No one knows exactly why some people develop Parkinson’s disease. It can seemingly strike at random, though genetics and environmental factors are thought to play a role.
The neurological disorder can cause myriad symptoms, including a hallmark tremor and other uncontrollable movements, muscle rigidity or stiffness, impaired balance, gradual loss of spontaneous movement, decreased coordination, delayed reactions, mood changes and cognitive decline.
Parkinson’s disease is progressive and there is no cure. But a procedure called deep brain stimulation (DBS), which involves implanting an electrical device in the brain, can, when combined with medication, provide relief from symptoms and help patients regain control of movement. It’s become a lifeline for thousands of people with Parkinson’s disease. Just ask Renee Smith.
Parkinson’s often starts with a slight tremble, but no two patients are alike. Smith, 62, had spent about a decade before her diagnosis seeing various doctors in her former home, Denver, for chronic pain.
“I was going to doctors all the time because my body was hurting,” she says. “I had a lot of back problems and a lot of pain, but I couldn’t find anybody that would diagnose me with anything.”
After moving to Menifee, she again sought help for pain management and the occasional inability to move her legs — she described it as feeling like her feet were glued to the ground. That doctor noticed Smith’s muted facial expressions and brought up the possibility of Parkinson’s disease. It came as a shock to Smith, but she followed the doctor’s advice and saw a neurologist, who confirmed the first doctor’s suspicion.
Smith was prescribed medication, saw a couple more doctors who worked to get the combinations and dosages right, then eventually began seeing Melissa Houser, MD, a neurologist at Scripps Clinic Torrey Pines, and founder and clinical director of the Parkinson’s Disease and Movement Disorder Center at Scripps Clinic.
“Parkinson’s disease is a neurological disorder that for reasons we don’t clearly understand yet causes the brain to very slowly, over time, stop making a critical neurotransmitter called dopamine,” says Dr. Houser.
“Without dopamine, you can’t move properly,” she explains. “You either move too much, like in the case of tremor, or you move too little — something that we call bradykinesia. And often people have muscle rigidity, so the muscles feel tight and weak. Many patients describe it as trying to move through molasses or trying to walk with a parking brake on.”
While medications can help manage symptoms of Parkinson’s disease and stabilize neurotransmitters, they provide limited relief. Since Parkinson’s disease is progressive, many patients eventually see a decline in their condition, even with medication.
DBS can be an option when Parkinson’s disease and related symptoms need supplemental treatment. The FDA-approved surgery has helped more than 100,000 patients worldwide who have Parkinson’s, essential tremor and dystonia.
In some cases, DBS can significantly reduce the need for medication, so it may be beneficial when a patient is on a high dose of medication that could cause unwelcome side effects if increased.
Dr. Houser wasn’t the first doctor to suggest Smith undergo DBS, but when she brought the procedure up during a visit two years ago, Smith, who had been relying on medication to reduce her symptoms, was finally ready to give it a go.
“Dr. Houser recommended it to me again and I thought, maybe I am ready, maybe it’s time,” Smith says.
DBS surgery involves implanting electrodes in certain parts of the brain. They deliver electrical stimulation via a thin insulated wire that runs under the skin of the head and neck and is connected to a stopwatch-sized programmable battery placed just under the skin in the patient’s chest. DBS signals stimulate specific areas of the brain to treat and improve tremors and other Parkinson’s symptoms.
“Think of like a pacemaker, but instead of the wire going to the heart to pace the heart signals, it’s going to go to the brain, giving it a stimulation frequency that’s going to override the abnormal frequency,” says Nelson Hwynn, DO, a neurologist who specializes in Parkinson’s disease at Scripps Clinic.
DBS can be done on one hemisphere of the brain, unilaterally, or on both sides simultaneously. Not every patient is a candidate for DBS and a team of experts makes a recommendation in each case.
After neuropsychological testing, memory tests, off/on medication video scoring and other measures, Smith and her multidisciplinary care team decided unilateral DBS would be the best course of action. She underwent the first procedure on the left side in 2021 and received the second DBS implant this fall.
