Toni Pais is 59 years old. He's a hands-on restaurant owner who is often prepping for the dinner crowd by himself. However, tremors from Parkinson's disease almost forced him to quit.
"It's very dangerous because you are dealing with fire with hot pans, sometimes you try to shake the pan, your brain wants to move, but your muscles don't," said Pais.
Medication was losing its affect. Pais couldn't tolerate the traditional surgical method for implantation of deep brain stimulators, which would require him to be awake during surgery.
During DBS, surgeons implant thin electrodes at very specific targets in the brain to deliver electrical pulses. Doctors interact with the patient to ensure the electrodes are in the correct place.
"The problem is, there is a significant population of patients with Parkinson's who are too anxious, or too symptomatic, or both to undergo awake surgery in the frame," explained Mark Richardson, MD, PhD, Director of Epilepsy and Movement Disorders Surgery, UPMC.
Now surgeons have begun performing the procedure on patients who stay "under" the whole time using customized software and an MRI machine. Surgeons attach an aiming device to the skull and the surgeon maps the trajectory of the electrode in real time.
More than one year after surgery, Pais says his tremors are minimal, so are his other symptoms.
"Now if I'm relaxing, sleeping, lying down, [or] contemplating, I'm calm as calm can be," Pais explained.
UPMC researchers say a preliminary analysis of patient outcomes shows there is no difference in side effects or benefits for patients who undergo the procedure asleep.
Parkinson's disease is a condition of the brain affecting approximately six million people. It is most commonly characterized by slowness of movement, stiffness, shaking, and loss of balance. Parkinson's often develops after the age of 50. Although Parkinson's disease is one of the most common nervous system disorders for the elderly, it can affect young people too, usually because a form of the disease runs in their family. Nerve cells use a brain chemical called dopamine to control muscles. When the nerve cells in the brain that produce dopamine are destroyed as a result of Parkinson's, the nerve cells in that particular part of the brain will not properly send messages. The result is the loss of muscle control. The damage gets worse over time. (Source: www.ncbi.nlm.nih.gov)
SIGNS/SYMPTOMS: The first symptoms of Parkinson's disease can be hard to diagnose, especially in older patients, and often start out mild and worsen over time. The most common signs of Parkinson's disease are shaking, called tremors, and jerky, stiff movements. Some of the other possible signs include:
- Depression, anxiety, and memory loss
- Slowed movements, slow blinking, and slowed speech
- Difficulty swallowing and drooling
- Problems with balance and walking (www.mayoclinic.org)
NEW TECHNOLOGY: Deep brain stimulation is a technique that has been used for years now to treat conditions like Parkinson's, dystonia, and essential tremor. The procedure to put the electrode in place usually takes place with the patient awake, because brain mapping is easier when the patient isn't under anesthesia and so doctors can periodically check with the patient. However, now doctors can use MRI to place the electrodes needed for the neurostimulator. This means the patients can be put under general anesthesia for the surgery. The MRI helps doctors visualize in real time where the electrode needs to be placed. This is important for patients who are nervous, can't tolerate being awake, or too dystonic to be still during a surgery. (Source: www.upmc.org)
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