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Mark Richardson, M.D., prepares to insert a small electrode into the brain of patient Joyce Dowdy during surgery at UPMC Hamot in Erie on March 24. Dowdy, 66, is being treated for Parkinson's disease and was conscious during the procedure. GREG WOHLFORD/ERIE TIMES-NEWS Powerful medicines that help control the 66-year-old Springfield Township woman's tremors and keep her muscles loose are working for shorter periods of time.
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ERIE, Pa. -- Joyce Dowdy is slowly giving ground in her nearly 20-year battle with Parkinson's disease.
Powerful medicines that help control the 66-year-old Springfield Township woman's tremors and keep her muscles loose are working for shorter periods of time.
"Unfortunately it's common with Parkinson's patients to see the medication not last as long," said Dimitrios Nacopoulos, M.D., a UPMC Hamot neurologist who treats Dowdy.
Instead of increasing Dowdy's medications, which could cause serious side effects, Nacopoulos and other UPMC physicians offered Dowdy deep-brain stimulation.
It's a surgery where tiny electrodes are placed deep in the areas of Dowdy's brain responsible for movement. Electrical charges are delivered through the electrodes to block the abnormal nerve signals that cause tremors and related Parkinson's symptoms."Not everyone with Parkinson's is a good candidate," Nacopoulos said. "Patients, like Joyce, who still respond to medication tend to do well, even if they maybe aren't responding to the medication as long."
Parkinson's patients who also have any type of dementia usually do not respond well to deep-brain stimulation.
Deep-brain stimulation is a treatment, but not a cure, for Parkinson's. The goal is to control tremors and other symptoms as well as medication does, only for longer periods of time, allowing doctors in many cases to reduce the amount of medication a patient requires.
Dowdy underwent the first stage of deep-brain stimulation Thursday at Hamot. UPMC neurosurgeon Mark Richardson, M.D., now performs deep-brain stimulation at the Erie hospital in addition to UPMC Presbyterian.
"Before we implant each DBS electrode, we thread three microelectrodes into that area of the brain," Richardson said in a Hamot operating room as his surgical team prepared Dowdy for surgery. "They allow us to monitor and record the neuron activity, which gives us a more precise map of exactly where the DBS electrode should go."
Dowdy was sedated but awake during the surgery because Richardson at times needed to ask her questions and have her raise her hands to test for Parkinson's symptoms.
"Joyce, can you say 'Today is a sunny day in Erie?'" Richardson asked Dowdy.
"Today is a sunny day in Erie," Dowdy said clearly.
It took Richardson and his team about four hours to implant two DBS electrodes in Dowdy's brain through a pair of 14-millimeter holes near the top of her head, then test the electrodes to see if they reduced her Parkinson's symptoms.
Dowdy underwent a second procedure Friday where a wire was threaded down her neck and attached to a pacemaker-like device under her collarbone that generates a pulse to block the abnormal nerve signals.
"We will wait about four weeks to turn on her device," Nacopoulos said. "Her brain needs time to heal from the surgery."
Nacopoulos will tweak Dowdy's device during three postoperative office visits, making small changes in the pulse's voltage, frequency and area.
By the end of the third visit, Dowdy should be able to walk as well as she does during her best moments on medication, but for most of the day instead of just a couple of hours, Nacopoulos said.
Some patients have benefitted from deep-brain stimulation for more than 10 years.
"We can then see about decreasing her medications, which can help because as the disease progresses we can then increase those doses again," Nacopoulos said.
DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him on Twitter at twitter.com/ETNbruce.
http://www.goerie.com/deep-brain-stimulation-helps-erie-parkinsons-patients
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