Vanderbilt Deep Brain Stimulation Special - Part 2/4

Patients with Parkinson's disease understand that over time, their medications won't work as well to control symptoms causing their quality of life to deteriorate. So what can help some of these patients adding an electronic version of medication to the mix. This is Parkinson's patient Carroll Phillips singing in the church choir at this point she had Parkinson's for nine years. Notice how she can stay still that uncontrollable movement is a side effect from her medication and progression of her disease. It impacted everything. When I tried to feed myself, I would bring my fork up or spoon and I might hit my eye, or I might hit my nose. Carol dropped from about 130 pounds to just 94 pounds. Friends offered to help. They'd say, "Let me feed you." and I said, "No, no, I want my dignity for as long as I can get it." Carol relied on a cane or walker to get around. Even then, more side effects. i would be walking, and I would just freeze. I couldn't go anywhere. The good news, Carol didn't have any other serious illnesses, so that made her a good candidate for an electronic version of her medicine, deep brain stimulation or DBS. Deep brain stimulation is a method by which high frequency electrical stimulation through a very small electrode placed strategically in the brain can actually control the abnormal circuit in the brain and bring the patients' symptoms such as stiffness or tremor back into control for that person. the DBS system is made up of an electrode and a device that looks like a pacemaker. Patients may need one or to implants depending on whether symptoms on one side of the body or both this brain surgery is a delicate procedure with small but potentially serious risks everything from stroke paralysis to even death. Every week people make a decision that taking that small risk is worth it because the symptoms they have for their disease are so disabling or so painful or affect their life so severely that they find it valuable. Despite the risks Carol knew DBS was her only hope for a more normal life. This may sound like a lie, but I was never scared of anything. Because of the potential for life threatening risks each DBS candidate must first have a thorough physical and neurological assessment. During a monthly conference, staff ranging from neurologists, neurosurgeons electrophysiology to physical therapist discuss each patient's case weighing DBS risks versus benefits for each patient. Patient selection is one of the most important aspects of deep brain stimulation. The more people who can lay eyes on the patient preoperatively, the more likely we are to have a good outcome. They should be satisfied and have a better quality of life. Most hospitals map the DBS surgery and implant electrodes over a very long day. Vanderbilt specialists say that's difficult on patients, so they've modified it so DBS is done in four stages. It's more accurate that way. Plus, it's much easier on patients. In Stage One sedated patients have four small markers implanted which will secure the frame for the delicate brain surgery. Vanderbilt neurosurgeons no longer rely on the large metal stereotactic halo used by many hospitals. Instead four years ago, they were the first to use a unique stereotactic system. It's a much smaller and lighter frame tailor made for each patient. What this means for the patient is improved patient comfort because the surgery time is cut by at least two to three hours. It retains all the accuracy and,I feel in our research that we've published,that it's actually more accurate than the stereotactic frame. Patients also undergo a CT brain scan and an MRI scan. Research proves groups of faulty cells develop in specific areas deep in the brain causing debilitating symptoms like tremors. Neurosurgeons can't see those cells or targets in the scans, so they turn to a one-of-a-kind computer program developed at Vanderbilt. The computer can help us find that target faster and more accurately. That computer program combines standard brain maps, scans from previous DBS success cases, plus the patient's own scans to make a prediction of the specific area where electrodes must be place to control symptoms. A week later Stage Two: surgery to place electrodes in the brain. Using local anesthesia the frames attach so the electrodes can be guided to the target. As for the patient with no pain sensors in the brain they feel nothing. We may give them a little bit of sedation, but we need most of our patients awake because we want to see where the therapy is most effective and controlling their stiffness or their tremor. Right now I'm advancing an electrode down there. The electrophysiology listens for this the faulty brain activity, the predicted target, the first target a bullseye, the second almost dead center. That's how accurate that computer prediction process is for us. It's amazing. Next, a test simulation. A small electrical current is set to the target. Too much stimulation can cause side effects like tingling. The neurologist and patient help the neurosurgeon determine if the electrodes are truly in the best spot to relieve symptoms. The electrodes are then permanently implanted. The following week. Stage Three: the pacemaker-like device is surgically implanted under the skin and connected to the electrode. After healing about a month later, Stage Four a Vanderbilt neurologist programs the DBS system With this wireless device, he can send electricity to any of four contact points on the electrode in the patient's brain. tYou can make the shape of the electrical field less like a ball and more like a football. This custom programming plus adjusting the patient's medications will be what helps keep symptoms under control. This system makes a difference. When off, see how the tremors return? When on the tremors go away. So, for your left hand you have 1.9 volts and for your right hand 2.5 volts. The neurologist also sets parameters, so patients can safely adjust their electronic medication at home as needed. As for Carol... I have had people who don't even recognize me from the back because I'm not jerking and tremoring so much. She's back to doing the things she loves: gardening exercising, and reading. Look how steady her hands are. And she's back to a healthier weight because she can now feed herself again. As for her walker, it now houses are quilt. Carol is the typical DBS patient success story. She's got her Parkinson's pills from 37 a day to just 3. it took about six months of adjusting her medications and the DBS system to optimize the control of her symptoms. My dignity is there. Everything about my life is 100s of times better. Although the potential benefits are great there are rare times where a patient may need additional DBS surgery. An electrode like this it may have to be repositioned if it shifts, breaks or if an infection develops around it. Vanderbilt specialists say it's important patients understand that as they consider this treatment. Coming up, could DBS actually the first treatment to ever slow the progression of Parkinson's?