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Deep Brain Stimulation: One patient's life-changing experience with DBS
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In this episode you’ll meet Loreli Jenkins, an 80-year-old who was suffering from severe tremors that were taking a toll on her quality of life.
Dr. Patrick Senatus, Medical Director of the Deep Brain Stimulation Program for the Hartford HealthCare Ayer Neuroscience Institute, treated Loreli with Deep Brain Stimulation, or DBS, a surgical procedure that helped free Loreli from decades of medication and maintain her independence – tremor free.
Learn more about Deep Brain Stimulation at HartfordHealthCare.org/DBS. Be sure to subscribe to Hartford HealthCare’s More Life podcast for more episodes on a wide range of important health topics. Just search “Hartford HealthCare” on your favorite podcast platform.
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Neurosurgeon Dr. Patrick Senatus talks about deep brain stimulation as a way to treat Parkinson's disease and answers questions from our Facebook audience.
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You know, before we get started, Lorelai, can I see your tremor?
SPEAKER_01And my tremor is, where is it? It's gone. It's gone. Beautiful. Awesome. I have a new lease on life.
SPEAKER_02Yay! All right.
SPEAKER_00Welcome to More Life. In this episode, you'll meet Lorelite Jenkins, an 80-year-old who was suffering from severe tremors that were taking a toll on her quality of life. Dr. Patrick Senatis, medical director of the Deep Brain Stimulation Program for the Hartford Healthcare Iron Neuroscience Institute, treated Lorelei with Deep Brain Stimulation, or DBS, a surgical procedure that helped free Lorelei from decades of medication and maintain her independence. Tremor-free. Here's Steve Coates.
SPEAKER_03Thank you both for joining us. Lorelei, you had your surgery on October 28th, and we just heard you're doing pretty well. How much has DBS changed your life so far?
SPEAKER_01I it's hard to even say the difference, but before the thing I was scared of was that I was not going to be able to live independently. Um that terrified me. And now, I mean, I'm fine. I'm really good. I just have my 80th birthday, and my 80s are gonna be awesome.
SPEAKER_03That really is amazing. And I I want to talk a little bit more, Lorelai, about your decision uh to have DBS. But I also first, Doctor, tell us a little bit more about the science of deep brain stimulation.
SPEAKER_02Yes, so uh DBS stands for deep brain stimulation, and uh it's a technique, a surgical technique where one implants uh in a very precise way electrodes into the brain circuitry that might affect uh movement or other aspects of uh behavior. It's part of a suite of techniques called functional neurosurgery. What it tries to do is it tries to disrupt or desynchronize abnormal electrical activity that contributes to uh pathological or diseased states.
SPEAKER_03So, Lorelai, you're suffering from essential tremor, it's obviously having a big impact on your life. You hear the terms brain surgery, kind of scary. How do you make that decision?
SPEAKER_01Oh, I was terrified. You do are going to stick something in my brain. If they get it in the wrong place, I might be worse off. You sort of have to trust. And I met the team, they were great, so I went into it with a very positive attitude and just hoped that it would at least get better. And it didn't just get better, it went away.
SPEAKER_03Doctor, whether it's Parkinson's or essential tremor or another movement disorder, how do you decide which patients qualify for DBS?
SPEAKER_02Right. So that's a very um that's a very good question. The we um work in conjunction and we partner with a multidisciplinary team that evaluates our patients on multiple levels. The neurologists, neuropsychologists, social work. All of those different components are evaluated long before a patient comes to surgery. Everything has to be right, you know, for us to uh consider a patient an appropriate candidate. They have to have a reasonable expectation about what's possible with the surgery. They have to have uh the appropriate health screening to make sure that they can uh go through the surgery safely. And that's our you know, that's our most important touchstone is safety. We want to make sure the patient can go through the process safely and that they have a high likelihood of benefiting. Of course, there are non-surgical approaches to most of the disease processes that we treat, um, including um essential tremor. But if a patient is refractory, meaning does not respond adequately to those treatments, then uh they are a potential candidate. And then we vet them through our multidisciplinary process and uh lower life passed back with with flying colors.
SPEAKER_03You gave us a little overview of the science behind DBS, but really how does it work on the brain?
