Regaining control of Parkinson's disease

by Mary Hoff

Three years ago, there wasn't a whole lot Andrew Stickney could do. Trapped in the advanced stages of Parkinson's disease, he spent his days at home in the Twin Cities suburb of Woodbury swinging back and forth between being "frozen up" and wiggling uncontrollably due to side effects from the medications he took to "thaw" the frozen state.

Out of 16 waking hours, he'd spend 3 to 6 of them with arms and legs that did what he asked them to. The rest of the time his body refused to respond to his brain's wishes: Sometimes he was slow, sometimes he was mobile, and sometimes his wiggling state left him out of control. He often didn't know what the next hour — or minute — would bring.

"In the frozen state I was in a lot of pain because my muscles were tense, sort of like a charley horse feels," he says. "I'd take medications to relieve that and then, as I'd transition, I'd be overstimulated, wiggly." Stickney knows the symptoms well; he's been experiencing them since 1991. "It hampers everything you do. I remember at times rolling on the floor, crying, asking God for a new body."

Then, in December 2001, University of Minnesota neurosurgeon Robert Maxwell, M.D., Ph.D., turned Stickney's life around. In a 12-and-half-hour procedure, Maxwell implanted two tiny electrodes, one on each side, into key locations deep inside Stickney's brain. After making sure the electrodes were in the exact right spot — in the middle of a tiny island of brain tissue known as the subthalamic nucleus — he then connected the electrodes via wire leads beneath the skin to two battery-operated devices implanted just below Stickney's collarbone. After the surgery, the devices were programmed to deliver steady pulses of electricity to implanted electrodes deep within Stickney's brain. By lessening (or silencing) the abnormal "noisy" brain activity that characterizes Parkinson's, the pulses tamed Stickney's unruly body. You don't have to be a brain surgeon to see the difference the device has had on Stickney's life. Since receiving the implant, Stickney has been able to cut back on his medication and so reduce the negative side effects. He has had the energy and endurance to start a business making racks for the thin-film coating industry. He also is able to volunteer at school and on field trips, and bowls in an adult-child league with his seven-year-old son, Ben.

"My life has gone from 20 to 40 percent of my day being good, productive time, to about 80 to 90 percent now," he says.

Looking for better ways

Some 1.5 million Americans suffer from Parkinson's disease, a disorder in which the brain gradually loses its ability to make dopamine, a chemical that helps nerve cells tell muscles what to do. The consequences include tremors, stiffness, and difficulty moving. Early on, Parkinson's disease is often treated with medications that fill in for the missing dopamine. But over time the treatment loses its efficacy. In many cases it also causes uncontrolled movements called dyskinesias.

In the 1950s and '60s, researchers looking for better ways to control Parkinson's symptoms developed a treatment that involved creating lesions in the parts of the brain that control movement. The lesions were effective in some cases, but not all. They also caused adverse side effects and had the downside of being irreversible. Then, in the 1980s, French surgeons who were making lesions to control tremors noticed that stimulating certain parts of the brain with electrodes — part of the process of confirming the correct location for the incision — temporarily quelled Parkinson's symptoms. Why not, they thought, use deep brain stimulation rather than destruction to help Parkinson's patients regain control? The researchers began working with Medtronic, the Minnesota-based cardiac pacemaker manufacturer, to develop and refine a device that could do just that.

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