Brain Stimulation Therapy Aids Parkinson’s Patients

Premier Pulse     September 2017

McGregor_105Cameron McGregor, vice president, service integration, neuroscience and spine institutes, editorial message: According to the Parkinson’s Disease Foundation, as many as 1 million Americans live with Parkinson's disease, which is more than the number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig's disease combined. Premier Health is leading the way in our region with our team of movement disorder and functional neurosurgical specialists to help these patients live more active lives with better-managed symptoms.

A therapy developed for Parkinson’s disease is helping patients turn back time on the severity and progression of their symptoms.

Deep brain stimulation (DBS) is a low-risk therapy that implants electrodes into the right and left sides of a person’s brain to help control the tremors often associated with the disease. The benefit of DBS is that it enables physicians to adjust the stimulation delivered to a person’s brain over time, and offers more consistent relief to patients than the medication they currently take.

torresreveronJuan Torres-Reveron, MD, PhD, a neurosurgeon at Miami Valley Hospital, said the therapy can take a patient back to the state they were in when first diagnosed with the disease.

“I tell my patients that I am not curing your Parkinson’s disease, but I am turning the clock back to give you an extra 10 to 12 years with minimal side effects from medications,” said Dr. Torres-Reveron, who practices with Premier Physician Network. “I tell patients to think about their best state – probably when they first were diagnosed and medication worked really well. That’s what we hope to achieve with deep brain stimulation.”

Parkinson’s disease is the second most common neurodegenerative disorder behind Alzheimer’s disease. It’s a progressive disorder that causes dopamine cell loss in the brain. Dopamine is a neurotransmitter that when lessened or depleted in a person’s brain can cause them to have difficulty moving over time, said Mary Feldman, DO, a neurologist who specializes in movement disorders at CNSI.

“There are three major hallmarks to Parkinson’s disease,” Dr. Feldman said. “Bradykinesia, which means slowness of movement, rigidity and a tremor at rest.”

Treatment options for the disease have primarily centered on dopamine replacement therapy since Levodopa was first developed in the 1960s. Over time, other medications have been developed to enhance the efficacy of Levodopa, but the main goal of medicinal therapy has remained the same, Dr. Feldman said.

Patients who manage symptoms with medication often see success in the first few years of their diagnosis, and have relief from relatively small dosages of medication each day. However, as the disease progresses, the time between doses shortens and the swings between what is known as an “on” and “off” state become more drastic. A person’s quality of life begins to suffer when the length of relief from symptoms and the timing of their “off” state become more unpredictable, Dr. Feldman said.

DBS is one option for Parkinson’s disease patients; however, only selected individuals benefit from it. Dr. Feldman works closely with Dr. Torres-Reveron to determine which patients are good candidates for the procedure.

Patients must have a significant improvement on the United Parkinson’s Disease Rating Scale while on Levodopa. The United Parkinson’s Disease Rating Scale was developed by the Movement Disorders Society and is used widely in research trials, as well as by neurologists to measure how a Parkinson’s patient is progressing in their disease as time goes on. The scale looks at all aspects of a person’s functioning.

“It’s not just the severity of their tremors, but how they work in daily life, how they perform certain functions, limitations they have, and any problems associated with other disease processes,” said Dr. Torres-Reveron. “We then look at how responsive they are to medication and how many years they have had the disease.”

According to criteria, patients need to have had the disease for at least four years, Dr. Torres-Reveron said.

Those who fit the criteria and undergo the procedure can experience a new way of life.

“It can be pretty dramatic,” Dr. Torres-Reveron said. “Imagine having to carry your pills everywhere and maybe at one point forgetting to bring them along. Now you’re experiencing symptoms like horrible rigidity. DBS gives relief from that and a new peace to patients with the disease.”

For more information on the treatment of movement disorders, visit Premier Health

Back to the September 2017 issue of Premier Pulse