Dr. Miocinovic discusses how device-based therapies like deep brain stimulation are leading to more effective, personalized care for people with movement disorders like Parkinson’s, tremor, and dystonia.
At the American Brain Foundation, our commitment to the philosophy of Cure One, Cure Many drives our efforts to support researchers working in many different research areas. Research is the only way we will find better treatments, diagnosis methods, and cures for the brain diseases and disorders impacting millions of people worldwide. Our Next Generation Research Grants are offered in partnership with the American Academy of Neurology in order to fund early-career researchers pursuing innovative research projects across the whole spectrum of brain diseases and disorders.
Svjetlana Miocinovic, MD, PhD, was awarded a research grant funded by the American Brain Foundation in 2014 and has gone on to receive grants from the Dystonia Medical Research Foundation and the National Institutes of Health. Dr. Miocinovic is currently an Associate Professor in the Department of Neurology at Emory University School of Medicine. She is the principal Investigator at the Miocinovic Lab and specializes in Parkinson’s disease, dystonia, tremor and other movement disorders at Emory Healthcare.
Her research focuses on how electrical signals in the brain affect motor function in people with movement disorders like Parkinson’s disease and dystonia. We spoke with Dr. Miocinovic about how her American Brain Foundation-funded research established a foundation for her current work with the Miocinovic Lab and the role of computers and artificial intelligence in recent advancements in device-based therapies like deep brain stimulation.
The following interview has been condensed and edited for clarity.
Why were you inspired to study the brain?
I became interested in neuroscience in college. The brain is the most fascinating and complicated organ in our body. It is the final frontier when it comes to understanding our bodies and ourselves as humans. So that eventually got me interested in pursuing neurology.
What specific issue is your research trying to address?
I study movement disorders such as Parkinson’s disease and dystonia. These disorders arise from miscommunication between brain areas responsible for motor function. Deep brain stimulation (DBS) is a surgical treatment that we use to treat movement disorders when medications are not effective. DBS is a brain pacemaker. It injects small amounts of electrical current into the brain to correct miscommunication between the brain cells, which also communicate with each other by sending tiny electrical signals back and forth, similar to a telephone cable.
My research is focused on understanding how DBS works and how to make it better. Right now, after DBS surgery, patients have to spend many months getting the stimulator adjusted using a trial and error approach. Our goal is to make smart stimulators that can self-adjust using patients’ own brain waves. That way a person can get more stimulation when they need it, and less when they don’t (for example, when sleeping or not moving). This should also reduce unwanted side effects that can be caused by stimulation.
We are also working on developing computer-assisted DBS programming. There are many possible stimulation settings, and artificial intelligence can help improve this selection process. Finally, we are undertaking in-depth studies to learn which specific brain areas need more attention when it comes to treating movement disorders. We use high-resolution recording electrodes during DBS surgery to listen to how brain cells communicate with each other in people with Parkinson’s disease and other conditions.
What did your American Brain Foundation-funded Next Generation Research Grant enable you to work on?
I was awarded a research grant in 2014 just as I was finishing my clinical training to become a movement disorders neurologist. Prior to that I completed graduate school where my research focused on computer models and animal studies. The fellowship funding allowed me to spend two years in a clinical lab learning how to study these disorders in humans and use methods that would be directly applicable to my patients. Specifically, I recorded brain wave activity from people with Parkinson’s disease and dystonia to discover how DBS can correct underlying abnormalities.
What kinds of insights or discoveries did this research lead to? What additional or current research did it enable?
The research I did during my American Brain Foundation fellowship made me realize how we can use brain recordings to figure out which specific brain pathways are being activated by DBS. Up until then, these types of in-depth studies were mainly done in animals, but now we have a way to address these questions directly in patients. This led to my current research projects to improve DBS.
How did this early American Brain Foundation-supported research open doors for additional research funding or future research projects?
The fellowship made it possible to receive a coveted NIH career-development grant. This allowed me to start my own lab and pursue ideas I developed during the fellowship. After that I received a couple of other big NIH grants. This expanded the scope of the projects I could undertake. I was able to hire several researchers to work full time on my projects and answer these important questions.
How would discovering treatments or a cure for one brain disease impact other diseases?
Most of what we learn about DBS for movement disorders will be applicable to many other neurologic and psychiatric disorders where brain circuits miscommunicate. DBS has been studied as a treatment for depression, OCD, Alzheimer’s, and many other conditions. In all these conditions, we also need to better understand how the effects of stimulation spread through the brain and how to select the best stimulation settings for individual patients.
What do you hope your research will do to help patients and their families?
I hope that my research will make DBS accessible to a larger number of patients who could benefit from this therapy. Many people live far away from specialized DBS centers and are unable to come to frequent clinic appointments to adjust the stimulator. We also do not have enough neurologists who can perform this type of work because of its complexity. I hope that one day brain pacemakers will be as common and as simple to use as cardiac pacemakers.
How far has research come since you began your career, and what are the most exciting discoveries and developments you’ve seen since you entered the field?
When I started medical school, DBS was still considered an experimental treatment for Parkinson’s disease. Now it is a standard-of-care therapy for Parkinson’s, tremor, and dystonia, and it has been tried in dozens of other neuropsychiatric conditions.
Computers have also become more powerful and “intelligent,” and we can use them to answer many questions in neuroscience. We have much better ways of estimating the spread of stimulation effects in the brain using very sophisticated computer calculations. We have learned a lot about how neurons communicate with each other and how this goes awry in movement disorders, but there is still so much more we do not understand.
You can learn more about deep brain stimulation for movement disorders like Parkinson’s disease through our recent webinar and by following the research Dr. Miocinovic and her team are pursuing at the Miocinovic Lab.