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  • Writer's pictureRory Cellan-Jones

Deep Brain Stimulation

Updated: Feb 9

Each week Rory Cellan-Jones guides us between the laughs and moans in the pub. Here is Rory's summary of this week's episode. 


Warning - you may find this week’s episode of Movers and Shakers disturbing. This time, the podcast about living with Parkinson’s is all about the most radical treatment for the condition, Deep Brain Stimulation (DBS).


This involves surgery that can last up to 8 hours where electrodes are permanently implanted in the brain and then used to jam the abnormal signals being sent to the body which are at the heart of Parkinson’s.


A somewhat blurry photo of the recording of this episode. with Professor Zrinzo next to Gillian

We have an expert on the team, Gillian Lacey-Solymar, who had the operation four years ago and is extremely satisfied with its impact. She shocks us by playing us a horrific clip of a video showing how much pain she was in from dystonia - a form of cramp - before she had DBS.


And she brings along to the pub the brilliant surgeon Professor Ludwic Zrinzo who did her operation - "the only man who has ever got inside my head," as she puts it. He explains that deciding to have DBS involves lengthy discussions between the patient and the doctor to make sure it’s the right approach:


"Deep brain stimulation is one of the most successful surgical tools that we have. It's not for everybody and we have to ensure that we tailor our approach to helping people with Parkinson's according to what they need. Selecting the right patients is a very important part of the job, it's almost more important than the surgery itself."


The Movers and Shakers have lots of questions. "How often does it not work?" asks Jeremy Paxman. The professor tells us it depends on what you mean by "work" and what the expectations of the patient are:


"Sometimes if expectations are unrealistic, then I would counsel someone not to undergo surgery. There's no point me doing surgery because I think it's going to help you if actually your expectation of what we're doing is unrealistic."


Paul Mayhew-Archer, who is considering having DBS, wants to know about the dangers of the operation, having heard about someone who had a stroke and died. Professor Zrinzo accepts that can happen but says his hospital has operated on over 2000 people without any strokes or deaths.


Gillian’s DBS remote control - I want to know whether the system is on permanently. Gillian shows us what looks like a rather chunky mobile phone which is in fact her DBS remote control. She explains that while she is not supposed to switch it off she does from time to time, especially when she goes swimming as it can be dangerous.


At the end we work out whether we are now keener to have DBS. Jeremy hadn’t fancied it beforehand - "I thought I'm not going to have some clown going and sticking electrodes in my brain" - but has decided that Professor Zrinzo isn’t a clown and has warmed to the idea. Mark Mardell feels he’s at too early a stage to consider it but is "intellectually fascinated" by the idea. I too feel I’m not so afflicted by Parkinson’s that I need this - although my consultant startled me by mentioning DBS the last time we met - but some of my fears about the procedure have been allayed by what I heard in the pub. Judge Nick Mostyn is not convinced - "I remain fearful of the thought of people drilling into my skull and someone poking around in my brain." 


But we all came away feeling better informed about this technique only invented in the late 1980s and in awe of people like Ludwic Zrinzo who are refining it and making the operation a much quicker and simpler affair.


This week's main guest:

Professor Ludwic Zrinzo

Prof Zrinzo is head of the UCL functional neurosurgery unit. He specialises in the surgical management of chronic neurological disease including Parkinson's disease, dystonia, tremor, headache (cluster headache and other autonomic cephalalgias) as well as the surgical management of treatment refractory mental disorders, including Tourette's syndrome, obsessive compulsive disorder (OCD) and major depression. In addition to stereotactic ablation and deep brain stimulation (DBS) he also specialises in disorders of the cranial nerves, including microvascular decompression (MVD) procedures for trigeminal neuralgia and hemifacial spasm.


 Prof Zrinzo completed undergraduate medical studies in Malta, before moving to London to train in neurosurgery (Atkinson Morley Hospital, Royal London Hospital, Great Ormond Street Hospital, The National Hospital for Neurology and Neurosurgery and Old church Hospital). He was awarded an MSc in clinical neuroscience with distinction from the UCL Institute of Neurology, London and completed two fellowships in stereotactic and functional neurosurgery, at Queen Square and at UCLA, Los Angeles, USA.


Prof Zrinzo's research interests have been directed towards continued improvement in the surgical care of with particular emphasis on improving safety, accuracy and efficacy of surgery. He is the author of numerous peer-reviewed publications, abstracts and several book chapters and his work has received several international awards.


For more information visit UCLH.


 
New DBS trial offers hope for Parkinson's, Rory Cellan-Jones

When I first started telling people about my Parkinson’s diagnosis three years ago, a few who knew a bit about the condition had a question for me - are you going to try Deep Brain Stimulation?














Image by Hellerhoff, via Wikipedia (CC BY-SA 3.0)


DBS is a pretty serious surgical procedure involving placing a device in the brain which sends electrical impulses to target specific areas with the aim of controlling Parkinson’s symptoms such as tremors. It’s used only when medication has failed to do that job.


So my answer was always a polite "no", while thinking privately "are you bonkers? I’m not having my head drilled open in some Frankenstein experiment when my symptoms aren’t that bad and I’m only just starting on medication."


No doubt an over-reaction on my part, though the statistics appear to show that DBS, which first got regulatory approval in    the US 25 years ago, is still a pretty fringe treatment, available to under 5% of people with Parkinson’s worldwide.


But this week comes news of a trial which could make Deep Brain Stimulation a simpler and less expensive procedure, meaning it could be offered to far more people. The trial is happening in Bristol and involves finding out whether the world’s smallest DBS device is both safe and effective.


Existing devices involve a battery being implanted in the patient’s chest with wires then running up under the skin to the brain. But the Picostim DBS system, is about a third the size of conventional devices, meaning the battery can be implanted directly into the skull, making the whole procedure simpler and less of an ordeal.


The plan is for up to 25 patients to test the device but one, Tony, had his implanted back in November 2020 and seems happy with the results, explaining that he woke after surgery and was surprised that he had no pain. "I was operated on a Wednesday and went home on Thursday afternoon, I felt tired but, I still had no pain," he says. "The impact has been amazing, the dystonia which is a side effect from the medication has gone.  I can now walk two miles or more, whereas before DBS, I could get about 200 yards then I would have to rest. I am back playing golf, not as well as I used to, but that’s probably down to old age catching up; but at least I’m back playing."


 

This episode was recorded before Paul began his Deep Brain Stimulation journey. If you would like to listen to Paul's diary please click here.


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