no discussion of the cost of this procedure or the maintenance costs of the device. These numbers should be well-known as the device is currently used in Parkinson’s patients and others. An article published in WebMD in 2011 estimated the surgery runs between $30,000 and $50,000.
This release summarizes a stage 2 trial looking primarily at safety following the first 90 days of the trial. It did not report on whether or not the device implantation improved cognition or slowed or halted decline. The news release says Dr. Ponce will report on potential efficacy after the last patient finishes two years of the study. The release was appropriately mum on this point and didn’t make predictions/guesses based on incomplete and preliminary data.
The release only reports the mild adverse effects, including headache and infection, which occurred in 11.9 percent or 5 out of 42 patients. It was a glaring omission not to report serious side effects that required some of the patients to undergo corrective surgery following the procedure. According to the published study:
“Twenty-six (61.9%) patients experienced 64 AEs related to the study procedure, of which 7 were serious AEs experienced by 5 patients (11.9%). Four (9.5%) patients required return to surgery: 2 patients for explantation due to infection, 1 patient for lead repositioning, and 1 patient for chronic subdural hematoma.”
The news release doesn’t tell us that the study was double-blind, randomized, and controlled, which it was. This is important to include to be able to ascertain the study’s quality.
And while there are copious amounts of data in the published study, most is not included in the news release. The release doesn’t convey the number and severity of adverse events that occurred. The overall number of events at almost 62 percent was very high. According to the published study, 9.5% required a return to surgery–not a small thing. While the surgeon-investigator feels that the study “demonstrated the safety,” we think that’s debatable.
Finally, there’s no background or context provided for lead author Dr. Ponce’s claim that deep brain stimulation has “even shown metabolic changes in the brain that may slow the progression of the disease.”
There is no disease mongering here. Alzheimer’s disease is increasing in prevalence among a population that is living longer than ever before. The impact of the disease on the patients, their families and societies is enormous.
There is no mention of the funding sources. ClinicalTrials.gov shows that the trial was sponsored by Functional Neuromodulation, Ltd. the device being studied. At least one author is associated with Functional Neuromodulation, Ltd.
The release briefly mentions the fact that there are “few promising pharmacologic treatment options,” but there is little discussion of their use or efficacy. Except for that, there is no mention of other treatment. Based on growing evidence, there’s increasing support for the idea that prevention may be the best bet to impact Alzheimer’s and other forms of dementia.
The release states that the device is only approved for use in patients with Parkinson’s disease and essential tremor. It’s available to those patients, and only for research in other conditions.
The release implies novelty by stating that the research “helps pave the way” for a new treatment option. Deep brain stimulation is used for other brain disorders, so it is obviously not a new device or new surgical approach, and the release makes this clear. However, as an approach to treat Alzheimer’s disease it is novel.
There is no explicitly unjustifiable language in this story, however, one wonders why this story was written at all. True, it reports that results of a phase 2 trial “suggest that DBS surgery targeting the fornix can be performed safely in this patient population.” For reasons described under the Harms section, for which we already gave the release a failing grade, we wonder if this news release accurately portrayed the device’s safety, and if the study really met its safety endpoint.
Systematic, Criteria-Driven
The @nytimeswell effort is shown to be unwell once again.
There's pervasive media bias toward hyping treatment benefits while neglecting negative results & harms.
Big part of this is reliance on experts with financial &/or intellectual conflicts of interest.
Att'n journalists: Use this list 100 independent experts to correct imbalance https://twitter.com/garyschwitzer/status/1177189641218330625
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