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School of Medicine
NeuroNow - Deep Brain Stimulation
Deep Brain Stimulation
Date: September 1, 2007
Fred Lenz evaluates Parkinson’s patient Martha Kowal to see if she is a candidate for deep brain stimulation.
Parkinson’s disease is caused by a deficiency of dopamine, a chemical that transmits signals between nerve cells. In 1988, when a Hopkins team discovered that the deficiency led certain brain cells to be over-stimulated, not under-stimulated as was previously believed, it became clear that over-active cells could be addressed surgically. In 1997 deep brain stimulation, or DBS, a procedure that had almost disappeared after the introduction of the drug L-dopa around 1965, was approved in the United States for movement disorders.
Now DBS is a standard of care for Parkinson’s, but it also has broad implications for conditions as diverse as obsessive compulsive disorder, obesity and psychiatric disease. Johns Hopkins, with its team of neurosurgeons and fellowship-trained neurologists, is a leading center for DBS in the United States and well positioned to pursue these powerful new treatments.
In DBS, a thin insulated wire, or electrode, is inserted through a small opening in the skull and positioned within the targeted brain area, usually, in Parkinson’s patients, the subthalamic nucleus, a tiny mid-brain structure. As with a cardiac pacemaker, an insulated wire is passed under the skin and connects the electrode with a neurostimulator, a battery-run power pack implanted under the skin usually near the collarbone. The generator sends a steady stream of low voltage to the brain, blocking the electrical signals that cause symptoms.
Hopkins neurosurgeon Frederick Lenz was instrumental in reintroducing DBS to neurosurgery after its hiatus. He refined microelectrode recording, an extraordinarily sensitive brain-mapping system which, in DBS, allows surgeons to precisely target specific groups of brain cells.
Lenz and his team have performed more than 400 DBS procedures. “While DBS was once used only in relatively advanced cases of Parkinson’s, we are now taking patients earlier in the course of the disease,” he says.
In Lenz’s hands, involuntary movements improve significantly in 90 percent of patients. Gait improves in 70 to 80 percent. “Almost everyone gets at least a 50 percent reduction in medicine; some can stop taking their drugs completely,” says Lenz. “The risk of infection is 1.5 percent. The risk of a bleed is 1.5 percent. Of that group, less than 1 percent will have a serious hemorrhage. It’s up to the patients to decide whether the problems are significant enough to take the small but present risks of the procedure in order to achieve those results.”