Thank you very much. So next we'll have Dr. Vesper presenting on Outcomes of a Prospective Multicenter International Registry of DBS for Parkinson's Disease. Ladies and gentlemen, Mr. Chairman, thank you for the introduction and thank you for inviting me to present outcomes, interim analysis, outcome of a prospective multicenter international registry on deep brain stimulation for Parkinson's disease, which is basically primarily not very interesting. So if you know that such a registry doesn't exist at all after 20 years of deep brain stimulation, so one should basically get an introduction to real life experiences of Parkinson's disease. So what we can do now with this registry? These are my disclosures, and by the way, the most important one is not written on it here. That's because I'm personally addicted to deep brain stimulation. So far, we do have deep brain stimulation. We all know that it's effective treatment, reducing motor complications and also other symptoms in Parkinson's disease, not only in Parkinson's, but predominantly. And so we know that there's a sustained effect in several randomized controlled triats, especially also in younger patients and not as specifically the older end-stage Parkinson's patient, but also those who are younger than 60, which was proven by this early stim trial here in 2013 from Michael Schupach and all that was a European study at this time. So also deep brain stimulation is improving as a quality of life and not only up to 10 years, but at least 10 years after deep brain stimulation, it's a lifelong effective treatment. So we come later back to this issue. So with introducing such a registry, we have meanwhile a tool to prove not only the quality of life, but also the improvement of motor symptoms on a long time axis. So as I already mentioned, no registry database exists like this, and so we do have this now with a multisource constant current DBS system with a very unique constant current device for up to 1,000 patients. Meanwhile, we do have a couple of 300 patients included. And so what we have now, that is a unique tool to prove DBS in real life. So the study schematic is quite simple. By screening the patient for this device, so they were included and baseline lead implant activation and then a strong follow-up for three months, six months, and also one year, two year, up to three years after surgery, which is quite important that the patient are evaluated at the same time, all at the same time. So there's a key inclusion criteria that the patient basically understands what's going on. And also that he meets all those criterias for direction of use of deep brain stimulation devices. The key study assessments were predominantly as a neurological examination from UPDS, but also safety issues and predominantly clinical quality of life measurements. This was the most important thing. So baseline characteristics are interesting for those of you who are used to with deep brain stimulation issues know that their patients are quite young. They're becoming younger and younger compared to former publications. They are less than 60 years old. In the beginning, they were 70, 65, and 70 years old. And they are less affected. So those 300 patients who were screened had a UPDS-made off score of just 40. In the beginning of deep brain stimulation, 20, 25 years back, they were more than 50, 54 in the first publication. So we learned that the patient's becoming younger because the final effect for their daily life is much more dominant in younger patients than in elderly patients. So that's also true for the PDQ39, that they were less affected. So also they are less affected. The improvement in quality of life measured by PDQ39 with all their sub-items is amazing and significant in all those 300 patients sustained after 12 months. Also the sub-domains, which I do not show here, are showing a significant improvement and also sustained after one year post-implant, especially mobility and activity of daily living, stigmata, and bodily discomfort is improved. So also true for the neurological improvement. For those of you who are used to use this UPDS, this new MDS UPDS Part 3, they can see that the improvement from 47 to 30 is not as dramatic as it was before from the times when they had more than 50 in the UPDS. But again, that's also because of the patient were less affected preoperatively. So the most important thing is, and that proves that deep brain stimulation is a very predictable treatment, that there's no uncertainties anymore, that almost 100% of the patients are happy with the surgery. Not only the patient himself, but it is also true for the doctors and it's also true for the caregivers. There's almost no procedure in the field of neuromodulation, and not only in neuromodulation, but also in neurosurgery in general, so it's as predictable as deep brain stimulation. So even so, we have happy patients. So that is also true after 12 months, it's all the same. We also evaluated a subgroup of those patients who underwent surgery with segmented leads, and it is presented here to Congress as an e-poster, and it's all the same. And that is really interesting. So that deep brain stimulation is not only safe and predictable, but the outcome finally led to a normal life expectancy, which is basically reduced by Parkinson's disease after deep brain stimulation. They have a three years life expectancy of 98.3%, and that is almost normal, like a normal population. And on the other hand, on the dark side of the moon, so we have some side effects, specifically mechanical side effects, and of course, a neuropsychiatric complications, which are not as severe and not as many. So if you see this, it's about 1% to 2%, but there are some mechanical side effects, and also some very rarely below 1% is the risk of getting disabled from deep brain stimulation by means of intracranial hemorrhage. So at the end, I come back to my first statement, keep calm and neumodulate. Thank you for your attention, and open for questions. Thank you very much. It's a very interesting talk. Thank you very much. I have a question, but does anybody else first have a question in the audience? All right, you know, the outcomes are outstanding. I mean, how many centers fed into this? 70. I'm sorry? 70. 17. I mean, was there any variation in sites as far as the centers? Or is it fairly? So basically, I'm not aware, but it would be interesting of picking up the non-performer or the low performer. No, it's interesting. We all think that we have the best technique for doing it, but it's all uniform. So no, that was not the purpose of this study to figure out who's left-handed or right-handed by doing deep brain stimulation, but basically, in the end of the day, that might be possible to see. Very interesting. We had no, let's say, significant variations, to be serious. Are these all European centers? They're basically European centers. Is there a plan to extend the registry? Yes, especially for the segmented leads that will be extended very soon, I guess. Yeah? Tana? Yeah, sure. Thumbs up. Wonderful. Any other questions from the audience? It's very exciting. Thank you. You're very welcome.

deep brain stimulation

Parkinson's disease

registry

treatment outcomes

motor symptoms