With the latest advancements in technology and skilled doctors, movement disorders such as Parkinson's Disease and Essential Tremor can be treated with Deep Brain Stimulation.
Dr. Benjamin Gelber explains Deep Brain Stimulation and how this treatment can benefit patients with the various forms of tremors.
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How to Stop the Shakes: Help for Parkinson's & Essential Tremor
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Learn more about Benjamin Gelber, MD
Benjamin Gelber, MD, Neurological and Spinal Surgery
Dr. Benjamin Gelber is a neurosurgeon with Neurological and Spinal Surgery.Learn more about Benjamin Gelber, MD
Transcription:
How to Stop the Shakes: Help for Parkinson's & Essential Tremor
Melanie Cole (Host): If you suffer from tremors, and you’ve not seen positive effects from medication, a procedure called deep brain stimulation might just be for you. My guest is Dr. Benjamin Gelber. He’s a neurosurgeon with Neurological and Spine Surgery. Dr. Gelber, first let’s start with a little bit of a lesson on movement disorders. What are they and how are they classified?
Dr. Benjamin Gelber (Guest): Sure, we see in our neurosurgical practice, two common movement disorders, and then a third movement disorder, which is less common. The two common ones are Parkinson’s disease and what’s called benign essential tremor. Parkinson’s disease, many people are familiar with. It involves tremor, slowness of movement, poor expression of the face, difficulty walking, it’s progressive, usually occurs in people who are middle aged and older and can be treated medically with a dopamine like drug. Essential tremor does not have any of those findings of Parkinson’s disease, but instead is limited to tremor, which often begins in the arms, sometimes it occurs in the legs, sometimes it occurs in the head and neck, and sometimes in the voice. It’s often hereditary, but it’s not always hereditary. The less common one is called dystonia, which is more complicated to explain, but it has to do with poor relaxation and coordination of the muscle. It can be treated with deep brain stimulation which involves implanting electrodes into the brain and hooking them up to a device similar to a cardiac pacemaker.
Host: Tell us how these tremors affect a person’s quality of life.
Dr. Gelber: If someone has tremor, they may not be able to write, which of course means they can’t sign checks. They may not be able to drink out of a cup. So that when they try to drink coffee out of a cup they’ll spill it on themselves. This makes it difficult for them to go out to a restaurant to eat. The tremor, if it affects their speech, can make them sound very strange, and if it affects their head, people will wonder what are they nodding at, so it can be very disruptive.
Host: Dr. Gelber, how are movement disorders treated? Speak about a treatment called deep brain stimulation. Is this a new treatment? Is it dangerous? Tell us a little bit about it.
Dr. Gelber: Deep brain stimulation goes back about 15 years and so it’s not really new. It was approved by the FDA for Parkinson’s disease and for essential tremor. It’s also approved for use in dystonia under certain circumstances. It also is for Turret syndrome under certain circumstances, but the most common use for it is either essential tremor or Parkinson’s disease. It is done by first getting imaging of the brain, usually both CAT scan and MRI scan and then the patient is taken to surgery. We make a small hole in the skull, and then using our computerized image guide, we place an electrode down into the brain, deep into the brain into a small target in the structure of the brain called the thalamus. Then we attach a thing that looks like a TV remote to the electrode, place an electric current through the electrode, and look for the tremor to disappear. If it does, then we know that we hit the right target. If it does not, then we have the capability of moving it up or down or to the side until we reach the correct target. Finally after we’ve placed the electrode in the correct target, we place the wire under the skin and then down in front of the chest and attach it to a battery, which we call a pulse generator and place that into a pocket under the skin, very similar to the procedure used for cardiac pacemaker. Then usually within a month or so, a patient will return to the office where we will turn the system on where we will adjust the various parameters in order to give the best suppression of the tremor. Some of the other things that we see in Parkinson’s disease like stiffness and paucity of movement, et cetera can also be relieved by picking out the correct target in the brain.
Host: How long does the treatment last and who is it most effective for, Dr. Gelber?
Dr. Gelber: Well in Parkinson’s disease, it’s most effective in people who’ve had a good response to the Parkinson’s drug. So one of the utilities of the deep brain stimulation is it often can permit Parkinson’s patients to decrease their drug dose by about half, thereby decreasing the side effects that can occur from the drug and prolonging the amounts of time that the drugs are useful.
Host: Tell us about the DBS device programming itself, how does that work and what about the battery life? How long does that work for?
Dr. Gelber: The battery for the deep brain stimulator on the average lasts about five years. If the patient turns it off at night, then we would expect a five year lifespan. Some patients leave it on at night, and therefore the lifespan on the average is about half, or two and half years. One of the parameters that we can program is the strength or voltage, and if we have to program to a high voltage, then the battery doesn’t last as long as if we can program to a low voltage. That’s dependent on the anatomy of the patient. There’s a also a rechargeable battery that can be placed, and that needs to be recharged every ten days, which is done by just placing a magnetic type device over the battery. We don’t have to open the skin or anything, it’s all done externally and that device should last about nine years. The programming is done using a device that for one of the two companies that makes this model look like an iPhone and the other one looks like an iPad and the programming is done on the device. In addition, the patients have a smaller device that they can use at home to turn the deep brain stimulator system on or off and make some minor adjustments themselves.
