Walter Lindstrom is wired, each of the stopwatch-size devices implanted in his chest connect via leads running up his neck to a set of electrodes in his brain.
But the device that turns him on and off is wireless.
In a demonstration in his neurosurgeon’s office, a handheld “programmer” – roughly the size of a cellphone – sent a signal to the pacemaker-like device in the right side of his chest, delivering electrical pulses to the right side of his brain.
When Lindstrom, 72, gets turned on, his tremors turn off. Turned off, Lindstrom’s left hand immediately started to shake.
If deep brain stimulation sounds like a technique of torture, Lindstrom, who has Parkinson’s disease, said the surgeries to implant his devices were mostly painless. And for him, the results are “awesome,” he said, quelling his tremors and allowing him to cut the medication he takes by more than half.
The electrodes are implanted to regulate the abnormal impulses that accompany some neurological conditions. And it smooths out the “on time” and “off time” experienced by many patients as the effectiveness of their medication rises and falls.
“DBS has really revolutionized the care certainly for Parkinson’s disease and essential tremor and dystonia, to where you can really improve their quality of life,” said Jamie Mark, a nurse practitioner who works with DBS patients at Northwest Neurological in Spokane. “You can make them better. You can improve how they function on a day-to-day basis.”
Since the FDA approved deep brain stimulation, first in the late 1990s for essential tremor, it’s been performed on tens of thousands of people. And the treatment may be poised to expand its reach, drawing attention for its potential to treat problems beyond movement disorders, including Alzheimer’s disease, depression and obsessive-compulsive disorder.
Dr. Jonathan Carlson, a neurosurgeon at Inland Neurosurgery and Spine Associates, performed Lindstrom’s surgeries. Among brain and spine surgeries, he said, deep brain stimulation is his passion. Patients who undergo the therapy end up better, he said, rather than disabled as a result of the catastrophes – brain tumors, traumatic injuries – that sometimes lead to surgery for other patients.
But, because it comes with risks, it should only be done when medication doesn’t work or its effectiveness has worn off, Carlson said. Particularly for Parkinson’s patients, he said, drugs can work very well with minimal side effects for years.
The major risk of deep brain stimulation is bleeding in the brain, or stroke. About 3 in 1,000 patients suffer severe stroke-like effects, Carlson said.
Lindholm said he considered the risks and decided the benefits outweighed them.
For his brain surgery, he was fitted with a special frame to keep his head still. Two small holes were drilled in his skull, and wire leads with electrodes at the end inserted, one for each side of his brain.
He got local anesthesia to numb his scalp but was awake when doctors inserted the electrodes so they could talk to him, ensuring they were placing the electrodes correctly and stimulating the right areas of his brain.
To find the exact right spots, they consult MRIs of the patients’ brains and listen to individual neurons using tiny microphones – “they sound like fuzzy noise, popcorn-ish,” Carlson said. They turn on the stimulator during surgery and observe the effects. If a tremor stops, that’s good.
Lindholm’s second surgery was done under general anesthesia. Two neurostimulators, the pacemaker-like devices, were implanted under the skin on his chest, one on each side. Wires were run from his head down his neck and shoulder to connect the electrodes in his brain to the neurostimulators in his chest.
He returned to his doctor’s office a few weeks later for “programming” – the stimulators turned on using that wireless remote control, and the level of stimulation adjusted over time.
Getting the mix of programming – levels of electrical stimulation – and reduced medication just right takes about three to six months, Mark said.
It also involves reducing the side effects of stimulation, which include tingling, slurred speech, dizziness, vision changes and tightness in the face or arm.
Mark said she tells patients considering the treatment to consider how their disorders respond to medication. Deep brain stimulation is not a cure, and it does not slow disease progression, she said.
“The things that improve when they take medicine are most likely the things that’ll improve with surgery,” Mark said. “The other key is for them to think about their best ‘on time,’ when they take their medicines and they’re doing their best. DBS surgery is meant to give them more of that time. But it’s not expected to make them any better than their best on time, prior to surgery.”
Lindstrom, a retired firefighter who lives in Spokane Valley, was diagnosed about a decade ago with Parkinson’s.
Since starting the therapy, he’s been able to resume his work on cars, a hobby he’d had to abandon: “That’s a real trick with Parkinson’s, to line up wires and solder,” he said. “I can do it now.”
As a person with a movement disorder, Lindstrom is typical among people receiving deep brain stimulation.
But as researchers investigate the technique’s effectiveness for a range of disorders, the therapy may soon reach new categories of patients.
“We grew up watching these science fiction movies – people becoming the Borg or the Matrix,” Carlson said. “We’re instrumenting the brain. We’re sticking electricity into the brain and changing how the brain works. It’s really pretty cool.”
Along with depression, OCD and epilepsy, researchers throughout the U.S. are recruiting participants for studies on deep brain stimulation to treat a variety of ailments, including urinary tract infections, opiate addiction, alcohol addiction, schizophrenia, anorexia nervosa and Tourette’s syndrome.
The prospects of using the therapy to treat depression and Alzheimer’s, in particular, have generated buzz in the medical community.
But researchers have found a placebo effect – and the fact that patients received mental health therapy – responsible for improvements in patients with depression who received deep brain stimulation, Carlson said.
He said he’s cautiously hopeful, though, that it could help treat dementia or slow the progression of disease in people with Alzheimer’s.
“We really won’t know for another five years if it helps for Alzheimer’s,” Carlson said. “If it does, it’s going to be a really big deal.”
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