February 8, 1998 in City

Ray Of Hope For Tremor Sufferers Implant Of Wire In Brain One Of Several New Procedures

By The Spokesman-Review
 

When June Shepherd drew spirals, they looked like squiggles of modern art. Her signature resembled hieroglyphics. She picked up a cup of water and it boiled.

Shepherd has something called “essential tremor,” a little-understood neurological disorder that often runs in families. It causes severe shaking in one or both sides of the body, but few other symptoms. About 1,600 people in the county suffer from the disorder.

“I went to a restaurant maybe a week ago,” said Shepherd, 71. “I forgot. I picked up the syrup and I had syrup everywhere. Oh man, it was embarrassing. I was a sticky mess.”

Shepherd decided to have a new brain operation at Sacred Heart Medical Center that often corrects the problem. She was the fifth patient in Spokane to receive an implant - a wire thinner than a strand of spaghetti, with four electrodes on its tip.

The implant is placed into a walnut-sized region deep in the brain that coordinates signals that control movement. The implant emits a high-frequency signal that jams or blocks the faulty brain signals causing the tremors.

The surgery holds promise for people with Parkinson’s disease, and is one of several new neurological procedures now being performed at Sacred Heart.

The U.S. Food and Drug Administration approved the deep-brain implant in August, although it’s been used in Europe for several years.

As soon as the device was approved, Spokane neurologist David Greeley and neurosurgeon Jeff Hirschauer started looking for patients who could benefit - people with severe tremors that couldn’t be controlled with drugs.

“A lot of these people can’t go out to eat in a restaurant,” Hirschauer said. “They’re too embarrassed. A lot of them become recluses. Some people have tremors so severely they can’t eat at all. Other people have to feed them.”

Shepherd first noticed the shaking in her left arm a couple of years ago. The shaking got worse. Shepherd makes and restores jewelry, and she couldn’t hit the broad side of a bead with a needle because her hand shook so much.

Her home, where she’s lived for 65 years, is a shrine to beads, holding stacks of boxes sorted by colors. Boxes that haven’t been touched in years.

As soon as Shepherd learned about the surgery, she wanted it. The $20,000 cost is covered by Medicaid and Medicare.

Shepherd was the first woman - and the first left-hander - to have the surgery in Spokane.

She started the day at 5 a.m. An erector set-like frame was fixed on her head before she had an MRI scan. She was wheeled into the operating room about 10:30 a.m., and her head frame was fixed into another frame hooked to the operating table. Her head had to be kept as still as possible.

The whole procedure is tedious at times, lasting up to 10 hours. It’s like tuning a piano. There’s a lot of fiddling to make sure the device is planted in the right spot inside the thalamus, a spot in the brain that is mapped by the MRI.

Hirschauer made an incision in Shepherd’s scalp, then drilled a hole into her skull. Shepherd was awake and, thanks to a local anesthetic, didn’t feel a thing.

Greeley asked her to draw a concentric circle, the first of about 40. He asked her to say the alphabet and touch her finger to her nose.

“I’ll stop bugging you now,” Greeley said.

“Oh, I don’t mind,” Shepherd replied.

Hirschauer first pushed a stiff probe with an electrode on the tip toward the thalamus. When the probe got close, Hirschauer started running high-frequency signals into the electrode at every advance of a millimeter.

Meanwhile, Greeley asked Shepherd to draw more circles, hold out a cup and touch her nose again.

Shepherd kept apologizing, because she felt pain in her arm at times, and because her circles were still squiggles. At some points, her arms were dead weights, not capable of straightening, let alone holding, a pen.

There were magic spots, where Shepherd’s left arm was as steady as a surgeon’s, but those were fleeting. “You’re doing things exactly right,” Greeley told Shepherd. “Don’t worry.”

Hirschauer made three passes at the thalamus. Finally, on the last try, Shepherd’s circles got smoother. And she didn’t have the pain.

“Pretty rock steady,” said Greeley, watching Shepherd hold a plastic cup.

More adjustments were made, more frequencies tried. Finally, the real implant was inserted, with its four electrodes. The signal can be varied, from one electrode to another, to ensure the patient has the best results.

Shepherd held her arm out and signed her name.

“She’s smooth,” Greeley said. “And she’s tired out.”

Then, Shepherd was given a general anesthetic while the pulse generator was surgically implanted beneath her collarbone. The guide wire connecting the pulse generator to the implant was snaked beneath her skin.

“Well, this is the longest one to date,” said Hirschauer, just before 6 p.m.

The pulse generator’s batteries usually have to be replaced only once every 10 years. The implant should last a lifetime.

Shepherd was released from the hospital the next day. The following Monday, she went to Greeley’s office to have the device turned on.

“She has no tremor,” Greeley said. “She has the best placement of anybody. We got right on the spot.”

Later that week, Shepherd sat in her home and held out her left hand. It was still.

“Isn’t that pretty?” said Shepherd. “I was so excited. It’s fantastic. I wouldn’t trade it for a million dollars.”

, DataTimes ILLUSTRATION: Color photo

MEMO: This sidebar appeared with the story:

NEW CENTER

Spokane doctors have created a new center that could help people with movement disorders get the latest drugs and treatments.

The Northwest Movement Disorders and Dementia Clinical Research Center aims to get local patients with disorders like dystonia, essential tremor and Parkinson’s disease involved in investigational trials.

Neurologist David Greeley, neurosurgeon Jeff Hirschauer, neuropharmacologist Clarke St. Dennis and St. Luke’s Rehabilitation Institute are involved, Greeley said.

Many people in this area could benefit from cutting-edge treatments, he said.

This sidebar appeared with the story: NEW CENTER Spokane doctors have created a new center that could help people with movement disorders get the latest drugs and treatments. The Northwest Movement Disorders and Dementia Clinical Research Center aims to get local patients with disorders like dystonia, essential tremor and Parkinson’s disease involved in investigational trials. Neurologist David Greeley, neurosurgeon Jeff Hirschauer, neuropharmacologist Clarke St. Dennis and St. Luke’s Rehabilitation Institute are involved, Greeley said. Many people in this area could benefit from cutting-edge treatments, he said.


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