Sweet Dreams
Parkinson's, essential tremor patients can sleep through DBS

Although still in its infancy, the Barrow Center for Neuromodulation is quickly proving itself a leader in this exciting field—particularly when it comes to deep brain stimulation (DBS).

Not only is Barrow performing more DBS surgeries than anywhere else in the country, it is also one of only a handful of facilities to offer a safer, faster and more accurate procedure for patients with Parkinson’s disease and essential tremor.

Asleep DBS surgery

If the thought of having brain surgery while wide awake terrifies you, you’re not alone. The fact that DBS has traditionally been performed while patients are awake has kept some away. But in 2012, Barrow became the second facility in the United States to offer asleep DBS, allowing patients to essentially “sleep” through the procedure while under general anesthesia.

While both procedures have the same outcome—a pacemaker- like device in the chest sends electric impulses via wires to two electrodes in the brain—the difference is in the technology. Asleep DBS uses a high-resolution intraoperative CT scanner that allows the surgical team to verify that they have hit specific targets in the brain. In the awake procedure, the neurosurgeon and neurologist work together to do recordings of individual cells and measure their responses, taking significantly longer.

Francisco Ponce, MD, director of the Barrow Center for Neuromodulation, says that the asleep procedure offers many benefits.

“Asleep DBS improves the patient experience because they can literally sleep through the procedure,” says Dr. Ponce. “Not only that, the surgery is much shorter and more accurate. It’s also safer because we have better control over the patient's blood pressure, breathing and other vitals.”

Dr. Ponce adds that the best candidates for asleep DBS are those with Parkinson’s disease who have responded to medication, but have serious or intolerable side effects, or patients with essential tremor who do not respond to medication.

Phoenix native Tommy Zulegar fit the bill. Diagnosed with Parkinson’s at age 34, he tried various therapies.

“For a few years I went from one medication to another, most of which were worse than the Parkinson’s itself. At one point I had lost 30 pounds because the medication I was on made me sick every time I took it,” says Zulegar. “DBS was no longer a scary proposition. In fact, after researching the procedure, it began to look more and more promising.”

At the advice of his neurologist at Barrow’s Muhammad Ali Parkinson Center, Arshia Sadreddin, MD, Zulegar elected to undergo asleep DBS. In October 2012, at just 37 years old, he became the youngest patient ever to have the procedure done at Barrow.

“Asleep DBS is a real breakthrough for those who are anxious about having awake brain surgery, and for patients like Tommy who are young, healthy and have less chance of side effects from general anesthesia. This can allow more patients the opportunity to benefit from improved quality of life that they would not have enjoyed previously on medication alone,” says Dr. Sadreddin.

Zulegar says that his world changed the morning his DBS device was first turned on. “It was like someone was flipping a light switch on and off in my brain.”

One-stop shop for DBS

With more and more success stories like Zulegar’s, it’s no wonder that Barrow is seeing an increase in patients interested in the procedure. In fact, Barrow performed more DBS surgeries in the past year—117—than anywhere else in the country. About half of those were asleep DBS.

To help streamline the experience, last summer Barrow implemented a dedicated DBS Clinic at the Muhammad Ali Parkinson Center. The weekly clinic is a comprehensive resource for patients, offering education, medical evaluation, psychological assessment, imaging, surgery and post-surgical monitoring in one convenient location. Patients consult with a multidisciplinary team that includes a patient educator, neurologist, neurosurgeon and neuropsychologist, among others.

The clinic has made the entire DBS journey faster. Before, it might have taken patients up to a year to complete the evaluation process; now it takes only four to six weeks.

“We have dramatically reduced the waiting and evaluation time for patients,” says Rohit Dhall, MD, who heads the clinic. “In the past, waiting for evaluation and approval for this treatment could be frustrating for patients. So, we have added new resources to the Muhammad Ali Parkinson Center and established this clinic. It has already become very popular with people from all over Arizona, and as far away as Illinois, Wyoming and Michigan.”

New uses for DBS

Deep brain stimulation is not new. Barrow neurosurgeons and neurologists were involved in early clinical trials of the procedure as far back as the late 90s. However, there are many exciting developments on the horizon.

Barrow has partnered with the Banner Alzheimer’s Institute to participate in the ADvance Study, the first clinical trial in the country to test the effectiveness of DBS in slowing the progression of mild and early-stage Alzheimer’s disease. The trial is based on a previous Canadian study with promising results. As the study’s subinvestigator, Dr. Ponce implants the devices at Banner Good Samaritan Medical Center. The trial will compare the effects of DBS turned on to those observed with the system turned off.

“Over the past two decades, these brain pacemakers have revolutionized the treatment of patients with Parkinson’s disease and other movement disorders,” Dr. Ponce said.  “Our goal is to give patients the function of their body and mind back and maximize their quality of life,” says Dr. Ponce.

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