After enduring brain surgery while awake, Parkinson's patient lives life anew
Wed Jun 12, 9:33 PM ET
By LINDA A. JOHNSON, Associated Press Writer
NEW BRUNSWICK, New Jersey - Over the course of 18 years, Parkinson's disease ( news - web sites) stole Jack Goldman's ability to drive, write and speak on the telephone.
Because of shaking hands, he couldn't eat without spilling his food. He couldn't zip his pants.
At times his joints were frozen. Other times, his medicine caused his body to squirm and jerk violently, throwing him out of his chair.
"I had gotten to the point where life was barely worth living," he recalls.
So three months ago he said yes to a grueling, even terrifying, operation. Wide awake with only local anesthesia, Goldman lay on an operating table while doctors drilled two half-inch holes into his skull in a six-hour operation at Robert Wood Johnson University Hospital.
He breathed in the acrid smell from the high-speed drill boring into his head. His hands and feet trembled continuously, but his head and neck were held rigid by a black "halo bracket" screwed into his skull.
"When I wasn't thinking of, 'Was I going to make it,' I was thinking, 'When are they going to finish?'" he said.
Droplets of blood dribbled down the inside of the sterile plastic sheeting covering all but his hands, feet and the top of his bald head where doctors were working.
Once the holes were drilled, surgeons inserted two tiny electrodes deep in his brain.
Neurologist Dr. Anette Nieves, two biomedical engineers and others assisting the surgeons alternately consulted 3-D computer images of the depths of Goldman's brain and took readings from monitors.
Because Goldman was awake, he was able to help neurosurgeon Dr. Richard M. Lehman and the rest of the surgical team precisely adjust the electrodes' positions. The patient moved his legs and arms, tapped his fingers and clenched his fists on their commands, and reported when he felt tingling or numbness.
Then, as Lehman delicately maneuvered the electrodes, Goldman's hands and feet almost magically stilled.
Hailed as the biggest advance against Parkinson's in decades, Medtronic Inc.'s Activa system delivers controlled electrical pulses that in many patients dramatically reduce Parkinson's symptoms: rhythmic shaking of limbs and other body parts, rigid joints and slowness or inability to move at times.
"It's a very big breakthrough," said Dr. Rajesh Pahwa of the University of Kansas National Parkinson Foundation Center of Excellence, which has put the system in 70 patients. "If the patient is appropriately selected and if you get the electrode in the right position, the patient is going to benefit."
Many patients reduce their medication use by half, and with it, side effects, Pahwa said.
A week after his first surgery, Goldman had a second operation under general anesthesia in which Lehman, a professor of neurosurgery at Robert Wood Johnson Medical School, inserted a "neurostimulator" under each collarbone. The pacemaker-like instruments were then connected to the electrodes in Goldman's brain through wiring that runs under his scalp.
A couple of weeks later, Nieves, a movement disorder specialist, turned on the devices.
"Right away, there was a change in rigidity that I was able to see and a change in mobility," she said.
Over the next several weeks, she adjusted the rate, amplitude and pulse width of the electrical signals the system emits. When she was through, Goldman and his wife took a train home to Sarasota, Florida, where a local neurologist monitors him.
Now, recovered from his surgery, the 63-year-old Goldman is driving again, eating out, bowling and playing cards - all unthinkable just this past winter. He no longer thrashes around and falls out of chairs, has cut his medications 60 percent, and was able to speak to a reporter by telephone for an hour.
An estimated 1.5 million Americans have Parkinson's disease, and several million more have a related condition called essential tremor.
The cause of Parkinson's is unknown, but it involves degeneration of a small brain area called the substantia nigra. Brain cells there die, depriving the brain of the chemical messenger dopamine, which enables motor control cells in the brain to communicate.
Medicine helps less as the disease progresses, and increasing dosage worsens the side effects - uncontrollable wiggling and squirming.
Activa works by stimulating two brain areas that become hyperactive in Parkinson's disease and are linked to the substantia nigra in an electrical "circuit."
The Food and Drug Administration ( news - web sites) approved Activa in January for implantation in both those brain areas; previously, its use was limited to one side of the brain, mainly for patients with less severe symptoms or with essential tremor. It has been implanted in about 15,000 people worldwide since 1997.
Research shows patients getting implants in both sides of the brain can move normally and easily about three times longer each day than a comparison group of Parkinson's patients. Small studies following patients for up to eight years found they still had very few tremors and almost no limb rigidity.
Robert Wood Johnson Hospital in New Brunswick, where doctors first diagnosed Goldman, began offering the operation in February.
The surgery, which costs between dlrs 50,000 to dlrs 60,000, is covered by Medicare in most states and by many private insurers.
Goldman says the operations were an ordeal, and he's having some trouble with his balance now but would recommend Activa to anyone. Now that he can live "a regular, normal life," he and his wife, Suzanne, are planning a long-awaited trip to Alaska.
"I'm free now," he says. But best of all, "I can hold my wife's hand."
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