Electrodes in the brain used to treat Parkinson's Disease

Central Community Theater is currently rehearsing for their production of Cinderella, a play associate director Karen Clinkingbeard can relate to.  The difference is that her fairy-godmother came with a scalpel, and instead of glass slippers she received a remote control to change her life.

Seven years ago Karen was diagnosed with Parkinson's disease, a degenerative neurological disorder that can affect motor skills and other brain functions.  It's also associated with anxiety and depression.

"I didn't know what would happen to me," said Clinkingbeard.

Over time, she watched her fine motor skills fade away.  It became difficult to move her fingers or even walk.  Medication helped, but not consistently and it caused side effects that made it hard to function day to day.

Neurologist Dr. Gerald Calegan says there is no one simple cause for Parkinson's Disease. He says it is a combination of genetic and environmental factors.  The disease has no cure, and Calegan says as the disease progresses it can be harder to control symptoms with medication.

When her symptoms and side effects of treatment became too much to bear, her neurologist suggested a procedure called Deep Brain Stimulation or DBS.

"It's a wire that is implanted into the brain while patients are awake. It's hooked up under the skin to a little pacemaker device that I can control and program through the skin with a hand held computer," said Calegan.

The wire is less than a millimeter wide and emits low electrical pulses that help the brain function more normally.

It is installed deep in the brain in three steps.  The first step is to implant a series of screws in the skull.

Neurosurgeon Dr. Paul Waguespack explains that the screws act as precise markers to guide surgeons and the device to the correct spot.  That procedure is done while the patient is sedated.  The second step is to actually implant the wire.

Waguespack uses a device that looks almost like a microscope.  It attaches to the screws and allows the him to precisely guide the wire through a hole drilled into the skull.

When treating Parkinson's, surgeons aim for a spot in the brain that is the size of a pea called the subthalamic nucleus.  They use scans and a 3-D model of the patient's brain as a roadmap.  For this part, the patient must be awake, although the scalp is numbed.  As surgeons implant the wire, the neurologist uses a series of simple motor tests to make sure that the wire is in the correct spot and not interfering with other parts of the brain.

Finally, a battery pack is implanted in the patient's abdomen and the entire device is connected.  The final product is hidden under the skin, much like a pacemaker.

Patients see results on the surgical table.

"We see the effect immediately, and the patient sees it immediately at the same time," said Waguespack. "We've had patients cry on the table because they realize that they're life is going to change instantaneously with a flip of a switch."

Clinkingbeard calls her DBS device a miracle.  She has a remote that allows her to turn it on or off, but she says it runs all the time.  Since her procedure, she has been able to return to her busy life nearly symptom free and greatly reduce her medication.

"It's so great. I don't feel like I have this horrible disease that will make me go down so far in the years to come," said Clinkingbeard.

Calegan says the device is not a cure for the disease, but it can be used throughout the patient's life as the disease progresses as some studies suggest that it may even slow down the progression.  The intensity of the electrical pulse can also be increased or decreased.  The device requires no maintenance, and the battery pack lasts for five years.  DBS is also used to treat another neurological disorder called Essential Tremors.  Waguespack says it also has the potential to treat conditions like Tourette syndrome and Obsessive Compulsive Disorder as well.

The procedure is covered by most insurance policies.    

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