DBS: Pacemaker For The Brain Gives Parkinson's Patients Relief
Wire Reports  http://www.tulsaworld.com
8/6/2004

FORT WORTH, Texas -- For William Chappell, brain surgery to control the
twitching, poor balance, blurred speech and muscle rigidity of Parkinson's disease
"was just so easy -- apiece of cake."

And, "this was brain surgery!" the Fort Worth resident says, as if he can't quite
believe it.

Before the surgery, Chappell, who will be 60 in September, sometimes had difficulty
separating the symptoms of Parkinson's from the side effects of a combination of
drugs he was taking: He took drugs for Parkinson's, several drugs for general
anxiety and drugs to stay awake -- because being on so many drugs made him
drowsy.

"I was having a miserable time with medication," he says. "I started going steadily
downhill on the drugs prescribed for me. Deep brain stimulation has really saved my
life and given me additional quality of life."

Deep brain stimulation involves implanting fine wire electrodes deep inside the
brain. The wires are attached to pacemakers implanted under the skin of the upper
chest, usually one under each shoulder blade. This pacemaker for the brain system
gives off tiny sparks of electricity that interfere with faulty nerve cell communications
in the brain and help control involuntary muscle movements.

Originally developed for essential tremor and now used to treat Parkinson's as well
as dystonia, a neurological condition that causes involuntary muscle contractions,
deep brain stimulation may someday be used to curb a person's appetite, control
addictions and cure Tourette's syndrome.

"Part of the beauty of this is that you can focally affect the brain. When you give
drugs by mouth, they affect the total brain and you get side effects in parts of the
brain you don't want to affect," says Dr. Padraig O'Suilleabhain, assistant professor
of neurology at the University of Texas Southwestern Medical School, who
prescribed deep brain stimulation for Chappell.

"If we could target drugs precisely the way we can electrical currents, we could do
the same thing with drugs," O'Suilleabhain says. "Deep brain stimulation has the
advantage of better targeting, and you can turn it on and off in an instant -- not true
of drugs."

Deep brain stimulation (DBS) can be thought of as an electronic version of Sinemet,
the standard drug for Parkinson's disease, says Dr. Cole Giller, associate professor
of neurological surgery and radiology at UT Southwestern. He implanted Chappell's
electrodes and brain pacemakers in October and November.

"Electrical and chemical signals overlap and interact in the brain," Giller says.
"Think of this as giving (the patient) an electronic version of Sinemet without
complications and side effects. It makes perfect sense because the brain is an
electrical organ."

Good candidates for surgery are those who initially responded well to drug therapy,
Giller says.

DBS doesn't cure Parkinson's, but it relieves major symptoms well enough that most
patients are glad they went through the procedure, says Giller, who has done about
130 of the procedures using a tiny flashlight device he developed with engineers at
the University of Texas at Arlington to guide placement of the electrodes.

"We use a little microfiber flashlight to analyze where we are in the brain, to tell
gray matter from white, to keep track of the different layers and differentiate
structures so we get the probes exactly where we want them very quickly," Giller
says. "It is surprisingly safe."

And, because patients are only partially sedated, advanced age is not a major risk,
says Giller, who has implanted the devices in patients who are in their late 80s.

DBS dramatically improves quality of life with significant reduction of symptoms in
people with Parkinson's and essential tremor 75 to 80 percent of the time, the
doctors say. (Results are not quite as good for dystonia.)

In DBS, high-frequency electrical pulses are programmed and "turned on" about a
month after the initial surgery, and once the stimulation is properly adjusted, not
much follow-up is needed until the pacemaker's batteries are worn out, four to 10
years later, depending on how much stimulation is used to control symptoms.

When the system is activated, the effect is often very quick and dramatic. A severe
tremor can disappear right before your eyes, O'Suilleabhain says.

The U.S. Food and Drug Administration approved electrical stimulation therapy for
Parkinson's disease about 18 months ago. It works in much the same way as
making permanent surgical lesions deep in the brain to destroy the parts that are
causing symptoms of Parkinson's, but it can be adjusted on an ongoing basis for the
maximum therapeutic value, and it can be reversed.

Compared with surgical ablation (tissue destruction), stimulation is less invasive
and has fewer serious side effects and complications, O'Suilleabhain says. It is
easier, safer, adjustable, removable and allows for future surgical advances. It
requires two to three days hospitalization, he says.

Neither treatment actually stops the destruction of nerve cells and progressive loss
of dopamine in the brain, which is at the root of Parkinson's, but both procedures
slow the progression of the disease and can help control symptoms.

Cost is about $70,000 -- $20,000 for the electrical system itself, and $50,000 for
surgical and hospital fees. Insurance, including Medicare, usually covers the
treatment.

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ONLINE:

For more information about pacemakers for the brain, go to
http://www.medtronic.com

For more information on Parkinson's and other movement disorders, go to
Worldwide Education and Awareness for Movement Disorders at
http://www.wemove.org

For additional information about dystonia, go to http://www.spasmodictorticollis.org

SOURCE: Tulsa World, OK - Friday, August 06, 2004
http://www.tulsaworld.com/HealthStory.asp?ID=040806_He_SENpark_1

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