Spring 2008 Issue

Groundbreaking Deep Brain Stimulation Eliminates Essential Tremor
Brain Mapping Technology Allows For Greater Precision

With DBS, an electrode is placed in the brain and connects to a stimulator implanted under the skin of the patient's chest.
Carolina Neurosurgery & Spine Associates neurosurgeon Martin Henegar, M.D., recently performed Deep Brain Stimulation (DBS) with brain mapping to treat Essential Tremor, a nerve disorder characterized by uncontrollable shaking in different parts or sides of the body.

This surgery, using an advanced frameless technique for the first time in Charlotte, was performed on 61-year-old patient Johnnie Humphries. For more than 15 years he suffered from Essential Tremor. Over time, the tremors worsened, making it difficult to eat, drink and write his name.

Johnnie was referred to Sanjay Iyer, M.D., of Carolinas Medical Center's Department of Neurology. “We tried medications to control the tremors, but they just made me feel like a zombie,” said Johnnie. Dr. Iyer then suggested he see Dr. Henegar at Carolina Neurosurgery & Spine Associates, who determined that Johnnie was a prime candidate for the DBS procedure.

“DBS is often a viable option for many patients with Parkinson's Disease or Essential Tremor whose symptoms have become resistant to medical therapies,” said Dr. Henegar.

The DBS surgery involves implanting a very thin wire with four electrode contacts into the specific part of the brain that is causing the tremors. This wire then extends through a small opening in the skull and is connected to an extension wire. This leads to a stimulator implanted under the skin of the patient's chest. The stimulator emits pulses of energy that travel to the electrodes in the brain and block the abnormal activity that cause a patient's tremors.

The Kinetra stimulator by Medtronic is implanted in the patient’s chest and controlled with an external remote.
During this groundbreaking surgery in Charlotte, Dr. Henegar implanted the electrodes while Dr. Iyer monitored the brain mapping device.

“The key to a successful DBS procedure is the precise placement of the electrodes,” said Dr. Henegar. “To ensure we are affecting the correct part of the brain, we use local anesthesia and the patient remains awake during the procedure.”

Computerized brain mapping technology and immediate patient response allow doctors to determine the exact location in the brain where nerve signals generate tremors and other symptoms. At one point during Johnnie's surgery, he was given a heavy jar and asked to repeatedly move his hand as if he were pouring water from it. The doctors adjusted the target area of the electrodes until his hand became steady with each pour.

Johnnie's procedure was a tremendous success. Now he is able to write, eat and drink normally, and do all the things that his tremor had prevented him from doing.

“It sounds silly, but one of the first things I did once the tremors stopped was eat corn,” said Johnnie. ”It's the small pleasures in life I had missed the most. This surgery changed my life.”

More About Essential Tremor (ET)
ET is a nerve disorder characterized by uncontrollable shaking, or tremors, in different parts or sides of the body. ET often affects the hands, arms, head, larynx, tongue, and chin. While most people can live normal lives with ET, everyday activities like eating, drinking, dressing and writing are difficult. These problems can also lead the patient to withdraw socially. When the tremors become severe they can cause disability. While there is no single treatment for ET, some patients benefit from physical therapy, medication and lifestyle changes, such as eliminating caffeine. If these non-invasive options are ineffective, DBS can often be a solution.

For more information about Deep Brain Stimulation, contact Carolina Neurosurgery & Spine Associates at 800-344-6716.

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