SPEAKER_02We are very complex organisms. Our brain is probably one of the most complex things that we are that we are aware of. At the microscopic levels, nerve cells communicate with other nerve cells. They do that by uh electrical and chemical signals. Now, oftentimes, when someone decides to do something, the volitional choice to do that starts in the cerebral cortex, then it goes through a series of processing steps, and eventually a signal goes back to the cortex that says, okay, it's okay to do that. So it gets processed. Now, sometimes those loops get stuck or get synchronized like a mini seizure eddy deep in the system. And so when we implant an electrode, and we implant it with extreme precision, fractions of a millimeter can make a significant difference. But if we find the correct node, then we can impart electrical energy to desynchronize that. Desynchronizing that will allow the brain to, in that specific area, to sort of reboot. So that's what we're doing in a in a continuous fashion with the deep brain stimulator.
SPEAKER_03So this would be an ongoing process. There would be more surgeries when the symptoms of the disease come back?
SPEAKER_02With essential tremor, the target is the is a part of the brain called the thalamus. Okay. The thalamus is sort of like the executive secretary to the to the cortex. Now, in the past, prior to formal deep brain stimulation, patients to affect tremor used to have lesions. So you would burn a very specific spot in the brain to achieve the tremor control. But what would happen if the same part of the brain were treated at the same time, patients could develop significant uh side effects. Um, one thing is Islamic mutism, which is a syndrome. And so basically, what we do is we do it in staged fashion. We try to address the most severe side first, we allow that to recover and programming to occur. Once we have that, then we can go to the other side. And so it's out of an abundance of caution that we take it one side at a time.
SPEAKER_03Laura Lai, you talked earlier about the initial fear of having brain surgery, but take us through the process from pre-surgery to after you had the procedure.
SPEAKER_01I had made the decision to have the surgery and to trust these wonderful people. So by the time I got to the hospital, I was in good shape. They took me in, they prepped me. Um there were people everywhere caring for me. Um I felt good. Um I made the decision to have my hair removed, all of it, rather than just part of it. That was done. Um then they sedated me a little bit and took me in and put a funny thing on my head. And uh and then I went to sleep, so I didn't hear the rest of it. And when I woke up, again, there were people there caring for me and reassuring me that everything was fine. So it was it was good, it was good.
SPEAKER_03And doctor, this obviously isn't outpatient surgery, it is brain surgery. Talk a little bit about the length of the procedure. Is there a stay, uh hospital stay in the neural ICU following it?
SPEAKER_02Yeah, so Lorelei um, you know, described what was going on well. So we after we bring her into the OR, we apply what's called a frame. That's the funny thing that's on your head. And uh it's supposed to be fixed, steady with respect to the skull. So we take great care to make sure that that's properly placed, and then we use a special little cage that stays on temporarily so that we can do a scan. And from that scan, we get the very specific targeting instructions that now we can feed into a computer and use navigation. Most of this is done asleep, so you're not aware of what's uh what's going on. And then we get the access, you know, also while you're asleep. And so we access through an opening the size of a dime. And from that opening, we choose the safest straight line pathway between the surface of the brain and the point of interest. And as deep brain stimulation implies, that's the target tends to be deep below the brain surface. As we're going through, we hear different cells essentially talking to us. We understand the electrical activity and the pattern and the intensity, and so we can confirm that we're there. Once we believe that we're there, we now will wake up our patient. So we woke up Lorelei, and then now we wanted her to participate. We start to stimulate the brain in different ways. And one, we make sure it's safe so she's not having any unexpected side effects, and we ask where she's feeling any tingling or buzzing, and that also confirms for us that we know where we are. And then we impart a therapeutic dose of electrical activity, and then we have her move her arms, have her stick her arm out, and then we kind of test the efficacy. Once we do that and we're we're comfortable that we're in a safe place, we implant the therapeutic electrode, um, which is a little bit bigger and has a span, and then we test that as well. Once we're happy with the placement, then you go back to sleep. Okay. Uh, patients may have what's called a honeymoon effect or a or a lesion effect, where the tremor will go away for for a time just by placement of the electrode, and there's some swelling, you know, around there that tends to, you know, once again desynchronize the uh abnormal activity. After that, you know, in a second surgery, we implant the uh the battery. But the the surgery itself, and your question was how long does this last? And and keep in mind that everything is done with with extreme precision and care. So we we definitely believe in the measure twice and cut once, you know, uh philosophy, right? And and and it's more like you know, measure four times, and then you have also your your assistance, you know, check, double check as well. So everybody's on the same page, you know, before we do anything, because you know, we we believe that the brain is precious, and so we we only want to do um what's going to be beneficial. So the surgery itself for one side is probably about two to three hours of actual uh surgery. There's a lot of positioning and double checking and rechecking prior to to uh to being uh complete. And then after that, you're admitted to, we admit to one level below ICU, so a step-down unit um level of care. They still have eyes on you very carefully in that time. Prior to getting to the step-down unit, we do another scan, um, actually, another two scans before you get there. One to make sure that where the electrode is placed agrees with where we planned it, and then we get another scan to make sure that there's there's no evolution of any hematomas or any untoward or unwanted uh structural findings.
