Synaptic Chats: Stopping the Shaking: Treating Parkinson's with Deep Brain Stimulation

In June of this year, a video came out on Youtube that has now achieved over 1 million views. Unlike may viral Youtube videos, it is not images of cats chasing lasers, or people running into glass doors. Instead, it is of a man, sitting down in a chair talking to the camera. This man’s name is Andrew Johnson (AJ), and 4 years earlier at 35, just starting a family with 5 and 3 year old children, he was diagnosed with Early Onset Parkinson’s Disease. You would not know this by looking at the video though. Parkinson’s Disease is a progressive disorder affecting motor movement, most famously tremors and stiffness/slowing. The AJ on camera’s movements are fluid, his speech is normal and understandable. He goes through some simple motor tests with his hands, showing complete movement. AJ then goes on to explain in 2012, he underwent surgery for Deep Brain Stimulation (DBS). He picks up a remote control, puts it to his chest, and pushes a button. Almost immediately, his hand starts to tremor. He holds his hands up and they blur in front of the camera. His neck tightens and his head tilts. His speech is slow and broken. With trouble, he grabs the remote again and turns his device in his chest back on. Again, almost immediately, he is returned to his original state.

At first watch, it is hard to believe. It seems that science has founds a complete cure for Parkinson’s. This is not the case though. DBS does not stop Parkinson’s symptoms as seen when AJ stops his stimulator, and it is often used alongside other treatment methods. It does not stop the progression of the disease either, and because of that the DBS must continually reprogrammed.

What DBS does do is treat some of the motor symptoms of Parkinson’s. Thin electrodes inserted into brain target motor circuits that are not working properly. A device implanted in the chest acts like a pace maker and shoots electrical impulses through the electrodes deep into the brain, mainly the Globus Pallidus and Subthalamic Nucleus regions. These signals take the place of the overactive or underactive signals from the non-working motor circuits causing the motor symptoms. In the x-ray below, you can see the two thin electrodes inserted bilaterally into the center of the brain, then coiled up on the top of the skull and running down the sides (the white sections around the teeth are dentures).

This surgery is an option for certain kinds of Parkinson’s patients. The main problematic symptoms for these patients are motor, most often tremors (also called dyskinesia). These symptoms must not be treatable with common Parkinson medication like Levodopa, or in some cases, the medication can cause too many adverse side effects. DBS can reduce these motor symptoms drastically without as many side effects. Again, it is not a cure all though. Most patients need to supplement DBS with medication. DBS also has cognitive effects on certain patients. Parkinson’s can cause, especially in the later stages of progression, serious cognitive deficits. In these patients, DBS can increase these symptoms. Just when you gain back you motor functions, you loose your mental ones.

Even with all this, DBS is a life changing chance for many Parkinson’s patients like AJ. Because these patients are completely while they slowly loose the ability to do every day activities, it is an extremely hard disease on the mental state of its victims and their families. AJ continually repeats this in his blog, which I will link to at the bottom of the post.

“Of course as a husband and a father all you want to do is protect them from and to fix the problem. But when something that is happening to you IS the problem, and when that problem is incurable and progressively gets worse, the sense of helplessness is acute…I see the pain my family are in. I am wracked out of guilt and anger, not at them or myself, but at this greedy insidious devil which is stripping me of my ability to do pretty much everything, much much faster than I ever understood was possible. I feel sick inside knowing that I am the cause of their torment-the anxiety, the worry, the struggle to understand why daddy can’t do things… Because I don’t have Parkinsons. We have Parkinsons.”

For cases like AJ, DBS is a procedure that can completely change how patients are able to interact with their family and life, allowing them to enjoy more than previously thought possible in the face of this debilitating disease.

To learn more about AJ’s experience:

AJ’s amazing viral video: http://www.youtube.com/watch?feature=player_embedded&v=uBh2LxTW0s0

AJ’s blog Young and Shaky following his progression from diagnosis to surgery and beyond: http://youngandshaky.com/

To learn more about DBS:

The National Parkinson’s Foundation’s:

http://www.parkinson.org/Parkinson-s-Disease/Treatment/Surgical-Treatment-Options/Deep-Brain-Stimulation

A TED talk by the pioneer of DBS about its functions beyond Parkinson’s:

http://www.ted.com/talks/andres_lozano_parkinson_s_depression_and_the_switch_that_might_turn_them_off.html

A 3D animation of how DBS works:

http://www.youtube.com/watch?feature=player_embedded&v=izKL1mVXF7c

A video from the Mayfield Clinic explaining the procedure:

*WARNING* This video does show the entire DBS procedure, including drilling into the skull and inserting electrodes. Do not watch if open-wound-shy.