The London Clinic’s International Newsletter

PIONEERING TECHNOLOGY FOR MOVEMENT DISORDERS AND CHRONIC PAIN

NEUROMODULATION FOR MOVEMENT DISORDERSSpecific patients with treatment resistant movement disorders, such as Parkinson’s disease, tremor and dystonia, can benefit from Deep Brain Stimulation (DBS).

DBS is a surgical procedure that involves implanting electrodes into the deep structures of the brain. The electrodes are connected to an implanted pulse generator which is battery powered. When the pulse generator, a device like a pacemaker, is turned on it delivers precise electrical signals to the targeted area of the brain to modulate or disrupt abnormal signals that cause the undesired movement symptoms.

ISSUE 2

The London Clinic, a private hospital in the heart of Harley Street, has a team of leading specialists who offer a state-of-the-art approach for treating movement disorders and chronic pain. The team of neurological, neurosurgical and pain experts approach the need of every individual patient in a holistic manner.

The London Clinic is the first private hospital in the UK to use the innovative Abbott InfinityTM DBS System to treat movement disorders. The electrodes implanted into the brain are segmented, which enables us to precisely steer electrical currents to the desired area in the brain, maximising the therapeutic benefit whilst reducing the potential side effects. DBS is performed using a minimally invasive technique, without shaving the hair, under general anaesthetic for patient comfort.

The DBS system uses Bluetooth and iOS software (used in iPods, iPhones and iPads) which means the levels of stimulation from DBS can be adjusted with an external programmer to meet the patient’s specific needs. Patients are given an easy-to-use iPod controller that

they can use to adjust their DBS settings, within a pre-set range, giving them greater control

over their movement disorder. An added benefit of using a system on iOS is

it can be easily upgraded as the latest therapy advancements are approved and is available in multiple languages.

For patients with movement disorders, DBS can significantly improve their quality of life and help them reduce their medication.

CONTACT THE INTERNATIONAL OFFICEIf you would like to contact the International team, please do so using one of the following methods:Telephone: +44 (0) 20 3219 3266 Fax: +44 (0) 20 3219 3516 Email: internationaloffice@thelondonclinic.co.uk

HOW THE ABBOTT INFINITYTM DBS SYSTEM WORKS:

1 Brain sends electrical signals to your body causing involuntary movements

2 Neurostimulator device sends stimulation pulses to targeted areas of your brain

3 Directional lead delivers these pulses to a targeted area of your brain

4 Pulses block the brain’s signals that cause involuntary movements to help reduce symptoms

DBS FOR TREMOR Tremor can be a symptom of a number of disorders, some of which are hereditary. Sometimes tremor can occur as a result of a head injury or stroke but sometimes the cause is not known. DBS surgery may help treat tremor in suitable patients who have not responded to first line drug treatments such as beta-blockers or anti-epileptic drugs.

For patients who have little or no relief from pain medication, nerve blocks or other pain management therapies they can be considered for spinal cord stimulation (SCS) or dorsal root ganglion (DRG) stimulation depending on the location and type of the pain.

NEUROMODULATION FOR CHRONIC PAINChronic pain is pain that lasts three to six months or longer. Examples of chronic pain include:

DBS FOR PARKINSON’S DISEASE DBS surgery helps treat the “motor” symptoms of Parkinson’s disease including stiffness, slowness and tremor.

While it is not a cure, it can help patients control many of their symptoms, giving them more independence in their lives. It may also mean patients have to take less medication, which can reduce the risk of medication side effects, such as involuntary movements (dyskinesia).

DBS FOR DYSTONIA Dystonia is a disorder which causes abnormal contraction (tightening) of groups of muscles. This results in involuntary, sometimes painful movements of the affected parts of the body.

DBS can help treat some patients with the following types of dystonia:

• Generalised (involving much of the body)

• Segmental (involving certain parts of the body)

• Cervical (involving the neck and shoulders)

PAIN AFTER SURGERY SPINAL PAIN LIMB PAIN

• Hernia repair

• Failed back surgery syndrome

• After surgery

• Spinal cord injury

• Amputation

• Diabetes

• After joint replacement

HOW DOES IT WORK?

1 Fine wires or a paddle are implanted in the spine and sit there permanently

2 The wires are then attached to a small battery. The battery is fitted under the skin in the torso

3 Nerves in the spinal cord send pain signals to the brain By modulating the nerves, we can block these pain messages and usually make patients feel a pleasant sensation instead

4 The battery sends a small electrical current through the wires, which stimulate the nerves near them

5 Our pain experts work closely with every patient to find out which sensations best manage their pain. This means patients should be able to reduce the amount of painkillers they need

NEUROMODULATION FOR MOVEMENT DISORDERS CONTINUED

Image reproduced with permission of St. Jude Medical, © 2018. All rights reserved.

Image reproduced with permission of St. Jude Medical, © 2018. All rights reserved.

1

2

4

3

TREATMENT OF BLOOD CANCERS

At The London Clinic, the treatment and care of patients’ diagnoses are discussed at our cancer Multidisciplinary Team (MDT) meetings. These meetings ensure that all of our patients receive the best treatment pathway for their individual needs as each patient is discussed by a group of leading consultants from different medical disciplines.

Common treatments include chemotherapy and radiotherapy. However, for many patients suffering from blood related-cancer, a stem cell transplant is often the only chance of a cure.

