Parkinson's disease sufferers able to sleep through brain surgery after breakthrough

May 5, 2018

PHOTO: Grant Rowe's Parkinson's procedures have been life-changing for both him and his wife Lisa. (ABC News: Danielle Bonica)

Parkinson's disease sufferer Grant Rowe says it is a strange experience to be awake while a surgeon "is digging around" in his head, inserting electrodes the size of a grain of rice in his brain

Mr Rowe was diagnosed with the degenerative illness 10 years ago and has been undergoing deep brain stimulation (DBS), which helps reduce his symptoms of tremors, stiffness and slowed movement.

The procedure requires pinpoint accuracy so patients have had to remain awake, allowing surgeons to test their responses to make sure they are in the right spot.

If it's not, the treatment can be less effective or cause unwanted side-effects.

"It's a surreal experience being awake for surgery, cracking jokes with your doctor while he's digging around in your head," Mr Rowe said.

But being conscious during the surgery can be confronting for some.

Wesley Thevathasan, a clinical neurologist with the Bionics Institute, said many people who are eligible to have the procedure do not, because they find the idea too much to handle.

"Probably only 10 per cent of people who would benefit greatly from DBS actually get it," he said.

PHOTO: Dr Wesley Thevathasan said the discovered brainwave makes surgery much more accurate. (ABC News: Danielle Bonica)

But a breakthrough by researchers from the Bionics Institute and Melbourne's St Vincent's and Austin hospitals will now allow surgery to be performed while the patient is asleep.

While studying the brainwaves of 17 patients, researchers discovered a unique brain signal that could be used to guide the surgeon.

"For the surgery to be successful we need to hit the top of the 'grain of rice' — if we miss it by a millimetre we get away with it, if we miss it by 2mm the operation is a failure and we would have to do it again," Dr Thevathasan said.

"If you're driving a car you want to know what speed you're going.

"We've got these little signals that are absolutely miniscule … and this signal that we found is many orders of magnitude bigger, and therefore makes an ideal marker of where we are and if it's working."

Parkinson's occurs when the brain does not produce enough dopamine, which helps relay messages between cells in the brain.

The electrodes inserted during surgery stimulates an area of the brain — similar to a pacemaker in the heart — allowing the dopamine that is naturally produced to be used elsewhere.

PHOTO: Only 10 per cent of sufferers who would benefit from deep brain stimulation get the procedure, Dr Thevathasan says. (ABC News: Danielle Bonica)

When 'normal' feels like a miracle

Mr Rowe said he had been struggling before the treatment: "I basically felt old every day."

The 49-year-old dad said the DBS procedure had improved the quality of his daily life."I'm basically on no medication … because of the surgery," he said.

His wife Lisa said the improvements in her husband had been a relief for both of them.

"The first thing that changed [after treatment] … he wasn't stiff anymore. It's just that whole sense that he's mobile again, his gait is smoother, his walking pace," she said.

"I guess I'm not alert to 'what does he need from me'. I can can be a wife or partner. All of a sudden normal is a miracle, it's a god-send." 

  

Doctors hope the benefits of the breakthrough are twofold: one, it will mean more people will opt to have the surgery, the other could be in further technology improvements.

Currently, the level of stimulation administered to the brain is fixed, meaning it can sometimes be ineffective, or produce side-effects if it is too strong.

There is now hope a new electrode device could be created that can detect changes in the brain signal and respond to a patient's changing symptoms in real time.

http://www.abc.net.au/news/2018-05-05/parkinsons-disease-breakthrough-deep-brain-stimulation/9730850