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Procedure can help control systems for Parkinsons, other patients
Dr. Darlene Lobel, a neurosurgeon with the Northeast Georgia Physicians Group at Medical Park 1, explains the benefits of a brain-stimulation procedure for patients with neurological disorders. - photo by SARA GUEVARA
Dr. Darlene Lobel recalled one patient from a former practice who loved to fish but had long given up the pasttime after years of Parkinson’s disease had taken their toll.

“He couldn’t control the pole,” she said.

But after undergoing a procedure known as deep brain stimulation, the patient was able to pick up the rod and reel again. Three months later, he told Lobel, “I caught you a fish,” the Gainesville neurosurgeon said, smiling.

“It can really change a patient’s life,” she said. “And we can see an immediate benefit, which is really nice.”

Parkinson’s patients who no longer get relief from medicine or people who suffer from essential tremors — a neurological disorder that involves trembling, usually of the hands and affecting elderly people — can benefit from the brain surgery.

To prepare for the procedure, patients undergo magnetic resonance imaging that helps doctors create a lightweight, synthetic frame that is placed over the patient’s head and “shows us exactly where we’re going to drill the holes on top of the head,” Lobel said.

The procedure involves implanting a thin wire, a brain stimulator lead, “through a very small hole in the skull, about the size of a dime,” she said. “It depends on the type of condition as to where we place this in the brain.”

Once the lead is properly placed, the other end of the stimulator is “hooked to an electric current,” Lobel said. “We turn the current on and the (patient’s) tremor will stop, which is just amazing, so they really get to see the benefit right away.”

Right away doesn’t mean when the patient wakes up in a recovery room.

“We do these surgeries while they’re awake, which is a great thing,” Lobel said. “It’s great because they get to see the benefit immediately.”

The procedure can take three to six hours, depending on whether one or two leads are placed in the brain.

“They stay in the hospital overnight, they go home and they come back two weeks later and they have a controller placed for the (stimulator),” Lobel said. “This goes underneath the collarbone. It kind of works like a pacemaker of the brain.

“In a Parkinson’s patient, their cells aren’t firing at a normal rate. This device sends electrical impulses through (the stimulator) so that the cells fire at a normal rate, and that’s what controls the tremor.”

The controller, or pulse generator, is connected to one end of the lead while the other end of the lead is implanted in the brain.

The procedure is recommended for patients before they get to the end stage of the disease, said Dr. John Gorecki, a neurologist who, along with Lobel, is part of the Northeast Georgia Physicians Group at Medical Park 1 off Jesse Jewell Parkway.

“Medications work for about a five-year period in these patients and then they require higher and higher doses,” Lobel said. “The problem with that ... is the medications don’t work as well for as long a period of time, so they wind up taking medicines every two to three hours.

“The other problem is they have side effects from these high doses. They get these abnormal movements. ... You may have seen (actor) Michael J. Fox writhing around in a chair.”

A patient who has had deep brain stimulation “has control of their symptoms for a large portion of the day,” Lobel said. “Their tremors are controlled, they’re not as stiff, they’re able to do their usual activities, such as cooking, cleaning, even dressing themselves.

“And some patients can even go back to hobbies that they really loved but weren’t able to do.”

Lobel recalled one patient who illustrated children’s books and had to give up her drawing.

After the procedure, she finished a book she had been working on. She also drew a picture for Lobel and sent it to her.

“The joy (patients) have is absolutely amazing,” Lobel said. “It gives them a new lease on life, and it’s really wonderful.”

Doctors began using the procedure in 1998 to treat tremors and 2002 for Parkinson’s patients.

“One of the great things about this technology is it can be used for so many different things,” Lobel said.

“There are clinical trials going on to treat depression and obsessive-compulsive disorder. ... There are even trials for obesity and Alzheimer’s disease, which is really exciting.”

Epilepsy will be approved soon for the procedure, Gorecki said.

“It’s a matter of where you place the lead deep inside the brain,” Lobel said.

“So, if we can find a way to either help a malfunctioning pathway function better or interrupt a pathological pathway in the brain with that stimulator, we can treat a number of diseases.”
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