Approximately one million Americans are living with Parkinson’s disease, a neurological movement disorder that causes tremor, stiffness, slowness of movement, and impaired balance. Parkinson’s is a progressive disease, which means that its symptoms worsen over time. Although there is no cure for Parkinson’s disease at this time, its symptoms may be controlled with medication, physical therapy and exercise. Some individuals may be candidates for deep brain stimulation (DBS), a highly effective therapy that delivers electrical impulses to targeted areas of the brain after the neurosurgical implantation of electrodes.
“Overlook is one of a select few centers in the region performing deep brain stimulation, and we can attest to the fact that it can significantly improve a patient’s quality of life,” states Tasneem Peeraully, MD, who graduated from University College London with fellowship training in movement disorders and deep brain stimulation at UCLA. She is medical director of the Movement Disorders Program at Atlantic Neuroscience Institute at Overlook Medical Center.
“Our movement disorders team includes two movement disorders neurologists who are fellowship-trained in DBS at university centers, a neurosurgeon with fellowship training in DBS, an experienced movement disorders nurse coordinating each step of the process, an on-site neuropsychologist, and a neuro ICU staffed with nurses trained to care for movement disorder patients. Our program has been designed to optimize each patient’s experience and provide the convenience of a community-based setting.”
What Is Deep Brain Stimulation?
DBS is a multistep surgical therapy that has been FDA-approved for over a decade. During the initial surgery, a neurosurgeon implants a thin wire lead with four electrodes at the tips into a targeted area of the brain, usually the subthalamic nucleus (STN) or the globus pallidus interna (GPI). The implants can be placed on one side or both sides of the brain, as needed.
Once the leads are implanted, anesthesia is paused for a brief period of testing. The neurosurgeon and neurologist can speak to the patient while stimulating the targeted areas of the brain to optimize placement of the electrodes and immediately assess improvement in motor function.
“A millimeter one way or another can make a tremendous difference,” observes neurosurgeon Paul R. Gigante, MD, a Harvard Medical School graduate who completed a fellowship in deep brain stimulation at Stanford University prior to joining the movement disorders team at Overlook last year. Dr. Gigante, who has been performing deep brain stimulation for more than eight years, is one of a select few neurosurgeons in the Tri-State Area using a frameless technique, which does not require the patient’s head to be immobilized in a frame for several hours.
In a follow-up surgery, a battery-operated medical device (about the size of a stopwatch) called an implantable pulse generator (IPG) is secured under the skin near the patient’s chest. The IPG is connected to the implanted electrodes in the brain via an insulated wire extension that is passed under the skin of the head, neck and shoulder. Once in place, the IPG is ready to deliver electrical stimulation to specific areas in the brain, helping to regulate dysfunctional circuits, much like a cardiac pacemaker controls heart rhythm.
The entire surgical process usually requires only one overnight stay in the hospital. After surgery and recovery, patients return to Overlook, where a neurologist programs the IPG device to a set of individual parameters that work best for them. The follow-up visits continue every two to three weeks for the next four to five months to optimize patient outcome.
Who Is a Candidate for DBS?
“The ideal candidate for DBS therapy is someone who has lived with Parkinson’s or essential tremor for four or more years and has motor complications that are not responding well to higher doses of medication,” comments Marcie L. Rabin, MD, a movement disorders neurologist who completed her neurology residency and movement disorders fellowship at Yale-New Haven Hospital with specialized training in DBS and Botox for the treatment of movement disorders and other neurological conditions. “Patients who can benefit from DBS should not have significant dementia,” she adds.
All candidates for DBS go through a thorough evaluation that Diane Babek, RN, MSN, the Movement Disorders Program nursing coordinator, carefully choreographs. Babek helps coordinate neuropsychological testing, assessments of patients’ symptoms with and without their medication, meetings with Dr. Gigante to discuss the surgical process, and brain imaging tests to analyze each patient’s brain structure. She answers patients’ questions and facilitates phone calls between prospective DBS patients and others who have already been through the procedure. “The patient-to-patient interaction is extremely helpful to those considering the procedure,” says Babek.
Optimizing the Patient Experience
“From the initial evaluation through surgery, programming and follow-up, we are committed to ensuring a patient’s physical and psychological comfort every step of the way,” explains Babek, who worked in the Atlantic Neuroscience Institute’s inpatient unit for 12 years prior to joining the Movement Disorders Program seven years ago. “We develop long-lasting relationships with our patients.”
“DBS is not a cure for Parkinson’s or essential tremor, but it certainly has the potential to transform lives,” says Dr. Rabin. “We have witnessed patients go from a disabled state to walking, running and driving within a matter of months. Many can also reduce their medication. These are the outcomes that make it so rewarding to provide DBS therapy to patients at Overlook!”