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Hospital offers surgery to help ease symptoms of Parkinson's disease
Patients now have hope for better life
Michael J. Fox attends A Funny Thing Happened On The Way To Cure Parkinson’s benefit for The Michael J. Fox Foundation for Parkinson’s Research on Nov. 9, 2013, in New York. His is one of 1 million Americans living with Parkinson's disease.

Who has Parkinson’s Disease?

  • As many as 1 million Americans live with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease.
  • Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year. Several celebrities suffering from Parkinson’s include American actor Michael J. Fox and Scottish actor Billy Connelly, boxer Muhammed Ali, cyclist Davis Phinney, professional athletes Ben Petrick and Brian Grant and college basketball coach Billy Kennedy.
  • Incidence of Parkinson’s increases with age, but an estimated 4 percent of people with the disease are diagnosed before the age of 50. The average age is 55.
  • Men are one and a half times more likely to have Parkinson’s than women.
  • It is rarely inherited.

What does Parkinson’s cost?

  •  The combined direct and indirect cost of Parkinson’s, including treatment, Social Security payments and lost income from inability to work, is estimated to be nearly $25 billion per year in the United States alone.
  • Medication costs for an individual person with PD average $2,500 a year, and therapeutic surgery can cost up to $100,000 dollars per patient.

Symptoms of Parkinson’s

  • The diagnosis of PD depends upon the presence of one or more of the four most common motor symptoms of the disease. In addition, there are other secondary and nonmotor symptoms that affect many people and are increasingly recognized by doctors as important to treating Parkinson’s.
  • Each person with Parkinson’s will experience symptoms differently. For example, many people experience tremor as their primary symptom, while others may not have tremors, but may have problems with balance. Also, for some people the disease progresses quickly, and in others it does not.
  • By definition, Parkinson’s is a progressive disease. Although some people with Parkinson’s only have symptoms on one side of the body for many years, eventually the symptoms begin on the other side. Symptoms on the other side of the body often do not become as severe as symptoms on the initial side.

Source: Parkinson’s Disease Foundation website

For the 1 million Americans living with Parkinson’s disease and especially those who are responding well to medication, more good news is at hand.

Northeast Georgia Medical Center has begun offering Deep Brain Stimulation surgery to help the good days become better.

And Gainesville resident Jaynes Wheeler is the proof.

Wheeler underwent DBS surgery last year and said it has improved his life tremendously. The tremors which constantly shake his body almost have been eliminated.

“As you can see there’s no shaking,” he said, indicating his left hand and arm. “When they turn (the DBS device) off, you will see a remarkable difference on my left side.”

In a brief demonstration, the DBS was turned off, causing Wheeler’s left hand and arm to shake violently. As it was switched on, the tremor was extremely reduced.

And the device has improved his quality of life so much, he is no longer on medication.

Deep Brain Stimulation is designed to help lessen the side effects of Parkinson’s disease in terms of “on” and “off” time and motor symptoms and side effects. Parkinson’s disease is a chronic and progressive movement disorder, meaning symptoms continue and worsen over time, according to the Parkinson’s Disease Foundation website. The cause is unknown, but treatment options include medication and surgery to manage its symptoms.

Deep Brain Stimulation involves a pacemaker device implanted behind the shoulder blade and an electrode implanted in the brain. Both are controlled by an external device and can be programmed to stimulate the correct areas with mild electrical signals. The stimulation helps stop tremor and improves periods of good mobility. DBS can also be used to treat essential tremor, and more than 100,000 patients have been treated with DBS since it became possible.

The device is installed in two procedures, one to put the pacemaker in, and a separate surgery to implant the electrode, which is roughly the size of a pencil lead. Dr. John Gorecki with Northeast Georgia Physicians Group Neurosurgery is one of four neurosurgeons in the metro Atlanta area who perform the DBS procedure.

The surgery is performed without total anesthesia so the patient can communicate and answer Gorecki’s questions as he implants the device. Keeping the patient awake helps the doctor know he has the device in the correct place.

DBS does not cure the disease, but it does ease some of the painful side effects, such as rigidity, tremor, slow movement, extra movement and motor fluctuations.

However, Gorecki and a colleague with Northeast Georgia Physicians Group Neurosurgery emphasized there is an ideal time to consider DBS surgery.

“They need to maximize their medical therapy first,” Dr. Shaena Blevins said. “As long as they’re well-controlled with medication, they don’t need to consider surgery because there are risks involved.”

If a patient responded well to medication but was beginning to progress into a more moderate stage of the disease, DBS might be ideal. But if a case is too severe, DBS will not be helpful.

“Once you reach a stage where dopamine has no effect or you have a cognitive loss, they’re no longer a good candidate for DBS,” Gorecki said.

Some patients who are not good candidates include those who may have some signs of dementia, those being treated or monitored for something that requires MRIs, or those who have severe depression. If a person’s symptoms are controlled with lower doses of medicine, then DBS may not be the best option at the time.

“Your best ‘on’ period is usually as good as it gets,” Blevins said.

Although it does not improve the “on” feeling, DBS does extend the period when that feeling lasts.

“A patient will get roughly five more hours of good mobility per day after programming,” Gorecki said.

Before surgery, Gorecki and Blevins run a number of tests to determine where the electrode should be implanted in the brain, if one or two should be used, and if it will significantly improve the patient’s “on” time. Gorecki explained more than 2,000 studies on DBS have been published, proving its effectiveness.

However, risks still arise with any surgery, especially on the brain. Infection, breakage, hemorrhage and the device protruding through the skin are all possibilities with the surgery. But Gorecki noted he has not seen many throughout his career.

After DBS, programming will take several months to ensure the right electricity in the right places, stimulation threshold and combination with medicine, but patients do see an instant improvement. Patients see their neurologist for programming.

“Programming visits are common through the first six months, and it can reduce medication in some patients,” Blevins said.

Lori McKellar had DBS surgery at Northeast Georgia Medical Center just seven weeks ago and has already returned to work with improvements.

“I had the stiff kind,” she said. “It takes a while to get the right stimulation, but it’s been a blessing to me. I’m a work in progress.”

Both doctors noted DBS does not treat Parkinson’s Plus diseases that show symptoms of Parkinson’s disease but may have a different cause, side effects, treatment, aggression and lower life expectancy.

For more information, discuss DBS with a neurologist or neurosurgeon to see if it is an appropriate option for Parkinson’s treatment.