Monday September 29, 2014
By Electa Draper
The Denver Post - For Parkinson's disease patients
struggling to control tremors, stiffness and abnormal movements, a
surgical procedure called deep brain stimulation has provided relief
— and a new technique, recently available in Colorado, is gaining ground.
It's
a very different patient experience.
In
traditional DBS, the patient is awake under local anesthesia during most of the
four- to eight-hour brain surgery so he or she can help guide the
surgical team. Diminished tremors indicate the surgeon is finding the
sweet spot in the brain.
In
recent years, surgeons at about a dozen U.S. surgical
facilities have been relying instead on improved imaging of the brain
during a typically much-shorter operation of two to three hours. And the
patient is asleep.
"Brain
surgery is a pretty scary thing to have, and brain surgery while you're awake
is even scarier," said Dr. David VanSickle of South Denver Neurosurgery on
the Littleton Adventist Hospital campus.
In
both asleep and awake versions of DBS,
a surgeon implants thin insulated wires, or electrodes, through a small
opening in the skull into targeted areas of the brain. The wires or
leads deliver electrical signals that block the abnormal
nerve signals responsible for the
most debilitating motor symptoms of Parkinson's. It's
done only after medication is no longer consistently
effective or if it is causing serious side effects.
Electrode
extensions are passed under the skin of the head, neck and shoulder and
connected to a battery-operated device, about the size of a stopwatch, called
an implantable pulse generator.
For
a young patient such as Katie Strittmatter, diagnosed with Parkinson's five
years ago at age 30, DBS has restored quality to life and motherhood. She
chose "asleep DBS."
"It's
incredible," said Strittmatter, the wife of Colorado Rockies catching
coordinator Mark Strittmatter. "I was taking 38 pills a day. Now I take
three. You would not know if you saw me that I have Parkinson's. I have no sign
of tremors."
One
side effect of the heavy medication she was taking was interference with sleep.
The mother of two children, ages 9 and 11, was exhausted all the time,
she said. DBS has restored more normal sleep, but the procedure wasn't a
snap.
"The
recovery was harder than I thought," she said. "It took three weeks.
It was really painful."
Strittmatter,
who weighed in at 98 pounds at the time of her surgery, said the battery
pack in her chest hurt her at first, as did the 60 metal staples in her head.
"It
is brain surgery," she said. "It is a risk. And it doesn't help
with the non-motor
symptoms of Parkinson's."
VanSickle,
her surgeon, has been performing DBS for seven years — and doing "asleep
DBS" for two years using an MRI, CT scans of the brain
and a robot the size of a soda can that places the electrodes in the brain.
Fewer
than 10 percent of Parkinson's patients undergo DBS, VanSickle said, a number
he and other neurosurgeons
say could be higher.
Awake
DBS has been used on roughly 100,000 patients since it was developed in France
in 1987, according to Medtronic, a leading supplier of DBS devices. Oregon
neurosurgeon Kim Burchiel was the first to use DBS in North America as part of
a 1991 clinical trial. The Food and Drug Administration approved it for
tremors associated with Parkinson's disease in 2002.
Burchiel,
chair of neurological surgery at Oregon Health and Science
University, developed the
new technique of asleep DBS, publishing details of the procedure
last year. He predicts it will become the dominant technique in the near
future.
VanSickle
said using advanced real-time imaging allows the surgical
team to verify that they have hit specific targets in the brain. That means
that electrodes don't have to be moved around to find the sweet spot.
"We're
making this a minimally invasive surgery," VanSickle said. "Fewer
hours in the brain is better. A smaller hole in the brain is better. Less
bleeding is better. Cheaper is better."
Dr.
Steven Ojemann, an associate professor of neurosurgery at the University of
Colorado School of Medicine, performs both awake and asleep procedures and
finds benefits and disadvantages to both. Each patient presents different
challenges, he said.
In
asleep DBS, Ojemann uses near-real-time MRI to place the electrodes.
"The
main drawback is that you don't have the feedback from the patient.
You're relying on anatomical precision," Ojemann said. "We're not at
a stage where we can make the contention that asleep surgery is superior."
The
advantages of
DBS have the neurosurgery world buzzing that it could one day
be used to treat
many conditions, including obsessive-compulsive disorders, obesity,
Alzheimer's disease and some forms of depression.
Electa
Draper: 303-954-1276, edraper@denverpost.com or twitter.com/electadraper
http://www.denverpost.com/news/ci_26624398/colorado-neurosurgeon-offers-new-technique-parkinsons-disease
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