Unrivalled HAEMATOLOGY SERVICES FOR BLOOD CANCER AND SERIOUS BLOOD DISORDERS

The London Clinic takes great pride in being the only independent private hospital in the UK to offer bone marrow and peripheral blood stem cell collection. The stem cell transplant unit is one of the largest stem cell collection centres in Europe.

Our stem cell unit is a purpose-built facility which allows us to treat and care for patients with serious blood disorders and blood cancers. The unit has been designed to help patients who need special facilities due to compromised immune systems.

We offer cutting-edge treatments, including the latest developments in chemotherapy, immunotherapy and stem cell transplant procedures.

The work carried out by the stem cell unit at The London Clinic is supported by our on-site pathology laboratory which includes a dedicated stem cell laboratory that is accredited by both JACIE and UKAS, UK regulatory marks of excellence. Consistent with our focus on quality, our stem cell laboratory team adopts best practices in the collection and handling and storage of stem cells, and we are able to show an excellent engraftment success rates for our patients.

Engraftment is the measure of whether stem cells ‘take’ to a recipient, and how quickly this happens.

THE HAEMATOLOGY CONSULTANTS AT THE LONDON CLINIC ARE INTERNATIONALLY RENOWNED AND HAVE SPECIALIST EXPERIENCE AND EXPERTISE IN ALL ASPECTS OF HAEMATOLOGY INCLUDING STEM CELL TRANSPLANTS, LEUKAEMIA, LYMPHOMA, MYELOMA AND GENETIC BLOOD DISORDERS SUCH AS THALASSEMIA.

CHEMOTHERAPYAs a centre of excellence in cancer care, we pride ourselves on both our technical ability and patient care. Our Chemotherapy Day Unit is based on the third floor of our specialist cancer centre, with treatment chairs located alongside large bright windows. Our patients often comment on the light and spacious feel of the unit.

Our integrated chemotherapy prescribing and scheduling system supports us being able to deliver chemotherapy within a set time.

We have a blood analyser within the chemotherapy unit to process the blood tests promptly and we are now able to ensure all patients receive their treatment within 90 minutes of their blood test results.While our patients wait for their treatment, they have access to our complementary therapy team who offer a range of treatments to support patients and their loved ones.

We also have a team of specialist nurses in symptom control and palliative care who can help support

patients with the more complex side effects of

treatment.

Patients receiving long infusions of chemotherapy are cared for in a bedroom on the inpatient ward. All our ward nurses undergo specialised chemotherapy and cancer training in order to provide

this service.

We provide an acute oncology service for all our patients who,

should they become unwell following treatment, can phone a dedicated hospital number for advice on the course of action to be taken.

STEM CELL TRANSPLANTSStem cells are the body’s primary cells. All other cells, tissues, organs and bones develop from stem cells. Blood stem cells, known as haematopoietic stem cells are found in the bone marrow and they produce different blood cells including red blood cells, white blood cells and platelets.

A stem cell transplant involves destroying unhealthy blood cells, using high-dose chemotherapy, and replacing them with stem cells removed from the blood or bone marrow.

Stems cells are used in two types of transplant: autologous and allogenic. In autologous transplants, the stem cells come from the patient. In allogenic transplants, they come from a donor.

AUTOLOGOUS TRANSPLANTS For an autologous transplant, stem cells are collected from the patient’s bone marrow or peripheral blood before they begin chemotherapy.

These cells are then frozen and stored at The London Clinic’s on-site pathology laboratory. After intensive chemotherapy, the patient’s stem cells

are re-introduced. These then generate new healthy white blood cells which start rebuilding the patients’ blood and immune system. The cancer is treated by the intensive chemotherapy and the stem cells allow prompt recovery from this.

ALLOGENIC TRANSPLANTSIn an allogenic transplant the patients receive blood-forming stem cells from a donor. The best treatment results occur when the donor’s cells are closely matched to the patient’s cell type, for example from a brother or sister. This type of transplant helps kill the cancer cells via the donors immune system.

At The London Clinic, we are able to use allogenic transplants to help patients who have specific conditions in which the patient’s blood or immune system has a fundamental congenital fault, and therefore is not performing properly.

For instance, thalassaemia is an inherited condition where the patient does not make enough haemoglobin; a substance in red blood cells that helps carry oxygen around the body.

TREATING GENETIC BLOOD DISORDERS SUCH AS THALASSEMIA WITH STEM CELLS

CONTACT THE INTERNATIONAL OFFICEIf you would like to contact the International team, please do so using one of the following methods:Telephone: +44 (0) 20 3219 3266 Fax: +44 (0) 20 3219 3516 Email: internationaloffice@thelondonclinic.co.uk

UNRIVALLED HAEMATOLOGY SERVICES CONTINUED

Having either no or too little haemoglobin can cause a wide range of problems including:

• Anaemia, this can be life-threatening in severe cases

• Excess iron levels (usually a side effect of repeated blood transfusions), which can lead to liver damage, diabetes, heart and thyroid problems

• Unusual bone growth and fragile bones

By introducing healthy haematopoietic stem cells from a donor, the patient can build a new blood system which functions efficiently and produces the necessary amount of haemoglobin in their red blood cells. This is a cure for an otherwise life long condition.