The mentors of two University of Florida Health physicians have received the Lasker Foundation’s Lasker-DeBakey Clinical Medical Research Award for their pioneering work in deep brain stimulation, work that the UF neuroscientists continue to build on today.
Mahlon DeLong, a neurologist at the Emory University School of Medicine, and Alim-Louis Benabid, emeritus professor of biophysics at the Joseph Fourier University in Grenoble, France, were honored for their contributions to improve the clinical treatment of patients. Michael S. Okun, M.D., a UF neurologist, studied under DeLong, whereas Kelly D. Foote, M.D., a UF neurosurgeon, studied under both DeLong and Benabid. Together Okun and Foote founded the UF Health Center for Movement Disorders and Neurorestoration and serve as its co-directors.
Okun has written a Perspective article about DeLong, Benabid and the state of the field of deep brain stimulation for The New England Journal of Medicine published today, Sept. 8, to coincide with the award’s announcement.
Deep brain stimulation is used to treat various movement disorders, including Parkinson’s disease and dystonia. Leads that terminate in electrodes are implanted into a problematic area of the brain, then attached to a pulse generator. The pulse generator emits electricity that modulates the misfiring neurons causing problematic symptoms in these movement disorders.
“To me, it’s really fitting that the award is being given to both a neurosurgeon and a neurologist because not only has the therapy helped more than 100,000 people, but it also spawned the idea of people working in teams to address the multiple symptoms of Parkinson’s disease,” Okun said.
Foote credits the two with beginning the entire field of deep brain stimulation.
“They were both pioneers in different ways,” Foote said. “One was a surgeon, and one was a neurology lab researcher and clinician, but their contributions were perfectly complementary. The whole deep brain stimulation therapy movement could never have happened without the contributions of Mahlon DeLong and what he figured out with his team about how brain circuitry worked. However, that understanding would not have been applied without someone who was as courageous and innovative as Benabid.”
Foote, who studied for a few months as a fellow at Emory University under DeLong, may be the only physician who has studied under both neuroscientists. The interplay between DeLong and Benabid’s work, as well as Foote’s time in both disciplines, has influenced the way Okun and Foote view their own partnership — and is something they pass down to the more than 40 neurology and neurosurgery doctors they have trained so far. As part of the center’s training program, Okun and Foote require their fellows to study both functional neurosurgery and neurology.
In The New England Journal article, Okun recalls how DeLong began his research in neurology as an associate in the Edward Evarts laboratory, a laboratory within the National Institutes of Health. There, researchers studied how particular parts of the brain were important to various body movements. DeLong began studying the largely ignored area called the basal ganglia.
At the time DeLong was at the NIH, physicians knew the basal ganglia was involved with Parkinson’s disease — but how it was involved was unknown. DeLong was the first researcher to tease out the relationship. He was able to record electric signals out of the basal ganglia, discovering which cells of the basal ganglia were associated with movement in the legs, arms and face — and which cells weren’t involved in movement at all. DeLong also discovered that the basal ganglia was actually a series of circuits that exchanged information with the cerebral cortex, Okun said. DeLong began studying how placing lesions in the brain alleviated symptoms of movement disorders.
“He really unlocked the field in 1986,” Okun said. “He understood that inside these brain circuits there was a map, and he understood that the map could pave the way for potential therapies for movement disorders such as Parkinson’s disease.”
Although the two never worked directly together, Benabid’s work built upon DeLong’s foundation. Benabid began placing lesions in the brains of patients with Parkinson’s disease and tremor. To find the area he needed to treat, Benabid would stimulate the area with an electrode before permanently burning it. He also knew he could not burn both sides of the brain for fear of severe adverse effects. Benabid wondered what might happen if he treated the brain with electricity.
Benabid tested his idea in a patient with tremor on both sides of his body. To alleviate the patient’s symptoms in one hand, Benabid burned a lesion. On the other side of the brain, however, he implanted an electrode and the patient’s tremor quieted.
“The treatment became much safer: Benabid wasn’t burning permanent holes in patients’ brains. The electrode had the benefit of being able to be turned off, adjusted, removed or replaced,” Foote said.
Since Benabid’s first surgery, more than 100,000 patients with Parkinson’s disease and other neurological disorders have been treated with deep brain stimulation for their symptoms. According to The Lasker Foundation’s website, 47 Lasker laureates in the past three decades have gone on to receive the Nobel Prize.