Deep Brain Stimulation (DBS), an exciting treatment option for people with Parkinson's Disease, Essential Tremor and Dystonia.
We are the only center in Ventura County, and one of the few in Southern California to offer this treatment.
While the selection process is thorough, we encourage anyone with one of these conditions to come in and discuss this option. Boiled down, when taking more pills is not the answer, come in and learn more. We expect to improve a patient's symptoms while at the same cutting meds in half--and sometimes more!
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Deep Brain Stimulation (DBS), an Exciting Treatment Option for People with Parkinson's Disease, Essential Tremor and Dystonia
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Dr. Hiner received his M.D. cum laude from the Ohio State University College of Medicine in 1982, having completed the usual 4 years in 3 years in an accelerated scholars program. He was inducted into the medical honor society, Alpha Omega Alpha by his second year. He completed Neurology training at Stanford University, chosen Administrative Chief Resident by the faculty his senior year. After a year of basic neurosciences fellowship he embarked on a career in clinical medicine and research, establishing one of the largest programs for Parkinson’s disease and other Movement disorders first at the Marshfield Clinic and then at the Medical College of Wisconsin. As full professor he developed one of the largest and most active programs specializing in advanced treatments including Deep Brain Stimulation (DBS), where he served as Neurologic Director. He has over 40 research publications in the field, and has participated in over 800 DBS surgeries performing intraoperative microelectrode recording (for precise targeting) and post-op DBS programming.
Dr. Hiner and his wife are proud grandparents of 4 wonderful girls, and relocated to Southern California to stay close to family. At the same time, he is excited to be in clinical practice with Link Neurosciences, developing a Parkinson’s disease and Movement Disorders program offering the most advanced care including DBS for these conditions. When not practicing medicine, Dr. Hiner enjoys golf and playing classical guitar.
Learn more about Bradley Hiner, MD
Bradley Hiner, MD
Transcription:
Deep Brain Stimulation (DBS), an Exciting Treatment Option for People with Parkinson's Disease, Essential Tremor and Dystonia
Cheryl Martin: There is an exciting treatment option for people diagnosed with Parkinson's disease, essential tremor and dystonia. Coming up, we explore deep brain stimulation or DBS with one of the nation's top experts.
This is Hello Healthy, a Dignity Health Podcast. I'm Cheryl Martin. With me this episode is Dr. Bradley Hiner, a neurologist and the Neurologic Director of the Deep Brain Stimulation Program at Dignity Health's Ventura Neuroscience Center and St. John's Hospital in Oxnard, California. Dr. Hiner, thanks for being on.
Dr. Bradley Hiner: My pleasure. Thanks for having me.
Cheryl Martin: I understand you developed one of the largest and most active programs specializing in DBS. So, what is deep brain stimulation?
Dr. Bradley Hiner: Cheryl, deep brain stimulation is a wonderful new addition to our treatment armamentarium, so to speak, in the management of disorders like Parkinson's disease, essential tremor, and dystonia. These are all movement disorders, and that is my area of expertise. Deep brain stimulation is a great option for those folks where really taking more pills is just not the answer. Unfortunately, these conditions oftentimes don't respond as well as we would like them to to medications. And having this as a treatment option has opened a whole new window for these folks. It gives them a new lease on life, and we're excited to be able to offer it here at St. John's Regional Medical Center in Oxnard.
Cheryl Martin: It sounds exciting. So how does it work?
Dr. Bradley Hiner: Deep brain stimulation in a nutshell is like a pacemaker for the brain. People are well aware of pacemakers for the heart. Well, in this case, it's actually a very similar type of battery. Everything's under the scan. You can't see it. The battery is about the size of a pack of matches. And then, the underneath the scan is a wire or we call it the lead, which then is placed directly into the spot on the brain that's causing the problem for each of those conditions. And we know exactly where to find that target, that spot with highly refined techniques, including something I do in the operating room called microelectrode recording, where we can identify the borders of this target within less than a millimeter, really, of accuracy. And once we place this lead or electrode, and bear in mind it's about the thickness of a strand of spaghetti, so we're not in there digging around with a shovel. It's very fine tuned. And once we get that lead placed in the sweet spot, so to speak, and we activate the battery, the improvement is just remarkable. And I've seen so many cases. Actually, I've done probably around 800 plus cases over the past 20 years now. So this is a technology which has tried and true. It's been tested. It's not experimental. And in the right people, it works.
Cheryl Martin: Speaking of the right people, is there an ideal patient for DBS?
