NWPF

Wellness CenterMarch 2015

Symptom Management: Deep Brain Stimulation

dbs2

A steady exercise routine, a strong support group and a primary-care physician are of utmost importance to Parkinson’s sufferers, but sometimes even that’s not enough.

Deep Brain Stimulation provides another option for those dealing with the disease, and University of Washington-based Dr. Andrew Ko is among the neurosurgeons who are happy to provide the service.

In addition to seven years of neurosurgical training at the UW, Dr. Ko spent an additional two years engaged in research and specialization in surgery for diseases like Parkinson’s. He returned to the UW this June, and he counts Deep Brain Stimulation as among the most personally rewarding.

“These types of procedures,” he said, “you see the effects, you see how you affect people, and that’s very gratifying.”

The concept of deep brain stimulus is nothing new, and the use of electrical stimulation for the treatment of Parkinson’s has been around since the 1950s. However, difficulty in accurately guiding stimulation, and unreliable hardware limited its success.

The modern procedure was first performed in the United States in 1991 and has gradually become fairly common nationally for patients with neurological movement disorders. It’s also been used to treat essential tremor and dystonia, but Deep Brain Stimulation is best known as a remedy for patients with Parkinson’s.

DBS, as it is commonly known, begins with a surgery involving a pacemaker-like device called an implantable pulse generator (IPG), which delivers an electrical current through the areas of the brain that help control movement.  These electrical currents modulate the activity of the brain, stabilizing tremor, and helping control some other Parkinson’s symptoms.

“It’s not a cure,” Ko said. “It doesn’t change the disease progression. It’s purely for symptomatic relief.”

The procedure can help people with Parkinson’s most in terms of tremor, and slowness of moving. It works in tandem with medication to improve motor symptoms in Parkinson’s.

“For certain patients, it’s proven to be better than the best medical management alone, if you’re at a certain point in the disease,” Ko said, adding that this treatment is not appropriate for everyone.

“As rule of thumb, people with Parkinson’s should have symptoms for at least five years before considering something like this,” he said, adding that patients who have side effects of medication or fluctuations in effectiveness are particularly well-suited for the procedure. “It’s a very effective treatment, but there are certain things that don’t get better, and certain people who shouldn’t get it.”

One who did was Marty Hovenkotter, a 63-year-old resident of Sammamish, Wash., who underwent the procedure in 2008. Hovenkotter was well into his Parkinson’s journey, having first been diagnosed in Nov. 1990 -- more than a year before Michael J. Fox was diagnosed with the disease and eight years before Fox went public with his Parkinson’s. At the time, Hovenkotter was told he would only have two years to live.  

More than 14 years later, Hovenkotter was still living life. And thanks to his DBS surgery, his quality of life has improved in recent years. So much so that Hovenkotter would recommend it to anyone with Parkinson’s who qualifies.

“I just told a guy the other day: sooner is better than later,” Hovenkotter said in January. “You don’t get the benefits of impulses forever. A person is better to get it done now and get on with their life.”

One of the perks of the surgery, Hovenkotter said, is that it’s cut his daily meds in half.

“That’s a gold standard for Parky’s,” he said. “It allows you to have movement. I was taking five or six of those (medications) a day, and I cut down to three.” DBS has cut down on Hovenkotter’s tremors while helping to stabilize the progression of other Parkinson’s symptoms. “For me, (the decision to have DBS surgery) was simple,” he said. “I almost felt like it was designed for me.”

Interested parties can further investigate the surgery by getting a referral from their neurologist or primary-care physician. Dr. Ko said he would be willing to answer any questions as well, while the University of Washington’s movement disorder clinic also provides feedback on the procedure.

Ko said the most important thing is for a person to do the homework before making a decision.

“It’s like getting married,” he said. “When you get this device implanted, it’s going to be with you the rest of your life.”

For more information, Dr. Ko’s clinic can be reached at:

3rd floor Surgery Pavilion

1959 NE Pacific Avenue

Seattle, 98195

(206) 598-1459

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