- I'VE HAD PARKINSON'S SINCE I WAS 28 YEARS OLD,
AND I'M 41 NOW.
- MR. O'GRADY IS A YOUNG-ONSET PARKINSON PATIENT
WHO DEVELOPED TREMOR-PREDOMINANT SYMPTOMS.
- MY PRINCIPAL SYMPTOMS AT FIRST WERE JUST A SLIGHT
TREMOR IN MY RIGHT HAND AND ARM, WHICH GOT WORSE, AND THEN
IT SWITCHED OVER TO MY LEFT ARM AND HAND, AND THEN
EVENTUALLY WENT TO MY FACIAL TREMORS, WHERE MY JAW WOULD
TREMOR AND MY LIPS WOULD ALSO HAVE A TREMOR IN THEM AS WELL.
- HE GOT TO A POINT WITH THE TREMORS BEING SO BAD THAT IF
WE WENT TO A RESTAURANT, HE COULDN'T CUT HIS OWN STEAK.
- HIS MAIN PROBLEM HAS BEEN TREMOR ALL ALONG.
FOR SOME PATIENTS, TREMOR IS THE MAIN PROBLEM, AND IT CAN
INTERFERE WITH USE OF THE HANDS BECAUSE OF THE SHAKING.
IN HIS CASE, I BELIEVE HE HAD TROUBLE AT WORK
BECAUSE OF THE TREMOR.
- HE HAD BEEN AN AIRCRAFT MECHANIC IN THE MILITARY
AND WAS ALWAYS VERY PROUD OF WHAT HE DID AND HIS ABILITY TO
DO THAT TYPE OF WORK.
SO THE WORK HE DOES NOW, IT DID START TO HAMPER WHAT HE
COULD DO BECAUSE HE'S A MECHANIC.
- IT GOT TO THE POINT TO WHERE IT WAS
GETTING--IMPACTING MY JOB.
I WASN'T ABLE TO HOLD THE NUT TO PUT ON A BOLT.
- MEDICATIONS REALLY BY DEFINITION HELP ALL PATIENTS
WITH PARKINSON'S DISEASE IN THE EARLY STAGES
OF THE DISEASE.
- AT FIRST, THE MEDICATIONS CONTROLLED MY TREMORS
PRETTY WELL,
AND THEN I HAD TO TAKE MORE AND MORE MEDICATION TO CONTROL
THEM TO WHERE IT GOT TO THE POINT WHERE THE MEDICATIONS
WERE NO LONGER HELPING.
- THE MOST COMMON THING WE SEE IS THAT A DOSE OF MEDICATION
DOESN'T LAST AS LONG AS IT USED TO.
SO NOW THE DOSES NEED TO BE TAKEN MORE
AND MORE FREQUENTLY.
AND THEN WE FIND THAT WE NEED TO ELEVATE THE DOSES
OF MEDICATION TO ACHIEVE THE SAME LEVEL OF SYMPTOM CONTROL,
AND WHEN WE DO THAT, WE SOMETIMES RUN INTO
SIDE EFFECTS.
- SIDE EFFECTS WERE DRY MOUTH, LETHARGIC WITH THE MEDICATIONS
THAT I WAS ON AND THE AMOUNT THAT I WAS TAKING AT THE TIME.
AND THERE WERE OTHER SYMPTOMS.
SOME DAYS, I'D BE REALLY TIRED.
SOME DAYS, I JUST DIDN'T REALLY WANT TO FUNCTION OR
EVEN GO TO WORK.
AND AT THAT POINT, THE DOCTORS DECIDED THAT IT WAS TIME FOR MY
QUALITY OF LIFE AND SATISFACTION, I GUESS,
BEING HAPPIER--IT WAS TIME TO HAVE THE DBS PROCEDURE DONE.
- DEEP BRAIN STIMULATION IS A SURGICAL TREATMENT
FOR PATIENTS WITH PARKINSON'S DISEASE THAT HAS ADVANCED TO
THE POINT WHERE THEIR MEDICINES ARE NO
LONGER EFFECTIVE.
- THE DBS SYSTEM HAS 3 COMPONENTS.
THERE IS AN ELECTRODE THAT'S IMPLANTED BY THE SURGEON INTO
THE BRAIN CONNECTED TO A WIRE THAT THEN IS CONNECTED TO
A PACEMAKER-TYPE DEVICE PLACED IN THE CHEST.
