Goodbye Drugs, Hello Medical Devices?

An interesting shift is occurring in the world of treating movement disorders and other neurological conditions. For decades, persons diagnosed with conditions like essential tremor (ET), Parkinson’s disease (PD), chronic nerve pain, migraines, etc. were given medications as the first line of defense. But that’s changing.

Pharmaceutical drugs have often proved effective for controlling a neurologic problem, at least initially. In the case of ET, about half of the persons who start taking a medication – usually Primidone or Propranolol – find it doesn’t help, while the other half does gain benefit. However, two downsides to medications can offset the benefits:

  1. Side effects may occur (depending on the drug, these may include fatigue/drowsiness, skin rash, irritability, loss of interest in sex, muscle cramps, trouble sleeping, etc.)
  2. As ET progresses, dosage increases may be necessary until eventually the drugs stop working

Economic trends reveal a shift in ET management strategy

News from global markets in both neurologic medical device and pharmaceutical use show a decided trend in which devices are outpacing medications. According to one report, the neurology device market “…is growing at 7.8% year on year against 5% for the equivalent pharma.”i At first glance, it might be tempting to think that doctor recommendation or patient preference is driving this. In fact, analysts attribute the swing to healthcare economies. “Due to their cost-to-utility ratio, the use of neurology devices, in particular neurostimulators and deep brain stimulators, is increasing in the treatment of epilepsy, chronic pain, Parkinson’s disease, migraines and post cancer pain.”ii

Broadly speaking, people are living longer and their health issues are costing more. We are seeing a rise in aging-related neurologic conditions like Parkinson’s disease and Alzheimer’s disease. While ET can occur at any age, especially in familial cases, it more often begins in mid-life or later. For persons who are older when ET starts, their condition tends to progress more quickly than it does with younger people, culminating in severe impairment and poor quality of life. Given other aging-related problems such as arthritis or cardiovascular problems, for older adults who also have ET it can be very difficult to get through a normal day.

At the same time that need is increasing, technologic developments in minimal-to-noninvasive neurosurgeries are making it feasible to eliminate medications as a way to treat tremors. Thus, a one-time outpatient procedure such as MRI-guided Focused Ultrasound (MRgFUS) can safely and durably control ET and ultimately save the healthcare costs associated with long-time drug use and side effect management.

It’s not just about healthcare dollars

That said, let’s return to the notion of doctor recommendation and patient preference. Individuals with ET actively and constantly explore alternatives to medication. The desire to be drug-free is powerful. On the other hand, when many of them consider Deep Brain Stimulation, the idea of having a hole drilled in their skull and wires implanted in their brain can be scary.

There is tremendous appeal to a neurosurgical procedure that involves no incisions or drilling of holes. For a patient who learns about MRgFUS, he or she is not thinking about an economic cost/benefits analysis in the global market place. Rather, their main concern is simple: could this restore the function of my hand and the quality of my life? The knowledge of what MRgFUS can do for them is what drives their personal decision.

For people with ET who have found that medication no longer works—or they don’t wish to start on drugs—Sperling Neurosurgery Associates offers Neuravive MRgFUS for drug-free control of ET. While we are proud to be at the forefront of revolutionary image-guided neurologic technology, what’s uppermost for us is what it does for our patients, who find the results transformative.

Contact us for more information, or to arrange a consultation.

i “Neurology Devices are Replacing Drugs as First Treatment Preference.” EIN Newswire, May 9, 2018.
iiIbid.

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