Deep Brain Stimulation

“Deep brain stimulation is a way to turn off parts of the brain without purposefully destroying those parts like more radical surgery does.”

DR. BRIAN WITWER, Grand Junction neurosurgeon

Deep brain stimulation

Electrical impulses steady tremors in patients with Parkinson’s, other movement disorders


By GREG RULAND

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A surgeon and a neurologist at St. Mary’s Hospital are treating patients with Parkinson’s disease and other tremor-causing illnesses using advanced medical technology and a cutting-edge procedure called deep brain stimulation.

Eight patients have received the treatment and responded successfully since September. The procedure is the only one of its kind available between Salt Lake City and Denver, hospital officials said.

“Movement disorders like Parkinson’s disease affect quality of life and disrupt patients’ and families’ everyday lives,” said Dr. Seth Kareus, a board-certified neurologist who specializes in Parkinson’s disease, tremor, Huntington’s chorea and related conditions.

Movement disorders are also “pretty stigmatizing,” Kareus said.

Michael J. Fox, the film and TV star who perseveres with Parkinson’s, sometimes displays chaotic movements that are caused by his medications, not his disease. The rolling, twitching movements in people who are not celebrities often draw fearful stares from strangers, he said.

These degenerative disorders destroy quality of life and take a huge toll on society. Parkinson’s disease is estimated to cost more than $20 billion annually in the U.S., according to the National Parkinson’s Foundation.

The deep brain stimulation (DBS) program is one more tool in the toolbox used to combat tremor-causing diseases. It begins with education and assessment for the patient. When indicated, the treatment progresses to surgery, Kareus said.

Electrodes placed in the brain during the surgery are connected by wires to a type of pacemaker device, called an impulse generator.

The impulse generator is implanted below the collarbone, under the skin of the chest, said Kareus’ cohort, Dr. Brian Witwer, the neurosurgeon who implants the electrodes. Once activated, the generator sends continuous, painless electrical pulses to the brain, blocking the impulses that cause tremors, Witwer said.

“Deep brain stimulation is a way to turn off parts of the brain without purposefully destroying those parts like more radical surgery does,” he said.

Under the new procedure, patients sleep comfortably instead of straining to maintain calm while remaining conscious during the surgery, as required under the former procedure, Witwer said.

Currently there is no Parkinson’s “test,” so the diagnosis of the disease is based on assessment of the patient’s symptoms, he said. “Brain scans can rule out other conditions, and imaging tests to diagnose Parkinson’s are in the early stages of development,” Kareus said.

Treatment for Parkinson’s symptoms is multi-pronged and differs from patient to patient. Medications can improve quality of life for some, he said.

“In recent years, exercise has been shown to really help some Parkinson’s patients,” Kareus said. “The more fit someone is, the better their quality of life with Parkinson’s.”

Surgery can also be beneficial for some patients with Parkinson’s and the key is identifying the right patients, he said.

Kareus, the only movement neurologist in the region, also works with patients with Huntington’s disease, dystonia and other movement disorders and provides general neurology services at St. Mary’s Neurology Clinic.

Medications aren’t every patient’s best solution, Kareus said.

“When medications don’t quite work or when their side effects take over, we have to consider surgery,” he said.

“After DBS surgery, I may see them once a month for three months for fine tuning. I can give some patients a degree of control so they can adjust the device to perform certain activities. One setting may allow them to write more comfortably and another may be appropriate when they don’t require fine motor skills.”

 


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