The procedure sounds like something out of a sci-fi novel or a rogue procedure from the Medieval Era.
But for people with Parkinson’s disease, deep brain stimulation is one of the ways to combat the effects of the disease that affects the nervous system.
DBS is a procedure that requires the patient to be awake while their skull is drilled into for electrodes to be strategically placed in the brain.
“If someone is under anesthesia, the brain cells are asleep. They’re not doing anything so people have to be awake so we can use that electrical activity to navigate,” said Michelle Burack M.D., director of the deep brain stimulation program at the University of Rochester Medical Center. “There are no pain receptors in the brain, so it’s not like as we’re advancing our wires through the skull they’re feeling it. As one of our patients said, ‘it’s medieval and amazing at the same time.’”
Parkinson’s disease affects mobility. Symptoms include slower movement, tremors, smallness of movement—such as small steps and reduced facial expressions or movement of facial muscles.
DBS is a way to turn back the clock for PD patients and restore movement they have lost. Burack estimates a less than 1 in 100 chance of patients ending up with worse symptoms than before the surgery.
“The DBS technology basically evolved out of the cardiac pacemaker technology,” she said. “This really is a pacemaker for the brain; it’s correcting abnormal rhythms in the brain.”
URMC does some 30 DBS surgeries a year. Technology has helped change the way doctors approach the symptoms.
“Before DBS, surgeons would just burn a hole in that node of the brain that’s malfunctioning. But if you burn a hole, basically whatever happens—it’s irreversible,” Burack said. “With DBS we’re basically jamming the signal, but if we wind up stimulating in the wrong place, it’s reversible.”
Thanks to advancements in MRI imaging, doctors have a better roadmap for DBS. They have a much more precise view of where to implant the electrodes than they did before.
“The analogy I used is, when I was first learning how to do this—we had the level of precision of a machete, and now I’ve got surgical scalpel level precision of how I can configure the setting,” Burack said.
DBS is a way for patients to add to their quality of life. It is not a cure.
“We’re buying people time,” Burack said. “It doesn’t cure the disease, so we’re buying them a window of time to keep doing the things that they love. It takes your symptom control back a few years.”
Telemedicine, the diagnosis and care of patients remotely, is another area that has supported patients with PD.
Depending on how far along the disease has progressed, patients with Parkinson’s disease, like others with chronic illnesses, may find it difficult to get to medical appointments based on a variety of factors, including location, ability to drive, availability of caregivers and overall health.
Ray Dorsey, a professor of neurology and director of the Center for Human Experimental Therapeutics at URMC, has been working on creating accessibility for the past few years.
“We have a fundamental flaw in the way we provide care. We ask sick patients to come see healthy clinicians on their terms,” he said. “Instead healthy clinicians should be seeing sick patients on their terms.”
To date, the program, Parkinson’s Disease Care New York, also known as PDC New York, has some 40 people receiving care remotely. The goal is to expand to 500 patients across the state in less than two years.
“We’re offering any New Yorker with Parkinson’s disease the ability to get care from us remotely,” Dorsey said. “For the first time, anyone with a given condition, in this case Parkinson’s disease, in a given geography, in this case New York, can receive care regardless of who they are, where they live and their ability to pay.”
Telemedicine works well for patients with internet access, but for reasons such as socioeconomic level or geography, connecting to everyone is difficult.
“That’s the biggest challenge: trying to overcome that divide and get care to the people that often need it the most,” Dorsey said.
The opportunities in telemedicine are vast and continue to grow, he said. Trying to reach patients with Parkinson’s disease opens the door for patients with other diseases to follow suit.
“If we can do that for Parkinson’s disease, how about Alzheimer’s? How about autism? Why can’t we do this for a wide range of conditions?” Dorsey said. “We hope other people will be similarly motivated and … take it to even higher levels for other conditions.”
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