Winter 2010 Issue

Deep Brain Stimulation
Reducing Parkinson’s Tremor, Improving Quality Of Life

Coronal view of the patient post-op. Artifact from metal in the electrode makes it appear larger.
Parkinson’s Tremor
Tremor experienced by patients with Parkinson’s Disease is very distinct and is often referred to as Parkinson’s tremor. This movement involves the thumb and fingers moving back and forth in a “pill rolling” motion. This movement is rhythmic and can occur up to five cycles per second. When the tremor first appears, it may only affect one side of the body, or one hand. As the disease progresses, many parts of the body may be affected.
Tremor, or uncontrollable shaking, in the hand, arm or leg is a notable symptom in the early stages of Parkinson’s Disease. Experiencing tremor is what finally leads many patients to seek medical help when they have ignored other symptoms. When medications for treating tremor prove ineffective or present unacceptable side effects, deep brain stimulation (DBS) can be the answer.

About Deep Brain Stimulation
During DBS, electrical stimulation is used to block the abnormal nerve signals that cause tremor. First, specific areas of the brain where symptoms originate are identified using MRI or CT scans. Surgery is then performed to insert an electrode into the targeted part of the brain. An extension wire that connects from the electrode to the neurostimulator serves as the battery pack and source for the electrical impulses. The neurostimulator is implanted under the skin near the collarbone and can be reprogrammed as the patient’s condition changes. The procedure is reversible, unlike other treatments such as pallidotomy, which permanently destroys nerve cells.

Case Study
Carolina Neurosurgery & Spine Associates has performed DBS procedures since 1998. A recent DBS case at the practice involved Earnest McFarland, a patient who was diagnosed with Parkinson’s Disease 15 years ago. After years of successful treatment with medications, he began suffering from right arm tremor that was particularly debilitating, and started experiencing hallucinations. His physician in Gastonia referred him to neurologist Danielle Englert, MD, who specializes in movement disorders at Carolinas Medical Center. She identified the medication that was causing the hallucinations and, after further examination, determined the patient would be a good candidate for DBS. Dr. Englert then contacted neurosurgeon Martin Henegar, MD, of Carolina Neurosurgery & Spine Associates to surgically implant the DBS device.

“The procedure was successful and only one electrode was needed,” said Dr. Henegar. “The patient is doing very well postoperatively, with good control of tremor and improved function.”

The effects of DBS depend on which part of the brain receives stimulation. Treating the subthalamic nucleus reduces symptoms of Parkinson’s Disease, and allows patients to reduce their dosage of levodopa, a drug used to increase dopamine levels. This decrease helps reduce the abnormal movements that result from long-term levodopa therapy. In contrast, stimulation of the globus pallidus reduces side effects associated with levodopa therapy. This allows patients to increase the amount of levodopa they are taking without increasing side effects.

To learn more about deep brain stimulation, call 800-344-6716.

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