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Deep Brain Stimulation at Swedish Medical Center

Swedish's Deep Brain Stimulation Program for Parkinson's Featured in KPLU Radio Series on Therapeutic Uses of Electricity in the Brain

A brave and patient Mayor Jones home from the hospital

By Sharon Kivisto

posted 03/13/2007
As he sat at a table on Feb. 21 - nine days after undergoing four and a half hours of brain surgery - Mayor David Jones' hand trembled as it had for the past seven years from the effects of Parkinson disease. He watched his hand as the voltage to one of the electrodes implanted in his brain was turned up. His hand slowly relaxed and the trembling stopped. "I feel like I've got my personality back," he thought.

Jones, who is the Mayor of Friday Harbor, recounted the scene and how he felt in an interview last week. He wants to spread the word about the deep brain stimulation (DBS) procedure. It is not a cure but is a treatment which can greatly improve the quality of life for Parkinson patients.

Of the 100,000 patients a year who may be eligible, only 1,000 have the treatment which is covered by Medicare.

As part of his committment to spread the word, he agreed to let Kathy Goertzen and a film crew from Channel 4 cover his pre-op care and the surgery. They will do a complete story about him once his treatment is completed.

Parkinsons is a degenerative disorder of the central nervous system. It's progressive and always gets worse but doesn't shorten one's life. The disease usually strikes around age 60 though it can occur in the 30s and 40s.

The disease is related to the chemical dopamine. By the time symptoms appear, a person has usually lost about 80 percent of the cells that produce dopamine.

The four major symptoms according to the National Institute of Neurological Disorders and Stroke are:

• Tremor
• Rigidity
• Bradykinesia, or the slowing down and loss of spontaneous and automatic movement
• Postural instability, or impaired balance, causes patients to fall easily

More information about other symptoms is available on the institute's Web site

The disease can also affect cognitive functions. The course of the disease is very individualistic, Jones said. It is hard to predict the speed at which the disease will progress. The most bothersome trait and the one most people associate with the disease is tremors, he said. Another thing people may not realize is the person's face lacks expression and animation. "I can smile again," said Jones.

Jones, 67, was hit with the disease at age 60. As the disease progressed he said his wife, Nancy, felt like she was losing her partner.

There are medications which can help with some of the symptoms but they have side effects. While doctors are looking for a cure, many patients are undergoing deep brain stimulation (DBS) surgery to improve the quality of their lives. The treatment is reversible, so if a cure is found, nothing has been precluded.

To qualify for the brain surgery, a patient must have responded positively to medication which stimulates dopamine. They must also be in good health, under 70 years of age and must have good cognitive skills.

The surgery has been done in the U.S for five years. It was started in Grenoble, France ten years ago.

During the surgery, a small electrode is inserted into the brain in order to deliver mild electrical pulses to the thalamus, blocking the brain signals that cause muscle tremor. Electrodes are inserted into each side of the brain. Wires are then placed under the skin down to the collar bone where two battery-operated impulse generators are placed under the skin in a separate procedure.

Jones was awake throughout the surgery. Music from Dr. Peter Nora's IPod filled the operating room. As the surgery progressed, "He turned off Frank Sinatra and turned on me," Jones said in the interview. The operating room filled with the 'snap, crackle pop' sound of Jones' brain activity. As the surgeon neared the area of concern, the noise changed to a rain shower, then the sound of a heavy rain on a tin roof. That was the spot where the electrode needed to be placed.

Jones was in Swedish Medical Center in Seattle for 30 hours for the brain surgery before he was discharged from intensive care and sent home. The surgery took place Monday, Feb. 12. On Friday, Feb. 16, he returned for the surgery to implant the battery-operated pulse generator (similar to a cardiac pacemaker) near the collarbone in the chest wall. He went in at 8 a.m. and was out at noon.

For the next three to six months he'll see the nurse practitioner Peggy Shortt on a regular basis for adjustments to the voltage. Currently he has one side set for 2.8 and the other for 2.5, he said. His medication has been reduced from nine to 12 pills a day to four pills. The goal is to get down to one or two.

The battery packs last for three to five years. Jones has a remote device which has already come in handy. He had been shopping at Nordstroms and about ninety minutes later, "I noticed I wasn't working," he said. His hands had started twitching. He didn't realize the anti-theft devices at the doors had turned off his implanted devices. He held up the remote device to his collar bone to check and turned the pulse generators back on.

While Jones can already see positive results from the surgery, it will be a few months before he sees the full benefits.

Nancy Jones, when asked for her reaction, said, "It's brought happiness back."

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