Rick Clary has some striking examples of the effects that essential tremor – an incurable neurological condition that causes uncontrolled movements – had on his life.
“One evening, my wife and I went out to eat,” said Clary, a 51-year-old Lesage resident. “We both ordered tea. The waitress brought my tea in a kid’s cup with a lid on it. I guess they thought I would spill it because I shook so much.”
Now, Clary says, a casual observer wouldn’t know that anything was wrong with him at all. The dramatic change happened thanks to a high-tech device and cutting-edge surgical treatment known as deep brain stimulation (DBS), provided by neurosurgeon Rida Mazagri, M.D., and neurologist Carl McComas, M.D., of the St. Mary’s Regional Neuroscience Center. DBS can help to control tremors in patients with Parkinson’s Disease as well as essential tremor.
The therapy uses an implanted medical device to deliver electrical stimulation to block the brain signals that cause the tremors. It involves implanting a thin, insulated wire (called a lead) with four small electrical contacts (called electrodes) in targeted structures of the brain. The lead then is connected by an extension to a battery-powered neurostimulator, which is implanted near the collarbone.
Two separate surgeries are required. In the first, which can require four to six hours, the lead is inserted through a small opening in the skull and implanted in the targeted site deep within the brain. Doctors use sedation and a numbing agent on the scalp to minimize pain, but it’s necessary for the patient to remain awake and alert during the surgery, so the system can be tested to see if it’s actually suppressing symptoms as intended.
In the second surgery, generally about two weeks later, the patient is put under with a general anesthetic so the extension can be passed under the skin of the scalp, neck and shoulder to connect the lead to the neurostimulator. A small incision is made near the collarbone and the neurostimulator is implanted beneath the skin.
Some time after the surgery, the patient returns to the physician so the neurostimulator can be programmed. The patient is given a magnet to use in turning the neurostimulator on and off.
Dr. Mazagri emphasizes that DBS therapy does not “cure” Parkinson’s disease or essential tremor.
“There is no cure at this time,” he said. “This therapy can treat some of the symptoms and improve function, but does not cure the underlying condition. If the therapy is discontinued, the patient’s symptoms will return.”
Since all the DBS components, with the exception of the hand-held magnet, are inside the body, people generally won’t notice them, Dr. Mazagri says. The neurostimulator may cause a small bulge under a patient’s skin, but shouldn’t be noticeable under clothing.
For many patients, the results can be dramatic, said Christy Franklin, director of St. Mary’s Regional Neuroscience Center. “They may be able to do things they hadn’t been able to do before,” she said. These might include taking a long walk or eating at a favorite restaurant.
Clary says that the improvement he’s seen from DBS has been nothing short of miraculous.
“For nine months, we tried everything we could with medication, but I got no relief,” he said. “I was getting to the point where my wife and kids assisted me with everything. I felt like I was a burden to my family, and nobody wants to do that.”
“When I saw Dr. McComas, he said, ‘I can’t cure you, but I can give you some relief,’” he said. “I said, ‘Let’s go for it,’”
In October, Dr. Mazagri performed the surgery to implant the electrodes in Clary’s brain, and followed two weeks later with the surgery to install the stimulation device. When the system was turned on, the improvement was immediate, Clary said.
“When they first turned it on, I couldn’t believe it,” he said. “I still have some small tremors, but nothing people around me notice.”
The relief of Clary’s debilitating symptoms has been a great benefit not only to him, but to his family, as well.
“I couldn’t have taken much more of what I went through in the last year or so,” he said. “Now, I can take care of myself, even shave myself,” he said. “Dr. McComas and Dr. Mazagri are miracle workers. They’ve taken great care of me.”
Clary recommends that others with essential tremor or Parkinson’s disease consider DBS as an option.
“If I could help someone, to refer them to Dr. Mazagri and Dr. McComas, I’d do it in a heartbeat,” he said. “It’s not an easy decision to make. Brain surgery is always a serious operation.”
“But when you’re stuck between a rock and a hard spot, you have to pick one. It paid off for me, and I don’t regret one second of it.”
For more information on the deep brain stimulation procedure, contact St. Mary’s Regional Neuroscience Center at (304) 526-1184.
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