Deep Brain Stimulation

A high tech treatment that allows Neurosurgeons to treat movement disorders like tremors derived from Parkinson’s Disease has just become more advanced. Reporter Maddie Orton has the story. Funding for this segment was provided by Levin Capital Strategies.

TRANSCRIPT

A high-tech treatment that allows neurosurgeons to treat movement disorders like tremors derived from Parkinson's disease has just gotten more advanced.

Reporter Maddie Orton has the story.

Ann McCloskey was diagnosed with Parkinson's disease in 1986.

Twelve years later, she became one of the first patients in the country to receive deep brain stimulation, or DBS surgery to help treat her disease.

It's a procedure where a device implanted in the upper chest sends electrical impulses into the brain through wires called leads that are tipped with electrode contacts.

The neurostimulation calms Parkinson symptoms like tremors, but recently McCloskey's 20-year-old device stopped working.

So, two decades after her first DBS surgery, she's scheduled for another one at Mount Sinai Hospital in New York City.

Dr. Brian Kopell is McCloskey's surgeon.

The lead fractured, and, like any man-made device, these leads can break.

You know, DBS is a pacemaker for the brain, and if it breaks, the electricity can't flow, and then they lose efficacy, and so that's, essentially, what happened with Ann.

Going into her second of two lead implant surgeries, McCloskey is optimistic.

She says she knows the procedure will allow her to go back to doing activities without a tremor because her first deep brain stimulation surgery two decades ago worked wonders.

It was a miracle -- just plain and simple, a miracle.

I was shaking when I went into the operating room, and I wasn't when I came out.

Nurse practitioner Joan Miravite, who is also assisting McCloskey with this process, says it's not entirely known why neurostimulation calms Parkinson symptoms, but its use in a case like this is clear.

For someone who has so many years of Parkinson's disease, it's hard for us to cover those symptoms with just medication alone.

She does respond well to medication, but it doesn't last as long, so the deep brain stimulation helps us to manage these on/off fluctuations, and so the off times become better, and so her medication can really last through the day.

The new DBS system will be implanted in both sides of McCloskey's brain, so the surgery is done over two days.

Once the leads are in, and she's had time to heal, McCloskey will return to have the device calibrated to the level of stimulation she requires.

This whole process has become more accurate thanks to a recent advance in the field.

The product that we use today is the first of the advances in the DBS lead design since DBS was introduced in the United States in the late '90s.

The traditional DBS lead had four contacts, and each four contacts looked like a little cylinder, so when you stimulated, you created a field that was symmetric on all sides of the lead.

If the lead were slightly too close to some area that you didn't want to stimulate, you had to sort of trade off between effective stimulation and side effects.

Kopell says surgeons like him wanted a lead that provides asymmetrical stimulation, allowing doctors to stimulate in one area, but not affect an adjacent area.

These new leads provide that capability.

In the operating room, Kopell orients the lead to take advantage of the new electrode layout.

Prior to the implant surgery, Kopell does several checks through brain imaging to make sure he identifies the optimal implant location.

All right. Ann?

Yes?

Do me a favor.

McCloskey is awake, but sedated.

In addition to following the map provided through brain imaging, Kopell also listens to frequencies given off by the brain's nuclei, which help him identify where the lead is stimulating within the brain.

Once the lead is in the targeted location, Kopell turns on the electrodes and asks the patient to follow commands.

He checks her reactions to see whether the stimulation causes McCloskey's normal tremor or stiffness to subside.

Open and close your hand big and wide.

How does that feel?

One month later, McCloskey visits Mount Sinai for a follow-up appointment, where her new DBS device is programmed by Nurse Practitioner Miravite.

Today is Ann McCloskey's first initial programming visit.

So we're going to be turning on her electrodes today.

She'll be off medicine, so we'll turn on the stimulation.

We'll see what the stimulation does by itself, and then we will have her take her meds so we can see what stimulation and medication does at the same time.

Five, four, three, two, one.

Okay.

Just a little tremor.

Miravite uses software on a smart device that allows her to go through each electrical contact in McCloskey's brain, set the amplitude, and test what happens to her symptoms.

Typically, we can treat the symptoms of Parkinson's.

They're called motor symptoms.

We can treat tremor, stiffness, slowness of movement, and dyskinesias, which are extra movements after patients are taking meds.

So those are the symptoms that I'm going to be targeting.

McCloskey's symptoms do lessen in intensity as Miravite tests her patient's ability to do basic physical movements while receiving the deep brain stimulation.

Looks better.

The appointment is a relief for Ann McCloskey, who arrived in a wheelchair suffering from freezing and tremors, but leaves the appointment walking with the help of her medication