Arthur Hirsch wrote: >...showing a DBS operation for tremor. Dan Rather's last comment was that this may soon help victims of Parkinson's Disease. He said, to this effect, "the treatment has already been approved in Europe. It will be tested in the U.S. starting this fall, and it may be available for PD patients within two years." -------------------------------------- Art, Brain monitor approved FDA clears way for 'pacemaker', which can control tremors ALAN BAVLEY-Medical Writer 5 August 1997 The tremors in Maurice Long's head and hands became so jarring, he was too embarrassed to leave the house. Then surgeons at the University of Kansas Medical Center gave Long an experimental "brain pacemaker" last year that short-circuited the nerve impulses giving him the shakes. After he got out of the hospital he was out on the golf course with steady hands, putting better than he had in years. "I was just tickled pink," the 72-year-old Hutchinson, Kan., man said. "It's a darned miracle." On Monday, the Food and Drug Administration approved the "brain pacemaker" for general use, clearing the way for thousands of people with Parkinson's disease or essential tremor to gain relief from their disabling conditions. About 500,000 people in the United States have Parkinson's disease and 4 million have essential tremor, a progressive disease that tends to run in families. "It's one of the most impressive things I've seen in medicine," said KU Medical Center neurologist William Koller, who has implanted the device in about 60 patients over the last three years as part of the clinical trial that led to FDA approval. "Some of these patients couldn't even drink a glass of liquid or brush their teeth. Life was a constant frustration." The Activa Tremor Control System manufactured by Medtronic is a 1.7-ounce, battery-powered electronic pulse generator that blocks faulty brain signals that cause tremors. It looks much like the cardiac pacemakers the Minneapolis-based Medtronic is known for. To implant the device, surgeons drill a hole through the skull and pass electrodes deep into the thalamus area of the brain. Connected to the electrode is an insulated wire that passes under the skin of the scalp and neck and attaches to the pulse generator. The generator is positioned under the skin near the collarbone. Together, the device and surgery cost about $25,000. Koller said he thinks insurance companies eventually will cover it. Before going to bed, patients can turn the device off to save battery power by passing a magnet over their chests. A second pass in the morning turns it on. Separate devices are needed for each side of the body. But because there is little evidence yet on double implants, the FDA has approved the use of only one per patient. It will usually be used to control tremors in the hand the patient uses most. Of 196 Parkinson's and essential tremor patients who have received the pacemaker in clinical testing, almost all improved. In more than half, tremors were reduced significantly. "It could have major benefits for both kinds of patients," said Judy Rosner, executive director of the Chicago-based United Parkinson Foundation. She predicted that the device would be appropriate for about 20 percent of patients, those who have severe cases that do not respond to drugs. Parkinson's disease and essential tremor are progressive conditions called movement disorders. Essential tremor usually has no symptoms other than tremor. Parkinson's disease also often includes stiffness of limbs and joints, slowness of movement and impaired balance and coordination. The device is not intended to relieve these other Parkinson's symptoms. Drugs for both essential tremor and Parkinson's disease have significant drawbacks, Rosner said. About one-third of essential tremor patients do not get good results from the drugs, and many suffer objectionable side effects such as impotence and drowsiness. Parkinson's disease drugs work primarily on muscle rigidity, rather than tremor. "Tremor is usually the last symptom to respond," Rosner said. When dosages are raised high enough to be effective against tremors, patients often experience twitching and jerking. Long had suffered essential tremor for 14 years. The condition was becoming worse and the medications he took less effective. "I couldn't write my name or drink a cup of coffee without spilling it," he said. Now, with the brain pacemaker, he is leading an active life. He credits it for the eight-stroke reduction in his golf handicap, and it has given him another advantage at the game. One time at the golf course, Long went in with his pacemaker turned off and made pre-game bets with the other players. Then he turned it on. "They only let me do that once," he said. -- Judith Richards, London, Ontario, Canada [log in to unmask]