SPEAKER_03And I didn't know that DBS is also used for some psychiatric conditions like OCD. Is it the same surgery and kind of the same pathway to get to you?
SPEAKER_02Yeah, it's it's essentially the same surgery, but with different components. So in general, let's say with OCD or Tourette's or another type of, we involve the psychiatrists uh or psychologists in the actual procedure. So let's say for OCD, what happens is you know, we use the patient triggers to test the efficacy of the of the implant. So that's you know part of the process. The the surgery basically looks looks about the same. Uh you wouldn't be able to tell just looking through a window uh what which one we were doing, but it's the testing and the modification of the unwanted sensations or behaviors that we're monitoring in those circumstances. And so it's been used, you know, what's it for OCD, for Tourette's, for depression. It's been also used for epilepsy, which is not a psychiatric uh process, but it's used in that. And there are numerous other conditions that are a point of active investigation.
SPEAKER_03Laura Lai, I can tell by your energy and your description at the beginning of the interview how much DBS has changed your life prior to the surgery. How was essential tremor impacting your life?
SPEAKER_01I was diagnosed with this in the late 80s and given medication. And as the years went by, the tremor got worse and the medication was increased until I got to the point where I was mixed out on the and the tremor, it's called an intentional tremor. So whenever I wanted to do something with my left hand, it just wouldn't let me, it would shake and jerk. I couldn't eat properly. I like to have a salad for lunch. I was down to eating the salad with my hands because I could not spear the lettuce on the fork. It was scary to try to use a knife to cut up vegetables. I cut myself numerous times. Um I didn't go out to lunch with friends because it was embarrassing. I probably shouldn't have been, but I was embarrassed to go out, so I stopped doing that. Um I couldn't eat soup. I eat soup now. It's great. There is a feeling inside of you that I don't know, like your insides are jellow. That tremor isn't just in the hand, it's inside. So you're tense all the time. Um when they activated the pulse generator, I relaxed for the first time in years and took a deep breath. It was wonderful.
SPEAKER_03Doctor, it's really special to see the relationship between you and Laura Lai and just your investment in her success following the surgery to see patients succeed like that. I mean, it has to be a tremendous feeling for you.
SPEAKER_02It's it's remarkable. It's it's really remarkable. Each and each and every time that I see it, it's like the first time. Each person is is different. And you know, if you're you're alleviating a burden and you're helping to you know to be part of that, it's a it's very humbling to be given the opportunity to do that because it's a scary process. And so to have someone put their faith in you and your team, you know, to relieve them of that burden. It's uh it's really a privilege to have that.
SPEAKER_03Lorelai, I wish you continued good health. Thank you both so much for being here today.
SPEAKER_02Thank you so much. I really appreciate it.
SPEAKER_00Thank you, Steve Coates, Dr. Senatus, and Laurelai. Learn more about deep brain stimulation at Hartfordhealthcare.org slash DBS. Be sure to subscribe to Hartford Healthcare's More Life Podcast for more episodes on a wide range of important health topics. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Enron DePierre. Thanks for listening to More Life.
SPEAKER_05I'm ready for my clothes up. You know, I love this feeling. We can go anywhere we go.