Host: What is life like post-surgery for the patient?
Dr. Gelber: The majority of the patients on whom we’ve done this have been very pleased. For example, I had one patient with essential tremor who was an accountant. He couldn’t work because he couldn’t write. Once we got his deep brain stimulator setup and working for him, he was able to return to work without any difficulty. People have been very pleased with it for the most part.
Host: So can this be used on other conditions where tremor might be an issue and speak about some of the promising new therapies that you see on the horizon, Dr. Gelber, in regards to tremor.
Dr. Gelber: We have seen three patients with tremor related to multiple sclerosis. Although the device has not been approved by the FDA specifically for multiple sclerosis, we have placed it into three patients and all three have done very well. It was life changing for all of them. One patient was confined to a wheelchair because of tremor and now she’s much more independent. Another patient, when we put he device in, turned it on and her tremor fell away. She exclaimed, that’s amazing!
Host: That’s certainly what you want to hear with your patients. So wrap it up for us, Dr. Gelber, what do you feel is important for listeners to understand about deep brain simulation and even the surgeon specialist experience. So the surgeon’s learning curve, and what you would like them to know about your expertise in this area.
Dr. Gelber: We’ve been doing deep brain stimulation here for about 11 years. We started in 2007 and the procedure itself is really not all that difficult, especially with our technology. In order to get optimum results it’s nice to have a multidisciplinary team. We have access to a movement disorder neurologist and we have one of our nurses who’s specially trained in programming and of course I have training in programming and in the actually technique of placing the device. Also in our practice, as I said, we have about 11 years of experience. I think for best results, it’s good to go to a place that has all these things in place so the patient gets the best possible evaluation.
Host: And now just wrap it up for us, your best advice about if someone does suffer from Parkinson’s or essential tremor, what you would like them to know about seeking help for their tremors.
Dr. Gelber: It used to be taught that the deep brain stimulation system was considered until everything else has failed and the patient, especially Parkinson’s patients, are late in the course of their disease. That’s been changed. Now it actually makes sense, especially in Parkinson’s disease, to consider deep brain stimulation in people who are fairly early in the course of their disease if their tremor is disabling enough because it can decrease the dose of the medication that they need and prolong the amount of time that the medication can be effective. So I would urge anybody who is suffering from these problems to obtain a consultation from a neurosurgeon or a neurosurgery department where deep brain stimulation is done and just see what the people on the team think.
Host: It’s great information, thank you so much Dr. Gelber, for joining us today, and a special thank you to our podcast partner, Inpatient Physician Associates. This is Bryan Health Podcast, and for more information, please visit bryanhealth.org. I’m Melanie Cole, thanks so much for listening.
How to Stop the Shakes: Help for Parkinson's & Essential Tremor
Melanie Cole (Host): If you suffer from tremors, and you’ve not seen positive effects from medication, a procedure called deep brain stimulation might just be for you. My guest is Dr. Benjamin Gelber. He’s a neurosurgeon with Neurological and Spine Surgery. Dr. Gelber, first let’s start with a little bit of a lesson on movement disorders. What are they and how are they classified?
Dr. Benjamin Gelber (Guest): Sure, we see in our neurosurgical practice, two common movement disorders, and then a third movement disorder, which is less common. The two common ones are Parkinson’s disease and what’s called benign essential tremor. Parkinson’s disease, many people are familiar with. It involves tremor, slowness of movement, poor expression of the face, difficulty walking, it’s progressive, usually occurs in people who are middle aged and older and can be treated medically with a dopamine like drug. Essential tremor does not have any of those findings of Parkinson’s disease, but instead is limited to tremor, which often begins in the arms, sometimes it occurs in the legs, sometimes it occurs in the head and neck, and sometimes in the voice. It’s often hereditary, but it’s not always hereditary. The less common one is called dystonia, which is more complicated to explain, but it has to do with poor relaxation and coordination of the muscle. It can be treated with deep brain stimulation which involves implanting electrodes into the brain and hooking them up to a device similar to a cardiac pacemaker.
Host: Tell us how these tremors affect a person’s quality of life.
Dr. Gelber: If someone has tremor, they may not be able to write, which of course means they can’t sign checks. They may not be able to drink out of a cup. So that when they try to drink coffee out of a cup they’ll spill it on themselves. This makes it difficult for them to go out to a restaurant to eat. The tremor, if it affects their speech, can make them sound very strange, and if it affects their head, people will wonder what are they nodding at, so it can be very disruptive.
Host: Dr. Gelber, how are movement disorders treated? Speak about a treatment called deep brain stimulation. Is this a new treatment? Is it dangerous? Tell us a little bit about it.
