The Minnesota connection
Maxwell, who headed the Department of Neurosurgery from 1995 to 2003, first implanted an experimental deep-brain-stimulation (DBS) device into one of his patients in the early 1990s. Several years later he and his colleague Timothy Ebner, M.D., Ph.D., began doing more of the surgeries as part of federally funded clinical trials of the Medtronic device.
"Once there was pretty solid evidence that it was effective, we gained authorization to do it in a research protocol in the latter part of the 1990s," he says, "and of course we found it to be quite effective."
In 1997, Medtronic's Activa Parkinson's Control System received FDA approval for treatment of essential tremor, a Parkinson's-like disorder. In 2002 it was approved for use in people with Parkinson's disease.
Not for everyone
To date, Maxwell has implanted more than 200 of the deep-brain-stimulation devices. But he is quick to point out that as life-altering as it is for some, DBS is not for everyone.
"We select patients using a number of fairly refined criteria," he says. Before surgery, patients are assessed by Paul Tuite, M.D., head of the Movement Disorders Clinic, to determine whether they're a good candidate for the procedure.
Of the 15,000 Minnesotans currently diagnosed with Parkinson's disease, perhaps 5 to 10 percent could be seriously considered for the treatment, says Tuite. Conditions that would preclude implantation of the Activa device include the presence of significant cognitive difficulties, atypical Parkinsonism, prior strokes, or other significant medical problems. Some believe those over age 70 may not do as well as others with the surgery. In addition, prospective recipients need to be able to understand and cooperate with the therapy and have a good support system as they adjust to their new, somewhat bionic lives. They also receive a thorough rundown of potential negative outcomes, which can include infection, bleeding, behavioral changes, and weight gain.
In the frozen state I was in a lot of pain because my muscles were tense, sort of like a charley horse feels. It hampers everything you do. I remember at times rolling on the floor, crying, asking God for a new body.— Andrew Stickney
"The majority of patients that have received surgery have obtained great benefits — less medication, more mobility, less involuntary wiggling," says Tuite. "But it's still a potentially risky proposition, as it is brain surgery with its inherent risks, and individuals will need to have their device managed after surgery."
Stickney did experience some problems with infection after his surgery. And he's in line for another surgery soon to replace the pulse generators implanted in his chest because the batteries are wearing out. But he has no second thoughts.
"I would do it all again in a heartbeat," he says.
Plenty of other people are following in his footsteps. Currently Maxwell and his team are implanting 30 to 40 devices each year. Other hospitals in Minnesota and around the country are beginning to offer the surgery, too.
Maxwell says physicians are increasingly likely to recommend that their patients with Parkinson's look into DBS as a treatment option. "It's that old axiom, 'Neither be the first to try the new nor the last to lay aside the old,' " he says. "We're out of that phase of being the first to try the new and into not wanting to be the last to lay the old aside."