Dr. Bradley Hiner: There are criteria that we use to identify who is going to benefit and who would not, because we certainly don't want to be doing this type of procedure on a patient where we can't feel confident that it's going to really make a difference. So, I do the intake. I do the evaluation. I make sure about the diagnosis. One of the things that falls in my lap is to make sure, is this the right person for this procedure? And when I feel like I've gone through my personal process, and if I tell a patient and their family that's so important that I think this procedure is going to make a big difference in their lives, I can feel confident that at the end of the day, they're going to be really happy with the results.
Cheryl Martin: Are you able to share some of the things you're looking for?
Dr. Bradley Hiner: Well, the things that we look for, the criteria to assign patients to this procedure are dependent upon which of those three diagnoses. So for Parkinson's disease, it's one set of criteria for essential tremor and dystonia, different because they're different conditions. But let's talk about Parkinson's, Parkinson's being the most common population that this procedure helps. And we want to see a person who's of sound mind and sound body. And bear in mind, there is no age discrimination here. The oldest patient that I've personally done was 86 years old, but he was a very good 86. And so, you know, we want to make sure that the patient's in good physical and mental health, we don't do this procedure if a patient has dementia, which does occur in some patients with Parkinson's, certainly not all and certainly not most Parkinson's patients, but we want to check a patient cognitively and we have some testing that we may do and there are some other things.
We want to make sure in Parkinson's, in any case, that they are at some point in their course or their career with their Parkinson's, that they are responsive to levodopa. And once we've determined that indeed they are levodopa-responsive, and it may only be for a half hour or an hour where they get a good response, but we want to see them change from not doing well to doing well with a dose of levodopa, even if it's just for a short period.
Levodopa responsiveness is very important and I assess that personally. If a patient is not levodopa-responsive, then it makes me wonder, "Well, maybe this patient doesn't have Parkinson's disease, but maybe it's one of the Parkinson's mimics," and there are a number of those and I've seen so many patients over the years that I can make that determination really within a one-hour visit with me. I'm usually able to say at least, on a preliminary basis that, "This is a procedure that's going to help you," or "I'm sorry, but this is not the right procedure for you."
Cheryl Martin: Now, you mentioned something I'm not familiar with when you said they need to be something responsive. Can you just explain what that is?
Dr. Bradley Hiner: Sure. This is specific for Parkinson's, mind you, not the other conditions, essential tremors or dystonia, but specifically for Parkinson's. Parkinson's disease, the symptoms of Parkinson's disease are the result of a loss of a chemical called dopamine in the brain. And we still don't know why a person loses their dopamine. It's not usually a genetic condition, mind you. It may run in families, but that's rare. Usually, Parkinson's happens, at this point, we don't know what the causation is. Is it something in the environment? We just don't know. But in any case, we know what happens, which is the brain is not making enough dopamine.
So the way that we help them make dopamine is with a medication called levodopa. And there are others, but levodopa is the main one. And we want to see that they have a response at some point to a dose of levodopa. And I take care of that. Patients don't have to worry about, you know, what's the right thing as far as levodopa responsiveness. So, that's my job.
Cheryl Martin: Okay. So how does DBS affect the long-term management of neurological disorders?
Dr. Bradley Hiner: Well, that's really where the remarkable news happens. DBS basically pushes a person's Parkinson's back five to 10 years. You know, we expect to be able to cut their medications on average in half. So, they don't need 50% of what they're taking, which is a godsend for a lot of folks to not have to take so many pills.
And there is more recent research that suggests that deep brain stimulation may actually slow the progression of Parkinson's disease. So, what a wonderful thing. We're able to help your symptoms right away. And I mean, I see it in the operating room almost as soon as we turn the DBS on. So, they get symptom improvement, but there is a suggestion that it may actually improve the long-term course and prognosis of the disease.
Cheryl Martin: That's wonderful. So how can a patient explore this breakthrough treatment further, Dr. Hiner?
Dr. Bradley Hiner: I recommend that they ask their personal physicians about obtaining a consultation or referral to me. I don't require, however, a physician referral. It's nice to have, it's good to have past medical records. But honestly, they can see me directly. Just make a phone call to my office at 805-988-2775. That's 805-988-2775, and I will see a patient even if they don't have a doctor's referral.
Cheryl Martin: Anything else you want to add on this breakthrough treatment? I love how you described it, the pacemaker for the brain.