Dr. Gelber: Deep brain stimulation goes back about 15 years and so it’s not really new. It was approved by the FDA for Parkinson’s disease and for essential tremor. It’s also approved for use in dystonia under certain circumstances. It also is for Turret syndrome under certain circumstances, but the most common use for it is either essential tremor or Parkinson’s disease. It is done by first getting imaging of the brain, usually both CAT scan and MRI scan and then the patient is taken to surgery. We make a small hole in the skull, and then using our computerized image guide, we place an electrode down into the brain, deep into the brain into a small target in the structure of the brain called the thalamus. Then we attach a thing that looks like a TV remote to the electrode, place an electric current through the electrode, and look for the tremor to disappear. If it does, then we know that we hit the right target. If it does not, then we have the capability of moving it up or down or to the side until we reach the correct target. Finally after we’ve placed the electrode in the correct target, we place the wire under the skin and then down in front of the chest and attach it to a battery, which we call a pulse generator and place that into a pocket under the skin, very similar to the procedure used for cardiac pacemaker. Then usually within a month or so, a patient will return to the office where we will turn the system on where we will adjust the various parameters in order to give the best suppression of the tremor. Some of the other things that we see in Parkinson’s disease like stiffness and paucity of movement, et cetera can also be relieved by picking out the correct target in the brain.
Host: How long does the treatment last and who is it most effective for, Dr. Gelber?
Dr. Gelber: Well in Parkinson’s disease, it’s most effective in people who’ve had a good response to the Parkinson’s drug. So one of the utilities of the deep brain stimulation is it often can permit Parkinson’s patients to decrease their drug dose by about half, thereby decreasing the side effects that can occur from the drug and prolonging the amounts of time that the drugs are useful.
Host: Tell us about the DBS device programming itself, how does that work and what about the battery life? How long does that work for?
Dr. Gelber: The battery for the deep brain stimulator on the average lasts about five years. If the patient turns it off at night, then we would expect a five year lifespan. Some patients leave it on at night, and therefore the lifespan on the average is about half, or two and half years. One of the parameters that we can program is the strength or voltage, and if we have to program to a high voltage, then the battery doesn’t last as long as if we can program to a low voltage. That’s dependent on the anatomy of the patient. There’s a also a rechargeable battery that can be placed, and that needs to be recharged every ten days, which is done by just placing a magnetic type device over the battery. We don’t have to open the skin or anything, it’s all done externally and that device should last about nine years. The programming is done using a device that for one of the two companies that makes this model look like an iPhone and the other one looks like an iPad and the programming is done on the device. In addition, the patients have a smaller device that they can use at home to turn the deep brain stimulator system on or off and make some minor adjustments themselves.
Host: What is life like post-surgery for the patient?
Dr. Gelber: The majority of the patients on whom we’ve done this have been very pleased. For example, I had one patient with essential tremor who was an accountant. He couldn’t work because he couldn’t write. Once we got his deep brain stimulator setup and working for him, he was able to return to work without any difficulty. People have been very pleased with it for the most part.
Host: So can this be used on other conditions where tremor might be an issue and speak about some of the promising new therapies that you see on the horizon, Dr. Gelber, in regards to tremor.
Dr. Gelber: We have seen three patients with tremor related to multiple sclerosis. Although the device has not been approved by the FDA specifically for multiple sclerosis, we have placed it into three patients and all three have done very well. It was life changing for all of them. One patient was confined to a wheelchair because of tremor and now she’s much more independent. Another patient, when we put he device in, turned it on and her tremor fell away. She exclaimed, that’s amazing!
Host: That’s certainly what you want to hear with your patients. So wrap it up for us, Dr. Gelber, what do you feel is important for listeners to understand about deep brain simulation and even the surgeon specialist experience. So the surgeon’s learning curve, and what you would like them to know about your expertise in this area.
Dr. Gelber: We’ve been doing deep brain stimulation here for about 11 years. We started in 2007 and the procedure itself is really not all that difficult, especially with our technology. In order to get optimum results it’s nice to have a multidisciplinary team. We have access to a movement disorder neurologist and we have one of our nurses who’s specially trained in programming and of course I have training in programming and in the actually technique of placing the device. Also in our practice, as I said, we have about 11 years of experience. I think for best results, it’s good to go to a place that has all these things in place so the patient gets the best possible evaluation.
Host: And now just wrap it up for us, your best advice about if someone does suffer from Parkinson’s or essential tremor, what you would like them to know about seeking help for their tremors.
Dr. Gelber: It used to be taught that the deep brain stimulation system was considered until everything else has failed and the patient, especially Parkinson’s patients, are late in the course of their disease. That’s been changed. Now it actually makes sense, especially in Parkinson’s disease, to consider deep brain stimulation in people who are fairly early in the course of their disease if their tremor is disabling enough because it can decrease the dose of the medication that they need and prolong the amount of time that the medication can be effective. So I would urge anybody who is suffering from these problems to obtain a consultation from a neurosurgeon or a neurosurgery department where deep brain stimulation is done and just see what the people on the team think.
Host: It’s great information, thank you so much Dr. Gelber, for joining us today, and a special thank you to our podcast partner, Inpatient Physician Associates. This is Bryan Health Podcast, and for more information, please visit bryanhealth.org. I’m Melanie Cole, thanks so much for listening.