THIS IS A FULLY IMPLANTABLE SYSTEM, AND THE DEVICE
DELIVERS ELECTRICAL PULSES TO THESE DEEP BRAIN TARGETS THAT
ARE MALFUNCTIONING IN PARKINSON'S DISEASE.
- PART OF THE SYSTEM IS THIS ELECTRODE.
THIS IS THE ELECTRODE THAT GOES INTO THE BRAIN, AND IT'S
QUITE SMALL, AND IT'S FLEXIBLE.
IT'S ABOUT THE SIZE OF A NUMBER TWO PENCIL LEAD.
IT'S 1.2 MILLIMETERS IN DIAMETER.
AND THE GOAL IS TO PLACE THIS INTO A SPECIFIC AREA
OF THE BRAIN.
I HAVE A CROSS-SECTION MODEL OF THE BRAIN HERE.
AND THESE STRUCTURES ARE ACTUALLY DOWN IN THE VERY
BOTTOM, THE VERY BASE OF THE BRAIN.
THAT'S WHY WE CALL IT "DEEP" BRAIN STIMULATION.
AND SO ONE OF THE AREAS IS THIS PURPLE AREA, FOR EXAMPLE.
THAT'S THE THALAMUS.
AND SO WE'LL COME THROUGH THIS PART, THIS FRONTAL PART
OF THE BRAIN CALLED THE FRONTAL LOBE, TO IMPLANT
THE ELECTRODE IN THIS AREA.
SO THE INCISION GOES ACROSS THE TOP OF THE HEAD, USUALLY
JUST BEHIND THE HAIRLINE,
AND WE'LL PUT A SMALL HOLE IN THE SKULL,
AND THIS WIRE WILL GO INTO THE BRAIN, AND THEN THE WIRE RUNS
UNDERNEATH THE SKIN, SORT OF BEHIND THE EAR DOWN ALONG THE
NECK, AND IT COMES JUST BELOW THE COLLARBONE TO ANOTHER
INCISION, WHERE WE PLACE THE BATTERY PACK, OR WE CALL IT
THE PULSE GENERATOR.
AND THIS IS WHAT THAT LOOKS LIKE.
- WE DON'T KNOW EXACTLY WHY IT'S HELPFUL, BUT WE THINK THE
ELECTRICAL PULSES BLOCK OR OVERRIDE THE ABNORMAL BRAIN
ACTIVITY THAT IS OCCURRING AT THOSE TARGETS.
WHEN THOSE CIRCUITS THEN HAVE MORE NORMAL ACTIVITY, THEY CAN
CONTROL MOVEMENTS BETTER.
SO THE TREMOR IS IMPROVED, THE STIFFNESS IS IMPROVED,
THE SLOWNESS IS IMPROVED, THE WALKING IS IMPROVED.
- SO THERE ARE RISKS WITH DOING DBS SURGERY.
IT IS A BRAIN OPERATION, AND WE'RE PUTTING THESE
ELECTRODES DEEP DOWN INTO THE BRAIN.
- AND THE MOST SERIOUS POTENTIAL COMPLICATION IS
BLEEDING IN THE BRAIN, HEMORRHAGE, WHICH CAN
CAUSE A STROKE.
- SO THE RISK OF CAUSING ANY AMOUNT OF BLEEDING
IN THE BRAIN IS ABOUT 2% TO 3%.
SO 2 OR 3 PEOPLE OUT OF 100 CAN HAVE BLEEDING IN THE BRAIN
WITH DBS SURGERY.
NOW, FORTUNATELY, MOST OF THE TIME, IT'S A VERY SMALL AMOUNT
OF BLOOD AND IT ACTUALLY DOESN'T CAUSE SYMPTOMS.
BUT THE RISK OF HAVING A HEMORRHAGE LARGE ENOUGH TO
CAUSE SYMPTOMS IS .5%.
SO IT'S 1 IN 200.
BUT IF YOU GET A BIG HEMORRHAGE, IT CAN
BE DEVASTATING.
IT COULD PARALYZE A PATIENT, IT COULD PUT A PATIENT
IN A COMA, AND IT COULD KILL THEM.
SO PEOPLE CAN AND HAVE DIED HAVING THIS SURGERY DONE.
SO THAT'S AN IMPORTANT THING TO THINK ABOUT.
- I HAD NO COMPLICATIONS WITH MY SURGERY.
SURGERY WENT FINE.
RECOVERY WAS...NO PROBLEM.
I WAS IN AND OUT OF THE HOSPITAL IN A COUPLE OF DAYS
AND BACK AT HOME.