Dr. Bradley Hiner: Yes. You know, there have been a couple of breakthroughs in the world of Parkinson's disease. The first was actually the advent and the introduction of levodopa, the medication I just discussed. That occurred in 1968 or '69, and it's been a mainstay of therapy. The second revolution of deep brain stimulation occurred in the late 1990s. It was approved for essential tremor in 1998 and for Parkinson's in 2001. So it's been around, it's been tried and true. It's a wonderful option for many patients. Quite simply, when more pills is not the answer, come see me.
Cheryl Martin: Dr. Bradley Hiner, thanks so much for sharing with us about this breakthrough treatment, DBS.
Dr. Bradley Hiner: It's my pleasure.
Cheryl Martin: Once again, you can call Dr. Hiner for a DBS consultation at 805-988-2775 or go to dignityhealth.org/phc. That's dignityhealth.org/phc and click on Ventura Neuroscience. If you found this podcast helpful, please share it with others. And thanks for listening to this episode of Hello Healthy, a Dignity Health podcast.
Deep Brain Stimulation (DBS), an Exciting Treatment Option for People with Parkinson's Disease, Essential Tremor and Dystonia
Cheryl Martin: There is an exciting treatment option for people diagnosed with Parkinson's disease, essential tremor and dystonia. Coming up, we explore deep brain stimulation or DBS with one of the nation's top experts.
This is Hello Healthy, a Dignity Health Podcast. I'm Cheryl Martin. With me this episode is Dr. Bradley Hiner, a neurologist and the Neurologic Director of the Deep Brain Stimulation Program at Dignity Health's Ventura Neuroscience Center and St. John's Hospital in Oxnard, California. Dr. Hiner, thanks for being on.
Dr. Bradley Hiner: My pleasure. Thanks for having me.
Cheryl Martin: I understand you developed one of the largest and most active programs specializing in DBS. So, what is deep brain stimulation?
Dr. Bradley Hiner: Cheryl, deep brain stimulation is a wonderful new addition to our treatment armamentarium, so to speak, in the management of disorders like Parkinson's disease, essential tremor, and dystonia. These are all movement disorders, and that is my area of expertise. Deep brain stimulation is a great option for those folks where really taking more pills is just not the answer. Unfortunately, these conditions oftentimes don't respond as well as we would like them to to medications. And having this as a treatment option has opened a whole new window for these folks. It gives them a new lease on life, and we're excited to be able to offer it here at St. John's Regional Medical Center in Oxnard.
Cheryl Martin: It sounds exciting. So how does it work?
Dr. Bradley Hiner: Deep brain stimulation in a nutshell is like a pacemaker for the brain. People are well aware of pacemakers for the heart. Well, in this case, it's actually a very similar type of battery. Everything's under the scan. You can't see it. The battery is about the size of a pack of matches. And then, the underneath the scan is a wire or we call it the lead, which then is placed directly into the spot on the brain that's causing the problem for each of those conditions. And we know exactly where to find that target, that spot with highly refined techniques, including something I do in the operating room called microelectrode recording, where we can identify the borders of this target within less than a millimeter, really, of accuracy. And once we place this lead or electrode, and bear in mind it's about the thickness of a strand of spaghetti, so we're not in there digging around with a shovel. It's very fine tuned. And once we get that lead placed in the sweet spot, so to speak, and we activate the battery, the improvement is just remarkable. And I've seen so many cases. Actually, I've done probably around 800 plus cases over the past 20 years now. So this is a technology which has tried and true. It's been tested. It's not experimental. And in the right people, it works.
Cheryl Martin: Speaking of the right people, is there an ideal patient for DBS?
Dr. Bradley Hiner: There are criteria that we use to identify who is going to benefit and who would not, because we certainly don't want to be doing this type of procedure on a patient where we can't feel confident that it's going to really make a difference. So, I do the intake. I do the evaluation. I make sure about the diagnosis. One of the things that falls in my lap is to make sure, is this the right person for this procedure? And when I feel like I've gone through my personal process, and if I tell a patient and their family that's so important that I think this procedure is going to make a big difference in their lives, I can feel confident that at the end of the day, they're going to be really happy with the results.
Cheryl Martin: Are you able to share some of the things you're looking for?
