Movement disorders related to diseases such as Parkinson’s afflict about one in 100 people older than 60, say specialists at the University of Michigan. Essential tremor, another disease causing uncontrolled movement, affects about 5 percent of that population, the doctors say.
Medications that reduce symptoms often do not work as well over time. While the tremors do not affect a person’s activities, people often are embarrassed and isolate themselves, said Dr. Kelvin Chou, co-director of the University of Michigan’s Surgical Therapies Improving Movement program and head of the department of neurology.
However, patients can see dramatic life changes after deep brain stimulation surgery, says Dr. Parag Patil, co-director of the STIM program and assistant professor of neurology.
“Deep brain stimulation is like a pacemaker,” he says. Electrodes are placed in the brain while the patient is awake, and reactions can be tested in the operating room. Then the patient is put under anesthesia and surgeons insert a thin, flexible wire, and a pulse generator is placed in the chest.
Q: What is the difference between Parkinson’s and essential tremor? (Full disclosure: I was diagnosed with early-stage Parkinson’s more than six years ago.)
A: Chou: Essential tremor is the opposite of Parkinson’s. In Parkinson’s, the tremor occurs when the hand is relaxed and not being used. With essential tremor, there is difficulty eating and writing, for example.
Parkinson’s patients essentially lose the dopamine in the brain, and that leads to tremors and sometimes stiffness and rigidity.
Q: Deep brain stimulation surgery is not really new. Why discuss it now?
A: Patil: We believe there is a difference in the way patients are evaluated and told risks and benefits. By educating people about the surgery, we hope to improve their quality of life. And many physicians are not at all clear when to send patients for this surgery. Some, of course, are not eligible. Michael J. Fox, the actor with Parkinson’s, had an older surgery around 2000 that kills some cells causing problems in the brain. It is not reversible. Stimulation is reversible, and it re-creates the signals creating dopamine in the brain.
Q: How quickly does Parkinson’s advance?
A: Chou: It is a slowly progressing disease. It could be 15 years before it interferes with the patient’s quality of life.
Patil: We have done studies with patients who do and who do not get deep brain stimulation surgery when the disease has progressed. For most, there is a definite improvement in their quality of life.
Chou: More important, it does not wear off over time. And you can turn it off when you are asleep because you don’t need it then.
Our data shows main motor symptoms can be preserved for 10 years or longer as a result of this surgery.
Many Parkinson’s patients who are forced to take medications every two hours or so just to keep themselves going — or essential tremor patients who don’t feel medications are helping — may turn to surgery. Patients often see dramatic, life-transforming changes.
Q: There is something about brain surgery that sounds scary.
A: Patil: Many people are afraid. We hope to educate them to make an informed decision, to make the best choice for themselves.
Q: Has the number of surgeries you do increased?
A: Patil: We have gone from about five to 30 or more a year. And with the boomers aging and displaying symptoms, we expect to do even more.