Originally created 04/02/04

Device aids in tremor control



SAVANNAH, Ga. - Linda Zeigler's tremors and involuntary jerking had become so severe that she was embarrassed to be in public.

Diagnosed with Parkinson's disease in 1997, the Chatham County woman was on medications to control the symptoms, but the results were minimal. She no longer could ballroom dance, move easily or turn over in bed.

Today, small electric wires in her brain send signals that curb the tremors and involuntary movements, letting her walk well, turn and pivot, even do a little slow dancing at a recent wedding.

Ms. Zeigler isn't cured, but Parkinson's is no longer severely limiting her life.

She credits the changes to deep-brain stimulation, which involves drilling a hole into the patient's skull and targeting areas of the brain with electrical impulses.

She is one of about 15 patients who have undergone the procedure at Savannah's St. Joseph's Hospital in roughly five years. Deep-brain stimulation is suited for someone who has been on Parkinson's medicine for a while and is not responding well.

It does not cure Parkinson's, nor completely eliminate the need for medication. The slow loss of nerve cells in a part of the brain continues despite the improvements.

However, in the appropriate patient, it is the surgical treatment of choice for Parkinson's disease, said Will Garrett, a neurologist at the Neurological Institute of Savannah. He does deep-brain stimulation procedures with a team that includes a neurosurgeon.

"It's a wonderful thing because it offered help and a dramatic treatment for patients at a time in their disease process when we were really running out of options," Dr. Garrett said.

More than 1 million Americans have Parkinson's, a progressive disease that occurs when the balance between two chemical messengers in the brain is offset, causing a loss of brain function, shaking, stiff muscles, slow movement and difficulty walking and balancing.

The causes of Parkinson's are unknown.

Before Ms. Zeigler underwent the surgery last summer at the age of 60, her biggest hesitancy was having a hole drilled in her head. She prayed about it, and a peace that followed helped Ms. Zeigler undergo what seemed like a radical surgery.

Patients are awake during the first part of the procedure. The scalp is numbed before the hole is drilled.

"I heard them drilling and they are talking to you the whole time," said Ms. Zeigler. "But I don't remember any pain at all."

Then doctors make a map of the brain and place tiny electrodes inside it.

She had to answer questions and move her hand, to point or do other types of motion, so doctors could check for tremors.

The process continued until her tremors stopped.

Later, while the patient is under general anesthesia, a small battery-powered device, a type of "brain pacemaker," is implanted in the chest and connected to electrodes in the brain by a wire.

The implant powers the electrodes placed deep in the brain. Deep-brain stimulation can be programmed so it delivers the correct level of signals and can be adjusted as needed. It can also be reversed and poses little risk.

Rehab after the surgery took longer than Ms. Zeigler expected. She had to reteach herself to walk.

After she made her feet do what she wanted, "it was awesome," Ms. Zeigler said. "I want to tell people with Parkinson's there is something they can do for you."