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"I got stuck." - Zeke Turner's Story
Imagine that your hand or arm shakes so
badly that you can’t write your name, get dressed or feed yourself. Or
that your muscles freeze up when you try to get up out of a chair or walk
across a room.
People with Parkinson’s disease, like
58-year-old Robert “Zeke” Turner of Huntsville, Ark., deal with the
debilitating effects of this degenerative disease on a daily basis when
the medications used to treat symptoms of Parkinson’s no longer work for
them.
Turner, a retired professional land surveyor, was diagnosed with
Parkinson’s shortly after an episode in 1998 when he couldn’t kick the
head off a dandelion while working in his yard one afternoon.
“I just couldn’t initiate the kick … I got stuck,” he says.
He eventually had to retire early from his profession, a job that he
loved.
“Medicine helped for awhile, but I developed a tolerance to it and it got
so that I was afraid to drive, which I had to do a lot for my job,” he
says.
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DBS involves putting the tip of
a hair-thin wire down inside the brain in the thalamus, the area
that controls movement, or other groups of neurons located deep
within the brain.
The surgery is performed by a neurosurgeon while the patient is
awake. The wire runs up through a small hole in the skull and under
the scalp down to a pacemaker-like device implanted under the
collarbone.
The device, called a neurostimulator, sends tiny
electrical impulses down the wire into the brain, which deactivate
the part of the brain responsible for the tremors, involuntary
movements and freezing-up.
After the surgery, the patient sees a neurologist to program the
stimulator, which is activated with a hand-held programming device.
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A new procedure – called deep brain
stimulation, or DBS, has proven to control the tremors, muscle stiffness
and slowness of movement for patients like Turner with Parkinson’s, as
well as for patients with dystonia and essential tremor. DBS can also be
used for chronic pain and is being researched for the treatment of obesity
and severe depression.
Dystonia refers to a group of complex muscle disorders that involve
involuntary twisting, repetitive movements that cause abnormal, sometimes
painful positions. Essential tremor refers to the rhythmic shaking of a
body part, usually a hand or arm, especially when the person tries to do
something like hold a pen or cup.
Earlier this year, Turner’s neurologist in
Fayetteville, Ark., recommended Turner consider deep brain stimulation.
The Fayetteville neurologist referred Turner to St. John’s neurosurgeon
Alan Scarrow, M.D., who performed the procedure in June.
“Accuracy is very important in this procedure because we have to have
exact placement of the electrodes for it to work optimally,” Dr. Scarrow
says. “We do a CT scan and an MRI before the procedure so we can target
the problem area. The patient is awake during the procedure, but we have a
movie playing on a laptop to distract them from the procedure as much as
possible. With tremor patients, we can often see their response
immediately because their shaking stops once we have the electrodes placed
exactly where they need to go.”
Turner sees his St. John’s neurologist regularly for
adjustments to the neurostimulator and to his Parkinson’s medication.
While some patients may be able to stop taking medication for their
Parkinson’s, most, like Turner, still need to take some, albeit a reduced
amount from what he was taking before the DBS procedure.
“DBS is in essence 24-hour medication for Parkinson’s, dystonia and
essential tremor patients. A part of their brain is hyperactive; the
electrodes used in DBS stimulate and depolarize the cell membranes in the
area of the brain where the problem is. The cells can’t fire anymore, so
the tremors, involuntary movements or muscle stiffness disappear or are
greatly reduced,” Dr. Habiger says.
Turner’s improvement after the surgery was immediate and he says he didn’t
feel anything during the procedure and doesn’t notice the neurostimulator
under his collarbone much. He sees Dr. Habiger every three to four weeks.
The visits will become farther apart over time as Turner improves and
requires fewer adjustments in stimulation and to his medication, Dr.
Habiger says.
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