NO INFECTIONS, NO BLEEDING.
- WELL, THE OUTCOME THAT MR. O'GRADY
ACHIEVED WAS PRETTY TYPICAL IN THAT THE TREMOR IS
SUBSTANTIALLY REDUCED, AND WE'VE BEEN ABLE TO
ACCOMPLISH THAT WITH LOWER DOSES OF MEDICATION AS WELL.
AND IN HIS CASE, THE MEDICINES HAD BEEN CAUSING SOME SIDE
EFFECTS FOR HIM, AND BY BEING ABLE TO REDUCE THE MEDICINES,
WE WERE ABLE TO REDUCE THOSE-- AND ELIMINATE, FRANKLY--
THE SIDE EFFECTS.
SO NOW HE HAS MUCH BETTER FUNCTION, THE ABILITY TO USE
THE HANDS.
THE TREMOR REALLY DOESN'T BOTHER HIM AT ALL, AND HE'S
ABLE TO TAKE LESS MEDICATION.
- FROM THE SECOND IT WAS OVER AND THEY CAME OUT AND SAID IT
WAS A SUCCESS, YOU KNOW, "IT'S AMAZING, YOU WON'T
BELIEVE THE RESULTS"...
- AS SOON AS THEY TURNED IT ON,
HERE IN THE OFFICE, WITH SUSAN PROGRAMMING ME,
IT WAS AMAZING.
- DEEP BRAIN STIMULATION PROGRAMMING IN THE BEGINNING,
THERE'S SEVERAL SESSIONS DEPENDING ON THE SYMPTOMS
AND WHEN YOU START, BUT AFTER YOU GET IT TUNED UP
TO WHERE THE PATIENT IS DOING WELL,
USUALLY ONCE A YEAR FOR AN ADJUSTMENT.
- SHE DOES SEVERAL TESTS WHERE SHE TESTS MY HAND MOVEMENTS,
MY SPEECH, MY LEG CONTROLS, DIFFERENT FUNCTIONS, AND THEN
SHE'LL MAKE A SMALL ADJUSTMENT UP OR DOWN ON THE SENSITIVITY.
- THE PATIENT CONTROLLER, THE PROGRAMMER, HAS A DISPLAY
ON IT THEY CAN SEE WHAT THEIR SETTINGS ARE.
- I CAN ALSO CONTROL THE STIMULATION UP AND DOWN WITHIN
A SET PARAMETER.
- ONE OF THE FEATURES THAT WE TAKE ADVANTAGE OF IS TO
PRE-PROGRAM INTO THE DEVICE DIFFERENT SCENARIOS,
AND THE PATIENT CAN TRY THEM ALL OUT.
- WE CAN GIVE THEM PLAN A OR GROUP A
AND GROUP B.
TRY THIS FOR A WEEK AND SEE HOW YOU LIKE IT, AND TRY THIS
FOR A WEEK AND SEE HOW YOU LIKE IT.
- WORK IS REALLY IMPORTANT TO ME.
I FEEL THE LONGER THAT I CAN WORK, THE LONGER IT'LL TAKE MY
PROGRESSION TO PROGRESS BECAUSE I'M STAYING ACTIVE.
- I THINK THAT THE SPOUSES NOTICE THAT WITH THE DBS
SURGERY, A TYPE OF BRADYKINESIA
IS LOSS OF FACIAL EXPRESSION, AND THEIR SMILE RETURNS.
- WE WERE IN THE ROOM, AND SUSAN WAS PROGRAMMING HIM,
AND SHE HAD HIM WALK, AND HE COULD SWING HIS ARMS AGAIN,
WHICH I HADN'T SEEN HIM DO IN A LONG, LONG TIME.
AND THAT'S WHEN I HAD TO LEAVE THE ROOM BECAUSE THAT WAS KIND
OF A TEARJERKER FOR ME.
AND HE COULD SMILE AGAIN.
HE HAD HIS BIG SMILE BACK, AND I THINK THAT WAS
THE MOMENT THAT I WAS MOST GRATEFUL FOR.
- I BELIEVED IN IT, THAT IT WAS GOING TO HELP.
IT WAS A BIG STEP FOR MYSELF TO TAKE.
BUT I'M GLAD I DID IT.
AND THE AFTEREFFECTS OF IT HAVE BEEN A REAL BIG POSITIVE
FOR ME IN MY LIFE, TO KNOW THAT I CAN KEEP BEING
PRODUCTIVE, SPEND TIME WITH MY WIFE AND MY KIDS.