Hello everyone,

With the recent posting about DBS I thought I would scan an article on the
procedure that appeared in our Halifax Daily News last March  29th. The
Queen Elizabeth II Health Sciences Centre, under the direction of Dr. Ivar
Mendez, is the only centre in Canada with a neural transplantation program.
Recently Dr. Mendez began to perform DBS surgery.

For more information, check the Dalhousie University Medical School,
Division of Neurosurgery (http://www.mcms.dal.ca/dnts/mainpage.html) for
more information. BTW, the Halifax Daily News was a pioneer on the Internet.

TTFN
Peter
==========================================================
Halifax Daily News, March 29, 1998

Electrode controls Parkinson's disease

By SHAUNE MacKINLAY

The Daily News

John Phinney used to shake so badly with Parkinson's disease he couldn't
even feed himself.  Sometimes the tremors were so severe he would shake
right out of bed.

Last month everything changed for the 56-year-old New Brunswick man thanks
to a new treatment at Halifax's QEII Health Sciences Centre.

Phinney is the first Atlantic Canadian to undergo a procedure called deep
brain stimulation.  Now, just over six weeks since his surgery, he's
regained some of the control that was robbed from him since Parkinson's hit
almost 13 years ago.

"I feel a lot different about life now," Phinney said in an interview from
his Campobello Island home.

During the procedure, which only gained American and Canadian approval in
the past year, a tiny electrode is guided into the middle of the brain to
the thalamus, where sensory nerves originate.  It's a very precise target,
about two millimetres wide and four millimetres long, explained neurosurgeon
Dr. Ivar Mendez.

"It's a little electrode that goes into the brain and it's connected by a
cable to a small computer implanted beneath the skin in the chest," he said.

The small device in the chest, called a pulse generator, can be programmed
through the skin by an external computer to provide varying degrees of
electrical stimulation to the brain.

For Phinney, that stimulation has meant an end to the tremors on one side of
his body.

"It's just like magic.  Can you imagine, after 12 years for the first time
he's able to use his right side," Mendez said.

A second surgery in six months' time for the other side of his brain should
make him appear relatively normal, Mendez said.

Parkinson's kills off brain cells that produce dopamine, a chemical
neurotransmitter which sends messages between nerve cells in the brain.  The
result is tremors, slow movement and muscle stiffness.

Deep brain stimulation does not affect dopamine levels, so it is considered
a treatment, not a cure.

"The only thing that it does is interrupts a pattern, that is their pattern
that produces tremor.  It's like a jamming device that jams the signals,"
Mendez says.

Phinney's wife, Sandra, calls it nothing short of a miracle."

As her husband's illness progressed, she became his caregiver.  She fed him,
dressed him, and shaved him.  A year ago, his condition deteriorated to the
point that he was unable to walk-
Now he's looking after himself again and he can walk up to a quarter-mile.
"He walked my granddaughter to the end of the driveway to the bus this
morning," Sandra Phinney said.

For a man who always looked after his family, life had become almost
unbearable.  "I didn't care if I lived or died," he said.

He was frightened by the prospect of brain surgery, but felt he had nowhere
else to turn.  His wife said she knew her husband had a skilled doctor, but
she put her faith in another set of hands.

"I prayed and my prayers were answered and I knew it was going to be all
right," she said.

Phinney now appears on a video used by Mendez to explain the surgery

In the first scene, he's sifting on a hospital bed, his arms, legs and mouth
moving constantly.  When tries to trace a spiral on a piece of paper or draw
a straight line, he can only scribble.

Before the surgery, an MRI scan of Phinney's brain was transmitted to a
computer where it was used to develop a model, a kind of virtual reality
plan for tie surgery

Coordinates determined by the model were then set on a metal head harness
attached to Phinney's skull with four pins.  The coordinates on the harness
determine precisely where the electrode will go.

"You make a small hole in the skull then you put this probe all the way up
to the middle of the brain," Mendez said.  The patient is awake the entire
time.

In Phinney's next video appearance, after the surgery, he continues to shake
until Mendez turns his pulse generator on with a magnetic switch.  One side
is quickly still.

When asked again to trace the spiral and draw a straight line, Phinney does
it with relative ease.

Mendez said the computer can stay in Phinney's chest forever, but he must
get the battery changed every five years.

There are now 14 people on the waiting list for the procedure at the QEH.

George Turnbull, president of the Parkinson's Foundation of Canada, Nova
Scotia division, said the surgery holds great promise for patients whose
condition has deteriorated to the point where it can no longer be managed
with drugs.

Despite its successful outcomes, he cautions the procedure is not an answer
for Parkinson's.  "It alleviates the symptoms, but it doesn't cure the
condition," he said.



**************************************************************************
Peter Kidd
Learning Materials Consulting Services
62 Coronation Avenue, Halifax, Nova Scotia B3N 2M6 Canada
Tel/FAX: (902) 443-4262 Email: [log in to unmask]
URL: http://www.chebucto.ns.ca/~aa163/peterkidd.html