Brain Stimulation Therapy Restores Movement, Renews Hope
Virginia Mason neurosurgeon Farrokh Farrokhi, MD, and neurologist John Roberts, MD, were testing the placement of electrodes in their patient’s brain. Under light sedation with a local anesthetic, the patient was conversing with Dr. Farrokhi about a children’s book she’d written. The patient, Sharon Standish, was undergoing deep brain stimulation (DBS) therapy to help control the symptoms of Parkinson’s disease.
“I remember Dr. Farrokhi just sitting with me, legs crossed, watching a screen as we chatted,” says Sharon. “at some point I heard him say, ‘there’s the sweet spot.’”
Not only were Sharon’s doctors looking for the spots, they were listening for them. Electrical activity in the brain cells makes noise — not unlike rain on a tin roof, says Dr. Farrokhi — identifying the areas where applying electrical current from a machine can control the involuntary movements of diseases like Parkinson’s.
The two electrodes in Sharon’s brain are permanent, connected by wires running under the skin of her neck to a small power pack implanted just beneath her collarbone. Sharon can adjust the pulse strength and turn the device on and off with a wireless, pager-sized controller. It’s thought the pulse generator works by blocking or erasing faulty brain signals that cause the severe tremors and dysfunction of Parkinson’s disease and other movement disorders. Painful muscle contractions caused by dystonia, a second condition Sharon was battling, are also relieved by DBS. By blocking “bad” brain code, it’s believed that normal code is allowed to pass through.
For Sharon, DBS therapy was the culmination of a tumultuous five-year journey. A diagnosis of Parkinson’s, then dystonia, first prompted drug regimens with life-altering side effects. Sharon suffered “sleep attacks,” once waking up in her car stalled on the road’s shoulder. Botox injections to ease muscle contractions became so numerous and painful that shot sessions meant missing a day teaching preschool. Drugs to replace dopamine, a neurotransmitter in the brain involved with muscle movement, eventually lost effectiveness. Sharon couldn’t go more than two hours without a dose.
As hard as her condition was, she resolved to keep living for herself, her family and her work. “I always knew there was hope, even on the darkest days,” says Sharon. “God didn’t give me Parkinson’s, but He would give me what I need to get through it.”
Sharon kept teaching half days, explaining to the kids that her body “just didn’t listen to me sometimes.” She turned her love of storytelling and drawing, despite the physical difficulty, into a published children’s book. Taking walks with her 5-year-old grandson, Brander, remained a pleasure, but not without risk. Once as they set out, Sharon fell and fractured her foot. There were other falls, other fractures.
“I learned I could still be capable during the hardest times, but I wanted a change, I wanted a chance,” says Sharon. “I still have so much to do.”
Pinky Agarwal, MD, Sharon’s neurologist with the Booth Gardner Parkinson’s Care Center at EvergreenHealth, had cared for Sharon since her diagnosis. With Sharon’s diminished response to medication, Dr. Agarwal knew DBS was her patient’s best hope. DBS surgery is offered at the Virginia Mason Neuroscience Institute as part of EvergreenHealth’s partnership with Virginia Mason. To Sharon’s surprise, Dr. Farrokhi introduced himself in person at her appointment with Dr. Agarwal.
“I told Dr. Farrokhi I want to be a good steward with this opportunity I’ve been given,“ says Sharon. “I’m so glad to have the chance to be well.”
Before, Sharon could barely bring her hands together. After DBS surgery she could clap. Since receiving her pulse generator, her dystonia symptoms have disappeared. She is back teaching three full days and can nearly complete an hourlong class of tae kwon do with her daughter. Physical therapy, along with electronic fitness games and a stationary bike at home, help her gain strength and balance. She still takes medication, but a fraction of what she used to.
Best of all are the walks with her grandson Brander. He understands now that his grandma’s brain needs special help to keep it working right. “When I grow up,” Brander told her, “I’m going to work on that.”
Jennifer Sorenson, communications program manager, wrote this story for the Virginia Mason 2012 Annual Report.