Dr Paul Silberstein
"My clinical collaboration with Dr Cook now spans nearly 20 years, having treated over 600 patients."
In 2000, half-way through my training to become a Neurologist, I remember coming across an Editorial about an emerging therapy - Deep Brain Stimulation (DBS). By this stage, I was already interested in subspecialising in the field of Movement Disorders – the Neurologic field in which DBS was being principally applied.
The following year I moved to London, England to take up an Australian Association of Neurology Fellowship at the Royal Free Hospital. During that time, I was introduced to Professor Peter Brown at The National Hospital for Neurology and Neurosurgery, Queen Square, London who agreed to support me to join his Clinical Research Group and supervise my Doctorate commencing 2002.
Professor Brown’s dominant research interest was in studying how changes in the rhythms in deep brain circuits might cause physical symptoms in Parkinson’s disease and Dystonia. He had active collaborations with DBS units in Europe and the UK, and was also about to start Deep Brain Recording work at Queen Square, where a DBS unit was to commence in 2002. Accordingly, I had the incredible fortune both to undertake DBS clinical research and train as a DBS Neurologist.
The field was young, novel and controversial. Many of the opinion leaders were only 10 years my senior and much of what we take as gospel today was not yet established. The DBS Neurologist at Queen Square, Professor Limousin, co-supervised my research and clinical work. Prior to this posting, she had worked with the Surgical group in Grenoble who invented the procedure less than a decade earlier.
The research work I undertook with Professor Brown made a substantial contribution to the understanding of how abnormal brain rhythms underscore movement abnormalities, most particularly in Parkinson’s disease. The brain rhythms we identified and characterised are now in clinical use in modern DBS devices, being used to help guide and improve the therapy.
Dr Cook, an already experienced Functional Neurosurgeon, commenced DBS surgery at North Shore Private Hospital with the assistance of Neurologist Professor Peter Silburn from Brisbane in 2001. On my return to Sydney in 2004, Dr Cook and Professor Silburn invited me to attend operations with them. Professor Silburn continued to support the surgery over the next year, all the while providing mentorship - upskilling me in operative planning and helping refine my skills in intraoperative neurophysiology.
During the early years, we treated patients from all over NSW, and provided a de facto service to South Australia before the procedure became established there. We started providing DBS services to New Caledonia in 2008 and continue to maintain a close collaboration with local Neurologists, with whom we have consulted together in Noumea for the last 10 years.
Starting a DBS practice had its challenges. In addition to the relative isolation of being the only implanting team in Sydney at the time, much about DBS was still poorly characterised or understood. Often through clinical experience we came to appreciate aspects of the therapy before the medical literature had caught up. This was most notable with respect to understanding the emotional and psychological adjustment that many patients experience in the first couple of months post operatively after DBS for Parkinson’s disease. The addition of neuropsychiatrist, Dr Linton Meagher to the team substantially bolstered our ability to care for our patients in a thoroughly wholistic manner, supporting their emotional and psychological needs in addition to improving control of their physical symptoms
In 2013, I was the lead author of the inaugural Australian DBS Guidelines, a combined work of DBS pioneers across Australia. In the prior and subsequent years, I have spoken at over 40 PD support group meetings and presented frequently to GP, Neurology trainee and Neurologist education sessions, and as an invited speaker at Australian and International Movement Disorder and DBS meetings. I have personally trained over a dozen Parkinson’s Nurses and Neurologists in DBS programming and am pleased that a number of these colleagues have joined me in clinical practice at Integrated Neurology, my practice base in Sydney.
DBS remains the core of my clinical practice. Indeed around ¾ of my practice life is committed to it. My clinical collaboration with Dr Cook now spans nearly 20 years, having treated over 600 patients.
DBS is now a mature therapy, 30 years since it was first practiced. In this time, there have been substantial improvements in operative technique, enhancing surgical accuracy and safety. The last five years has seen a revolution in Deep Brain Stimulation devices, optimising our ability to steer therapy in the brain, and the beginnings of utilising brain signal recordings to guide stimulation delivery. I continue to feel extremely fortunate to be able to practice in this continually improving and evolving field.