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Deep Brain Stimulation Helping Parkinson’s Patients

Nebraska has one of the highest risks for the disease in the country

It is estimated that as many as 3 percent of the population will develop Parkinson's disease during their lifetime and the risk is even higher in Nebraska. April is Parkinson's awareness month, a month to educate people about this complex disease.

"Many people will have Parkinson's for many years before it becomes apparent," says John Bertoni, MD, PhD, neurologist at The Nebraska Medical Center. Some of the more subtle symptoms of Parkinson's early on include: loss of sense of smell, thrashing in sleep, depression, loss of facial expression, excessive daytime sleepiness during the day, constipation, shortening of one's steps and a diminishing arm swing when walking. As the disease progresses, more advanced symptoms include slowness, rigidity, tremor and difficulty with balance and gait. Up to one-third of patients may develop dementia, usually in the later stages of the disease.

While a definitive cause for Parkinson's has not been found, a combination of factors may play a role, notes Dr. Bertoni. These include aging, having an inherited gene and exposure to environmental triggers such as pesticides and herbicides, which may explain Nebraska's higher prevalence of the disease. It also appears that the risk is higher for males, individuals with personalities that take less risk and those with higher education levels. "In general, it is the law-abiding citizen who is well-educated that is more likely to get Parkinson's rather than the renegade," says Dr. Bertoni.

Deep Brain Stimulation Helping Parkinson's Patients

Joe Solsky first came to see Dr. Bertoni for his Parkinson's when he was 55 years old. Now, 60, he looks back on his initial appointment.

"I could barely walk into the office during my first visit," says Solsky. "The right side of my body shook so badly I had to cling onto walls in order to walk into the waiting room. Even my cane didn't provide enough balance."

"My speech was slurred," recounts Solsky. "I could not complete a sentence without fumbling my words or drooling."

Many Parkinson's patients get significant relief from medications. "Initially, the medications can make a significant difference for most patients for up to 10 years," says Dr. Bertoni. "But eventually, they too begin to lose their effectiveness." Patients will also begin to experience undesirable side effects such as uncontrollable, restless movements if continued or overused.

Solsky had tried the maximum level of medications for his Parkinson's and had not received relief from his pain or involuntary movements. That's when Dr. Bertoni recommended surgical placement of a deep brain stimulator (DBS).

Kenneth Follett, MD, PhD, a neurosurgeon at The Nebraska Medical Center, has been performing the procedure for some 10 years with significant results. The Nebraska Medical Center performs approximately 40 DBS procedures a year, making the medical center the busiest center in the region and the most comprehensive with its team of experts.

"It's not a life-saving surgery, per se, but it can have a dramatic impact on the quality of life for these patients that I personally believe it merits any potential discomfort and risks of surgery," says Dr. Follett. "I never received many thank yous from patients until I began doing this procedure. Now I get letters back from patients and spouses saying 'it has given them their lives back.'"

Deep brain stimulation uses mild electric pulses to stimulate the brain and block the signals that cause Parkinson's symptoms or tremors. The surgery involves implanting an insulated wire in several areas of the brain. The lead wire is connected to a small pulse generator which is implanted beneath the skin in the chest area. The generator can be controlled by the patient and doctor to adjust the frequency and strength of the electrical impulses to fit each patient's needs.

"While only about 5 to 10 percent of Parkinson's patients will eventually be candidates for the procedure, for those 5 to 10 percent it can make a profound difference in their lives," says Dr. Follett.
Solsky calls Oct. 2, 2008, his rebirth date. That's the day DBS was turned on. Solsky says it has been life-changing. "My life has been given back to me," he says. "I could not have imagined the benefits from this procedure. It far exceeded my expectations." Solsky now walks without the cane and no assistance.

"Sometimes I feel so good that I forget I have Parkinson's," says Solsky.

Brighter Future for Parkinson's Disease

Dr. Bertoni says therapies and forms of self-help are also recommended to manage the effects of Parkinson's including occupational therapy, speech therapy, nutrition counseling, yoga, support groups and regular exercise to help maintain balance, flexibility and physical health.

"Individuals who take an active role in their own care, who exercise regularly, stay engaged, and participate in support groups, do the best in managing the disease and living a relatively healthy, active and quality life," says Dr. Bertoni.

"Our goal is to minimize symptoms and improve quality of life for these patients for as long as possible," says Dr. Bertoni. "We are continually learning more about the disease and there are many new treatments coming down the pipeline. There is a lot of hope for a brighter future for this disease. "