Could vibrations help those with Parkinson's?

How is the medical profession able to help people with the illness? We have a range of drugs that control the symptoms of the disease, which work chiefly by helping to replace some of the missing dopamine in the brain.There are also other interventions, including electrical stimulation to certain circuits in the brain and the spinal cord. But earlier this year, Addenbrooke’s Hospital in Cambridge became one of the first centres to try a new body-worn device that uses an observation going back two centuries and relies on vibration to help people with Parkinson’s to move more easily…

Alastair - My name's Alistair Mackett. I'm a consultant at Addenbrooke's Hospital in Cambridge. So interestingly, we started looking back to 200 years ago, back to Jean-Martin Charcot who, 200 years ago, noticed something really interesting: that patients that came to see him with Parkinson's were always better when they came to see him in his office than when he visited them at home. And I think he hypothesised that there was something about how they travelled and he thought, could this be vibration?

Chris - These would presumably have been horse-drawn carriages rattling over the cobbles of Paris. Because he was a French neurologist, wasn't he, Charcot?

Alastair - Absolutely. You've hit the nail on the head there. Absolutely he was saying, was this horse riding? Was this riding in the back of a carriage? And he got quite excited about it and they were sort of vibrating chairs back around 200 years ago. And we forgot about it with all the drugs and developments that have occurred. But more recently we've realised that some people can't tolerate some of the drugs or advanced therapies or are not suitable for things like deep brain stimulation. So there's a real appetite for non-invasive treatments or devices that may help some of the symptoms of Parkinson's.

Chris - Why would vibration make a difference? And is that real? If people are vibrated, is there evidence that it might improve things?

Alastair - So there's a body of evidence that suggests that it may have an impact and it may improve symptoms. And I think here in Cambridge we've been working with a CUE1 device, which is a small device. It's about the size of a two pound coin that sits on the chest on the sternum and supplies vibration. And that's picked up by your nerves and that signal goes up to the brain. And what we think is that when you get those signals up to the brain, it causes an alteration in brainwaves, which can be quite abnormal in Parkinson's. So we have particularly beta wave activity, which when it is normally high, makes you potentially stiff and slow. But when you provide some vibrotactile stimulation, it can bring down that beta wave activity and put you in a more ready to move state and really potentially some of those symptoms.

Chris - You've got one of these CUE1 devices on the table in front of us. As you say about the size of a big coin, two pounds. And quite thin. Is that sticky then, I'd stick that on my sternum.

Alastair - So I'll just put it on my chest here. So effectively there's an adhesive, a medical adhesive a bit like Velcro. It sticks the CUE1 device onto the chest and then you can turn it on and you may be able to hear a sort of vibrating noise.

Chris - Hmm. It's like when your phone's on vibrate mode and it's buzzing. That's transmitted into your chest.

Alastair - Yep, you can feel that transmitted. You know, it's a really simple intervention that seems to have benefits for some patients with Parkinson's.

Chris - Does it have to go on the chest on your sternum? Could I put that anywhere?

Alastair - People have tried it in other areas. It seems to be the sternum that has the biggest effect.

Chris - It's quite bony there. Is it getting in well?

Alastair - I think it's probably your rib cage resonating and giving a bigger effect.

Chris - So if you stick electrodes on someone's head and look at their brain waves when you are doing that, can you see a difference?

Alastair - So we can see changes within brainwave activity, which is really exciting and starts to hopefully explain what Jean-Martin Charcot was seeing 200 years ago. And obviously he couldn't prove that with an EEG in the way that we can now in the 21st century.

Chris - But if you ask a patient, 'are you moving more easily?' I know it's subjective, but do you get an improvement? Because it's hard to do a blind trial with this, isn't it? They know it's buzzing. So there must be quite a lot of kind of queuing or placebo effect here, but do they move more easily?

Alastair - So, of the data so far, around 75% of people are seeing evidence which is meaningful to them. As you say, quite rightly, there's always a concern that there is a placebo effect in Parkinson's. And further trials are planned in the coming months and years ahead to try and account for that. But as things stand, people are seeing meaningful benefits.

Chris - So how do you think it's working? What do you think it's actually doing in their brain? That means that just a bit of a vibration applied to the chest can get around some of the difficulties with Parkinson's.

Alastair - What we're giving them is a peripheral stimulus and that signal is going up to the premotor cortex within the brain. So it is tricking the body into the fact it's moving or in a moving state. And that seems to have a knock on effect by reducing the beta wave activity within the brain and effectively getting people to move more easily.