Deep Brain Stimulation Carried Out At Queen's Hospital For Patients With Parkinson's Disease

Main Category: Parkinson's Disease
Article Date: 16 Jan 2009 - 4:00 PDT

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A ground-breaking procedure being carried out at Queen's Hospital is transforming the lives of people with Parkinson's Disease. Deep Brain Stimulation is carried out in the Trust's specialist neurosurgical unit - the newest in the UK. The procedure sees a tiny electrode inserted into a specific area of the brain. When it is switched on, it can drastically reduce the tremors experienced by Parkinson's sufferers.

It is just as effective for people with other movement disorders, such as essential tremor and dystonia. But most people do not even know the treatment exists.

Parkinson's Disease is a debilitating condition which stiffens the joints to the point of immobility, and causes uncontrollable tremors.

John Lane from Mawney Road in Romford had been plagued with tremors that made getting up and down stairs and venturing to the shops a near impossibility for several years.

But in August this year he had Deep Brain Stimulation at Queen's.

" It is just incredible," he said. "I really didn't believe it could work, but it has completely changed my life.

" I had spent years taking more and more pills to try and control the shaking and I was at the end of my tether. But now things have changed totally. I feel 21 again."

The procedure was carried out by Consultant Neurosurgeon Ian Low.

Mr Lane, 63, said: "Mr Low walks on water as far as I'm concerned. He has given me my life back."

The procedure takes place in just one day.

A frame is attached to the head to keep it immobile, and an MRI scan of the brain is carried out.

The scan helps to pinpoint exactly where the electrode should be implanted, depending on the primary problem causing the tremor.

An incision and small bore hole is then made in the patient's skull and a microelectrode is passed into the brain.

The patient is under local anaesthetic but awake while this takes place.

A small electric current is passed into the brain when the target has been reached to quiet the abnormal signals in that area. Tremors will immediately stop. The current is slowly increased and the patient is asked to repeat certain words and perform several simple tasks.

If the position of the electrode needs readjustment, there may be temporary pins and needles, slurring of speech or double vision. If this is the case, it will be moved until there are no side effects and no shaking.

The final position of the electrode is critically dependant on what the patient tells the surgeon, which is why this happens while the patient is awake.

Once the exact position has been found, a permanent brain electrode is put in place and secured to the skull.

The patient is then given a general anaesthetic while the frame is removed and a neurostimulator is inserted under the skin near the collarbone. Wires connecting the stimulator to the brain electrodes are then passed under the skin, and all the wounds are closed.

When the brain swelling has died down, the neurostimulator is switched on and the patients themselves can control the electric current to their brain.

John Lane said: "The whole process only takes one day. It is a little bit traumatic at the time, but the benefits are incredible.

" One day you're shaking, and the next someone pops up, turns the stimulator on, and it changes your life. It's hard to describe how that feels."

Since he had the procedure John's life has been transformed. He has even been to Spain on holiday - something which he did not think he would ever be able to do again.

But despite the life-changing potential of the operation, many people are not even aware that it is available.

Studies show that ten per cent of patients with movement disorders would benefit from deep brain stimulation. That means that, in Essex alone, more than 800 could have their lives transformed by the procedure. But so far PCTs across the county have only approved funding for six operations.

Mr Low said: "There is good clinical evidence that Deep Brain Stimulation works, but many patients and their medical referrers aren't aware that it is a treatment option for people who have poorly controlled tremor. In appropriate patients, it has the potential to significantly improve the quality of someone's life."

John added: "I feel so sorry for people who don't know about this. It is something that the NHS should be so proud of."

As well as movement disorders, DBS can also be used to treat intractable pain and refractory epilepsy. Trials are also taking place to see if it could be used to treat depression.

This type of functional neurosurgery taking place at Queen's requires a whole team of specialist staff to see the process through, including movement disorder specialists, neuropsychologists, neuroradiologists, specialist nurses, physiotherapists and occupational therapists.

Source
http://www.bhrhospitals.nhs.uk

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