Awake for brain surgery: DBS used to treat Parkinson's

December 11, 2011

Doctors in Phoenix are using a medical procedure known as deep brain stimulation or DBS to treat symptoms of Parkinson’s disease. But DBS also is showing promise in the treatment of depression, Alzheimer’s and other disorders of the brain. KJZZ’s Terry Ward observed the procedure on a patient at Barrow Neurological Institute and has this report.

STEWART MARTZ:  My name is Stewart Martz. I’m 42 years old and I was diagnosed with Parkinson’s in 2003… and that’s me.

Deep brain stimulation surgery

Dr. Francisco Ponce prepares a patient for deep brain stimulation in hopes of treating the symptoms of Parkinson's disease. The procedure is performed at Barrow Neurological Institute in Phoenix. (Terry Ward – KJZZ)

TERRY WARD: You can’t tell by looking at Stewart Martz that he has Parkinson’s disease. His stride is slow and rigid when he walks, but absent are the tremors that typically define the disease. His symptoms are well-controlled by medication. And judging by his sense of humor, you also can’t tell that he’s scheduled for brain surgery tomorrow morning.

STEWART MARTZ:  I joke about that song by Cypress Hill, “Insane in the Membrane.” I thought that’d be fun if they’d play that while I’m in surgery. I always say everybody’s gotta have something and I have Parkinson’s so life is full of choices and you can choose to be happy or not. I go to work and love my job and give 110% and try to smile.

TERRY WARD: Martz is a Phoenix police officer assigned to the organized crime unit until his diagnosis at the unusually early age of 34.

STEWART MARTZ: I used to patrol so now I’m in a non-contact position, doing the paper shuffle. I used to worry about being shot. Now all I have to worry about is a paper cut.

TERRY WARD: About 60,000 new cases of Parkinson's are diagnosed in the United States each year. One million Americans have the disease. There is no cure.

Most Parkinson’s patients respond well to medication, but the meds tend to become less effective over time. And that’s when deep brain stimulation can be used.

FRANCISCO PONCE: We make the analogy to cardiac pacemakers.

For more on deep brain stimulation,
view a video from the Mayo Clinic.

TERRY WARD: Dr. Francisco Ponce is the neurosurgeon who will perform the operation on Martz. In deep brain stimulation, a nickel-sized opening is made in the patient’s skull, a thin wire or electrode is inserted into the brain.

FRANCISCO PONCE: It’s about 8 centimeters below the surface.

TERRY WARD: The electrodes are powered by a battery pack, implanted under the patient’s collarbone.

FRANCISCO PONCE: That sends electrical signals to these electrodes that are deep within the brain. And these signals help restore the normal chaos in the brain.

TERRY WARD: The way this procedure is done while the patient is awake.

STEWART MARTZ: It was kind of unnerving at first.

TERRY WARD: Dr. Ponce says being awake is vital to success.

FRANCISCO PONCE: The patient can tell when the stimulator is on. They can feel restoration of normal movement. And they’ll comment on that.

TERRY WARD: It’s early on a Tuesday morning and Stewart Martz is lying on a gurney in the operating room surrounded by several million dollars worth of medical equipment. His blood pressure scrolls across a bedside monitor: 129-over-80. Not bad for a patient preparing for brain surgery. He appears relaxed. He sees me as I walk in wearing gray scrubs.

STEWART MARTZ: Hey, what’s happening, Terry?

TERRY WARD: How do you feel, buddy?

STEWART MARTZ: Just a little hungry but other than that, ready to roll.

TERRY WARD: This may be a good time to tell you that brain surgery is not for the squeamish. Dr. Ponce starts the drilling. Water is poured over the area to lessen the heat build-up from the friction. Martz is aware of what’s going on but he has no reaction. His blood pressure and heart rate rise only slightly.

For the next hour or so, the procedure slows to a crawl. The electrode that eventually will deliver a small electrical charge to the target area digs deeper into Martz’ brain as a digital read-out counts the depth, a fraction of a millimeter at a time, until finally, the doctors feel they have reached the sweet spot.

ROHIT DHALL: Open-close hand. Tap tap tap.

TERRY WARD: Dr. Rohit Dhall, the attending neurologist at Barrow, is asking Martz a series of questions to confirm that the electrode has hit its target.

STEWART MARTZ: I can feel pulling in my right shoulder.

TERRY WARD: Along with getting the location right, setting the voltage also is critical to maximize the benefits.

ROHIT DHALL: The tone is better. I can tell.

TERRY WARD: The procedure appears to be a success. While doctors finish-up their work on Martz’ still-open skull, he says he could feel that the electrode was doing its job.

STEWART MARTZ: I could tell the difference when I was doing those movements. It’s been a long time since I’ve been able to move my hand like that. So… incredible.

TERRY WARD: The hard part is over. But it’ll be another week before the final battery pack is installed. Martz will have to wait at least that long before the full benefits are known. He’s agreed to a future interview to talk about his progress and what is hopefully, his new life without the debilitating symptoms of Parkinson’s disease. For KJZZ, I’m Terry Ward.

For more on deep brain stimulation, view a video from the Mayo Clinic.


EDITOR'S NOTE (12/13/2011): An earlier version of this story misspelled the name of Dr. Rohit Dhall.