“We’re one of the older established DBS centers in San Diego. We have a very comprehensive center that has doctors, nurses, neuropsychologists and physical therapists trained in Parkinson’s and we have experience with all three of the companies that make DBS devices, so we’re able to tailor treatment to each patient.”Nelson Hwynn, DO
Scripps Clinic Deep Brain Stimulation Program, part of the Parkinson’s Disease and Movement Disorder Center, brings together specialists in DBS surgery who use the most advanced technology. Scripps neurologists, neurosurgeons, neuropsychologists and others work together to provide appropriate treatment, and participate in ongoing research with the goal of advancing the science of DBS, and making continued improvements in patient outcomes.
“We’re one of the older established DBS centers in San Diego,” says Dr. Hwynn. “We have a very comprehensive center that has doctors, nurses, neuropsychologists and physical therapists trained in Parkinson’s and we have experience with all three of the companies that make DBS devices, so we’re able to tailor treatment to each patient.”
The team spirit extends to the operating room. The neurosurgeon and neurologist work together during DBS surgery. After a surgeon identifies the target area via stereotactic strategy planning and imaging, Dr. Hwynn, who has specialized knowledge in microelectrode recording, deciphers the signals that each set of nuclei cells gives off to guide the neurosurgeon as the electrodes are inserted into the brain to ensure they’ve reached the clinical sweet spot.
DBS surgery is typically done in two parts. The electrodes are placed first followed by the battery a couple weeks later. Most patients spend only one night in the hospital. Once they’re healed, the DBS device is programmed to best control symptoms. At Scripps, they’re programmed by Sherrie Gould, NP, a highly experienced programmer who educates medical professionals around the country.
The first programming visit is done in-office and unmedicated, so doctors and the programmer can see the results without medications masking the patient’s symptoms.
Many people feel some relief immediately, but results vary, and some require several programming sessions before experiencing the maximum benefit of DBS. For patients like Smith, that used to mean more than an hour in the car each way for each session. However, advances in technology make it possible to have the device programmed at home. All it takes is a smart phone and a good Wi-Fi connection.
“Up until recently, patients have had to come into the office for the programming visits, which is a little difficult when they live as far away as [Smith] does,” says Dr. Houser. “Even people in remote areas, especially out east, it’s too onerous to have to come to our office to get programmed. Now they can get it programmed remotely, and that’s a big advance for us.”
While on a video call with the patient, the programmer fine-tunes the power to the electrodes. They can be adjusted to various combinations that control tremor, slowness of movement, improve speech, or in Smith’s case, address the feeling of freezing in place. Earlier settings are saved, so the patient has some degree of control over their own treatment between sessions. The patient’s medications are also lowered accordingly. Patients are monitored and their devices recalibrated for life.
“I’d recommend DBS to anybody. It took me a while to decide that I was going to have it, but after I talked to the doctors, I felt comfortable, and I trusted them. I think I’m going to be very, very happy with this.”Renee Smith
“In general, the brain acts like an orchestra trying to tune up — various instruments going at various rates at various frequencies. But with Parkinson’s disease, the orchestra starts to all play the same tune, and it’s not supposed to,” says Dr. Houser.
“With deep brain stimulation, one theory is that it descrambles that synchrony, it desynchronizes the chatter and makes the brain a little bit more like the normal cacophony you hear when they’re not all playing together.”
Smith checks in with Gould every few months for programming. The process is done unmedicated and it’s painless.
“While I’m sitting there, I don’t feel anything, but the moment that she gets the right spot, I can get up and walk and I don’t have the problems I would have before,” Smith says.
Despite a few bumps during recovery from her first surgery, Smith has been able to reduce the number of medications she takes and has returned to some of her hobbies, including line dancing, pool volleyball, gardening, going on walks with her husband and connecting with her two adult children.
Her second surgery went off without a hitch and she was even able to resume boxing just a few weeks out. Pre-pandemic, she participated in a program at a local boxing gym designed for people with Parkinson’s disease that uses non-contact boxing moves to help patients “fight their disease.” She has taken what she learned there and translated it to her home gym where she has a setup with a heavy bag and a speed bag.
“That just opened up my world because it’s not only physical, it’s mental, too,” she says. “It gives you so much support and you’re with people that have the same issues. You can just talk with each other and relate. It’s a really good thing.”
Smith is thriving and especially active, and she credits her Scripps team for her renewed vigor.
“I’d recommend DBS to anybody,” she says. “It took me a while to decide that I was going to have it, but after I talked to the doctors, I felt comfortable, and I trusted them. I think I’m going to be very, very happy with this.”
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.