Dr. Bradley Hiner: Well, the things that we look for, the criteria to assign patients to this procedure are dependent upon which of those three diagnoses. So for Parkinson's disease, it's one set of criteria for essential tremor and dystonia, different because they're different conditions. But let's talk about Parkinson's, Parkinson's being the most common population that this procedure helps. And we want to see a person who's of sound mind and sound body. And bear in mind, there is no age discrimination here. The oldest patient that I've personally done was 86 years old, but he was a very good 86. And so, you know, we want to make sure that the patient's in good physical and mental health, we don't do this procedure if a patient has dementia, which does occur in some patients with Parkinson's, certainly not all and certainly not most Parkinson's patients, but we want to check a patient cognitively and we have some testing that we may do and there are some other things.
We want to make sure in Parkinson's, in any case, that they are at some point in their course or their career with their Parkinson's, that they are responsive to levodopa. And once we've determined that indeed they are levodopa-responsive, and it may only be for a half hour or an hour where they get a good response, but we want to see them change from not doing well to doing well with a dose of levodopa, even if it's just for a short period.
Levodopa responsiveness is very important and I assess that personally. If a patient is not levodopa-responsive, then it makes me wonder, "Well, maybe this patient doesn't have Parkinson's disease, but maybe it's one of the Parkinson's mimics," and there are a number of those and I've seen so many patients over the years that I can make that determination really within a one-hour visit with me. I'm usually able to say at least, on a preliminary basis that, "This is a procedure that's going to help you," or "I'm sorry, but this is not the right procedure for you."
Cheryl Martin: Now, you mentioned something I'm not familiar with when you said they need to be something responsive. Can you just explain what that is?
Dr. Bradley Hiner: Sure. This is specific for Parkinson's, mind you, not the other conditions, essential tremors or dystonia, but specifically for Parkinson's. Parkinson's disease, the symptoms of Parkinson's disease are the result of a loss of a chemical called dopamine in the brain. And we still don't know why a person loses their dopamine. It's not usually a genetic condition, mind you. It may run in families, but that's rare. Usually, Parkinson's happens, at this point, we don't know what the causation is. Is it something in the environment? We just don't know. But in any case, we know what happens, which is the brain is not making enough dopamine.
So the way that we help them make dopamine is with a medication called levodopa. And there are others, but levodopa is the main one. And we want to see that they have a response at some point to a dose of levodopa. And I take care of that. Patients don't have to worry about, you know, what's the right thing as far as levodopa responsiveness. So, that's my job.
Cheryl Martin: Okay. So how does DBS affect the long-term management of neurological disorders?
Dr. Bradley Hiner: Well, that's really where the remarkable news happens. DBS basically pushes a person's Parkinson's back five to 10 years. You know, we expect to be able to cut their medications on average in half. So, they don't need 50% of what they're taking, which is a godsend for a lot of folks to not have to take so many pills.
And there is more recent research that suggests that deep brain stimulation may actually slow the progression of Parkinson's disease. So, what a wonderful thing. We're able to help your symptoms right away. And I mean, I see it in the operating room almost as soon as we turn the DBS on. So, they get symptom improvement, but there is a suggestion that it may actually improve the long-term course and prognosis of the disease.
Cheryl Martin: That's wonderful. So how can a patient explore this breakthrough treatment further, Dr. Hiner?
Dr. Bradley Hiner: I recommend that they ask their personal physicians about obtaining a consultation or referral to me. I don't require, however, a physician referral. It's nice to have, it's good to have past medical records. But honestly, they can see me directly. Just make a phone call to my office at 805-988-2775. That's 805-988-2775, and I will see a patient even if they don't have a doctor's referral.
Cheryl Martin: Anything else you want to add on this breakthrough treatment? I love how you described it, the pacemaker for the brain.
Dr. Bradley Hiner: Yes. You know, there have been a couple of breakthroughs in the world of Parkinson's disease. The first was actually the advent and the introduction of levodopa, the medication I just discussed. That occurred in 1968 or '69, and it's been a mainstay of therapy. The second revolution of deep brain stimulation occurred in the late 1990s. It was approved for essential tremor in 1998 and for Parkinson's in 2001. So it's been around, it's been tried and true. It's a wonderful option for many patients. Quite simply, when more pills is not the answer, come see me.
Cheryl Martin: Dr. Bradley Hiner, thanks so much for sharing with us about this breakthrough treatment, DBS.
Dr. Bradley Hiner: It's my pleasure.
Cheryl Martin: Once again, you can call Dr. Hiner for a DBS consultation at 805-988-2775 or go to dignityhealth.org/phc. That's dignityhealth.org/phc and click on Ventura Neuroscience. If you found this podcast helpful, please share it with others. And thanks for listening to this episode of Hello Healthy, a Dignity Health podcast.