Deep Brain Stimulation
Replacing medication with electricity for Parkinson's patient
Ask Donna Jean Meadows how she feels, and she’ll tell you she feels incredible. That is quite a difference from her experience over the past few years.
“I can ride a bike, I can actually run, and I am looking forward to travelling again,” says DJ, as she is known.
DJ was diagnosed with Parkinson’s disease about 10 years ago when she was only 50.
“Everything became harder or slower. I never had the tremor people associate with Parkinson’s, but I had muscle rigidity, stiffening, and an inability to function normally,” says DJ.
At first her disease was managed with medication. DJ took up to 30 pills a day to reduce symptoms, not uncommon for Parkinson’s patients, and their effectiveness diminished over the years.
Dr. Mary Jenkins, LHSC neurologist, had spoken to her about Deep Brain Stimulation (DBS) as an option. DBS is an electrical stimulation which reduces the symptoms of Parkinson’s disease.
“It was a chance to regain some of my quality of life,” says DJ.
In June 2016, LHSC University Hospital neurosurgeon Dr. Keith MacDougall and his team performed an eight-hour surgery to implant two electrodes deep into DJ’s brain. The electrodes are connected to a battery-powered neurostimulator which is embedded under the skin just below her collarbone.
DBS surgery is an intense experience for the patient, who is awake for most of the operation.
“My biggest fear going into the surgery was being able to lie still for eight hours. They assured me I would be fine,” says DJ. In fact, she remembers little of the surgery which she attributes to the amnesticeffect of the medication.
The day starts at 7 a.m. The patient’s skull is frozen and a stereotactic (halo) frame is fitted to the patient’s head to keep it perfectly still. A computerized tomography (CT) scan is done before the patient is brought to the operating room and prepped for surgery.
Meanwhile, Dr. MacDougall and his team are merging the data from the CT scan and from a previous MRI and mathematically determining the coordinates to position the electrodes in the brain.
“We make two incisions, one on each side of the skull and insert five micro electrodes for testing and locating the exact spot for positioning the permanent electrodes,” says Dr. MacDougall.
Once the micro electrodes are inserted, Dr. MacDougall ‘listens’ to the brain.
“We use micro-electrode recordings to listen for the signature of the subthalamic nucleus in the brain, the overactive area affected by Parkinson’s,” says Dr. MacDougall.
When the location is determined, Dr. MacDougall tests for side effects before the permanent electrode is implanted. This includes talking with the patient.
“We turn on the electricity in the microelectrode and see if the patient has trouble with speech, double vision, or stiffening of the face or limbs,” he says.
When testing is completed, the electrode is anchored in place. The entire procedure is then repeated on the other side of the brain.
For the final portion of the surgery, the patient is put under general anesthetic while the surgeon runs the electrodes under the skin along the side of the neck to below the collarbone and attaches them to the implanted battery-powered neurostimulator. DJ has a 25-year rechargeable battery which she charges up every three or four days.
In essence, DBS is substituting electricity for medication, and DJ only takes three pills a day now.
“People say I’m brave to have the surgery,” says DJ, “but I think all people with Parkinson’s are brave because there are so few options.”
The patient is discharged as soon as they begin to feel better.
“For young patients it is not so unusual to be discharged in a day or two,” says Dr. MacDougall. “After surgery the patient has a CT or MRI scan and then is put back on somewhat less medication. If the patient feels normal, i.e. has no headache or delirium, then they can go home.”
DJ was home 23 hours after the operation. Initially the DBS is turned off and the patient remains on medication during the recovery period.
“I went back to University Hospital two weeks after surgery and the DBS was turned on. I felt relaxed, rested, full of energy,” says DJ.
Progress is slow after surgery and the changes incremental, but when DJ looks back she sees two different people.
“My husband says I am like a 24-year-old, I can’t slow down,” says DJ. “The first time I was back on my bike I squealed all the way to the lake. It was that sense of freedom, to be able to pedal myself.”
And she is able to travel again.
“My last big trip was in 2009. Parkinson’s would limit me in so many ways and eventually I couldn’t travel anymore,” says DJ.
“It is exciting. My son is getting married in Mexico in November and I already have my ticket booked.”
DJ is deeply appreciative of her care at LHSC.
“I had the best experience. Everything was great. The nurses, the doctors, everyone was wonderful. Dr. MacDougall is a hell of a surgeon. I am so grateful.”
DJ is committed to helping others with Parkinson’s disease learn from her experience. Anyone who wishes to speak to DJ Meadows about living with Parkinson’s disease or DBS can contact her at firstname.lastname@example.org