Lorean Stanek, 75, has Parkinson's disease. Her days used to revolve around a rigorous medication schedule.
Lorean Stanek, Lake Holcombe
The results were unsatisfactory. Another treatment, deep brain stimulation (DBS), has provided relief of debilitating symptoms to the Lake Holcombe, Wisconsin, woman. DBS has provided relief from the unpredictable tremors for many patients with Parkinson's disease who have not responded well to medications.
Parkinson's disease is perhaps the most recognized of all movement disorders. Its cause is unknown, possibly a combination of genetics and environmental factors.
"The brain is made up of many different types of cells," said Neurologist Sakshi Bajaj, M.D. Marshfield Clinic Marshfield Center, a specialist in movement disorders. "The cells talk to each other via circuits. With Parkinson's disease, some of the circuits have become abnormal. Deep brain stimulation modifies the abnormal circuits. Symptoms can improve enough that the patient usually will need less medication."
DBS is a two-step surgical treatment that effectively controls common symptoms of Parkinson's disease such as tremor, slowness and stiffness. Electrodes are placed in targeted areas of the brain and connected under the skin to an implantable pulse generator placed in the patient's chest.
The current generated by the implanted device can be controlled by the patient to help control Parkinson's symptoms. Periodic follow-up appointments with the doctor help the patient establish the amount of current necessary to achieve the best symptom control.
Stanek underwent DBS surgery in January 2012. "I saw this as a chance to find relief from the tremors and take fewer medications," she said.
"Lorean was on many medications, taken several times a day," said Dr. Bajaj. "In spite of that, she was not having adequate symptom control."
Stanek experienced unpredictable tremors, less control of voluntary movements such as handwriting, more dyskinesia (involuntary movements) and freezing (or not being able to bring her foot forward when walking).
"DBS works more consistently than medications because it doesn't wear off," said Dr. Bajaj. "Medications can wear off suddenly and then kick in again with a new dose, keeping patients on a bit of a roller coaster throughout the day. DBS can smooth out the peaks and troughs and make the day more predictable with symptom control."
A screening process, called a Levodopa challenge, determines whether DBS is appropriate for a patient. "Patients are evaluated while off their medications and again while on their medications," said Dr. Bajaj.
Other screenings are completed by specialists in neuropsychology and neurosurgery. Age is not a criterion. "Uncontrolled depression, dementia or atypical Parkinsonian conditions are reasons to not have a patient undergo DBS," said Dr. Bajaj.
Patients have many questions when considering DBS. "We also recommend talking with the neurosurgeon to better understand the surgical procedure," said Dr. Bajaj. "Many of our patients are willing to talk to other patients about their experience."
Stanek calmed her fears by reading anything she could find about DBS. "I wasn't really afraid at all," she said. "It was a video on the subject that convinced me, and I had faith."
DBS is not a cure for Parkinson's disease, said Dr. Bajaj. "But it has made a huge impact for patients whose symptoms are not adequately controlled by medications alone or who cannot tolerate the secondary side effects with increased medication dosages. It is covered by most insurances. Everything else on the horizon is experimental."
For Stanek, this treatment was worthwhile. "I feel that it was so worth it," she said. "I can go out with my husband and spend time with friends without the worry of tremors happening all of a sudden. DBS has been such a relief."