International Physician Update

Brain Stimulation Lets These Patients Live a Life

Neurosurgeon Fred Lenz with a patient during the procedure.

 Banker John Kellerman thought it odd that his left hand shook as he carried a bag of groceries. His wife, a nurse practitioner, shrugged it off, as the shaking soon stopped. But after the tremor reappeared, she worried. 

And, at 38, Kellerman found himself saddled with Parkinson’s disease, traveling the route of Sinemet and other drugs, then gradual decline as the disease outran their ability to help.

Eight years later, Kellerman had learned to cram his living into dwindling “on” time while enduring “off” ones—periods of rigidity and slowness or inability to move. Worse, his “on” times were increasingly disrupted by drug side effects: The dyskinesias are awful and unpredictable,” says Kellerman, referring to involuntary twisting movements—the last straw in isolating PD patients from society.

Thus, Kellerman became a Hopkins candidate for deep brain stimulation (DBS), a technique the FDA recently approved to diminish Parkinson’s tremor, slowness and gait problems. Frederick Lenz, M.D., Ph.D., veteran of 196 DBS surgeries, says the technique whittles down many patients’ drug needs. “They can function on less. One or two have gone off drugs altogether.”

In DBS surgery, Lenz and his team plot a path to the appropriate spot in patients’ brains to stimulate the subthalamic nucleus. Locating the nucleus is a careful, high-precision process, and the awake patient plays an active role in helping to pinpoint the target. Then, with the patient anesthesized, Lenz inserts and anchors a small electrode connected to a pacemaker-size neurostimulator he implants below the clavicle.

“The stimulation blocks the ability of target basal ganglia to fire,” Lenz explains, “as though they’ve been lesioned.” Once patients recover from surgery, telemetry allows clinicians to finetune stimulation frequency, distribution and voltage.

For Kellerman, who had DBS implanted in his right subthalamic nucleus, followed by the left a year later, dyskinesia greatly diminished while his balance and gait improved significantly. “I was literally on my hands and knees, unable to move. The DBS makes a real difference in my life.”