NEW TREATMENT FOR TREMORS SEEMS TO WORK FOR PARKINSON'S DISEASE PATIENTS

The tremors and rigidity of Parkinson's disease had gotten so bad, Robert R. Roberts said, he just couldn't live with it anymore.

His hands shook constantly, he couldn't control his mouth to talk, his movements had gotten so slow and his limbs so rigid, he couldn't get out of a chair himself.

But a new treatment for Parkinson's that involves deep brain stimulation has given Roberts at least some quality of life back, he said.

Roberts underwent thalamic stimulation therapy, a procedure that involves implanting deep into the brain an electrode at the end of a lead connected to a generator implanted in the chest.

The electronic stimulation this sends to the brain helps suppress the area that Parkinson's causes to be hyperactive, thus reducing tremors caused by the disease, said Dr. Kee B. Park, the neurosurgeon who implanted the device in Roberts' brain.

The deep brain stimulation also helps with the two other main symptoms of Parkinson's, rigidity and slowness of movement.

Roberts has undergone the treatment on the side of his brain that affects his left side. The other side will be done next month. Already, he can see improvement. He can hold a coffee cup now without spilling the contents. He can get out of his chair without help. He can walk better and talk better, he said.

"Patients don't go from Frankenstein to Gene Kelly," Park said. "But they do go from basically frozen to being able to walk again."

And until now, there has been no treatment for those Parkinson's patients who no longer respond to medication, Park said.

"Early Parkinson's is managed with medication, which is tremendously effective," Park said. But over time, patients develop tolerance to the medicine. To get the same effect, they have to increase dosage, which also increases side effects, he said.

Park said deep brain stimulation is for Parkinson's patients experiencing significant side effects from their medications or when the medications no longer provide significant control of symptoms.

The deep brain stimulation does have risks. There is a slight chance that positioning the electrode will cause bleeding in the brain, which could be fatal, Park said. But he said his patients have told him they are willing to risk death rather than face being frozen in their bodies.

"These people are desperate because their body is no longer their own," Park said.

The patient is awake during the implanting of the electrode into the brain.

"We need the patient awake so we know when we're in the right spot," Park said.

Using a CAT scan and a frame placed over the patient's head, doctors calculate where the electrode needs to be placed to reach the subthalamic nucleus, which is about the size of a small pea. While the target is small, Park said, the frame allows him to place the electrode within 1 to 2 millimeters of the target.

Once the electrode is in the brain, the stimulator is turned on to see if the tremors lessen.

"If the tremors stop, that's an indication we are in the right place," Park said.

Once the electrode is placed properly, the patient is put to sleep while the opening in the skull is closed and the generator is implanted.

He said patients still take medications after the procedure, but they are often able to reduce the amount of medication by about 50 percent.

Medicare coverage is now on a case-by-case basis since the procedure has FDA approval for treating essential tremor disorder but not for Parkinson's. Park said the FDA Advisory Panel has recommended the procedure be approved for Parkinson's, so Park expects the FDA to approve the procedure within the next year.

Until FDA approval, Park is still offering the procedure to some of his Parkinson's patients.

Park said the treatment is not a cure for Parkinson's, but it as the most effective treatment for tremors and rigidity he's seen yet. Plus, he said, the procedure is reversible.

"If a better procedure comes along, we can just take out the lead," Park said.

Roberts said he is glad he opted for the treatment and is looking forward to even more improvement when the procedure is done for his right side.

"It's really made a difference," he said.