• Deep in the brain

    Deep brain stimulation helps some people with Parkinson's achieve a more normal life
  • Watching Dennis Gladman feeding cattle, you wouldn't know he's had Parkinson's disease for 20 years.
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    • What is Parkinson's disease?
      Parkinson's disease is named for James Parkinson, a British physician who described what he called "the shaking palsy" in an 1817 essay.
      At the most basic level, Parkinson's disease can be descr...
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      What is Parkinson's disease?
      Parkinson's disease is named for James Parkinson, a British physician who described what he called "the shaking palsy" in an 1817 essay.

      At the most basic level, Parkinson's disease can be described as the brain's inability to produce adequate levels of dopamine, a chemical that helps the muscles move smoothly. The brain cells that normally produce dopamine gradually fail, and when dopamine levels drop sufficiently, the symptoms of Parkinson's appear.

      Parkinson's is not fatal, but complications from the disease are rated as the 14th top cause of death in the United States, according to the federal Centers for Disease Control and Prevention.

      Symptoms vary widely among patients. Four main symptoms include shaking (what physicians call "tremor") at rest; slowness of movement (bradykinesia); stiffness or rigidity of the arms, legs or trunk; and balance problems that can cause the patient to fall.

      Secondary symptoms include small, cramped handwriting (micrographia); foot drag that produces a shuffling walk; and low voice or muffled speech. Parkinson's is also associated with depression, anxiety, sleep disturbances and constipation.

      In the United States, at least 500,000 people are believed to suffer from Parkinson's disease, and the National Institute of Neurological Disorders and Stroke estimates that about 50,000 new cases are reported annually. Parkinson's appears to be slightly more common in men than women, and the average age of onset is about 60. Both prevalence and incidence increase with advancing age. The disease is rare among people under 40.

      Some 6 million cases have been diagnosed around the world, in varying rates. Researchers don't know whether the discrepancy is due to differences in data collection or real ethnic or geographic differences.
  • Watching Dennis Gladman feeding cattle, you wouldn't know he's had Parkinson's disease for 20 years.
    Gladman's hands are steady as he tosses hay to the cows that roam his 140-acre ranch in the Agate Desert, a dry patch of buckbrush and scattered timber where the suburbs of Central Point and Eagle Point give way to open country. He doesn't have the herky-jerky, jiggy, involuntary limb movements that are so common among Parkinson's patients.
    "I keep pretty busy," the 66-year-old Navy veteran says. "I do a lot of things around the farm, and I'm sure I can do more because of the procedure."
    "The procedure" Gladman's talking about changed his life. Back in 2008, physicians drilled holes on opposite sides of his skull and inserted two thin wires into his brain. The wires deliver a tiny electric current that dramatically reduces the uncontrollable shaking that can be embarrassing for Parkinson's patients.
    "It makes a huge difference in my comfort level with people," he says. "My hands are really steady."
    The electricity comes from a battery that is usually implanted beneath the patient's skin near the collarbone. Wires from the battery go under the skin to the skull. Batteries can be replaced, like those that are used for cardiac pacemakers.
    Physicians call the procedure "deep brain stimulation," or DBS, and it's been recognized as an effective treatment for Parkinson's for years. Most candidates for the surgery have struggled with Parkinson's for 10 years or longer. Drugs can control the symptoms, but patients have to take more medicine as their symptoms increase, and the side effects can become intolerable. Like Gladman, many find new relief after DBS.
    Ann Wolf of Eagle Point was able to resume playing golf after surgeons implanted the wires in her brain.
    "For two or three years after the procedure, you couldn't have even told I had Parkinson's," she says.
    Wolf was just 36 when she was diagnosed in 1986. She calls DBS "the best thing I've ever done. I felt like it extended my life. I just felt like I was dwindling and failing to thrive."
    Unfortunately, Parkinson's is a progressive disease for which there is still no cure, and DBS only relieves the symptoms. Over time patients' symptoms often return. Still, neurologists who have worked with Parkinson's patients for decades take satisfaction from how well DBS can control symptoms and improve patients' quality of life.
    "It is truly amazing," says Dr. Kevin Sullivan, a Medford neurologist who has been treating Parkinson's patients for about 40 years, and using DBS since 2000. He's worked with more than 50 local DBS patients, fine-tuning the current delivered to the brain after surgeons implant the wires, usually at Oregon Health & Science University.
    Sullivan uses a brick-sized electronic control device to adjust the strength of the current and select the site where it will be delivered in the brain. Effects vary with each patient's stage of disease. The results, he says, often are nothing short of magical.
    "I can pass an electronic wand over a patient's chest and hit a button, and the movements stop cold."
    Sullivan says new studies suggest DBS could one day be used to treat Alzheimer's disease. In one small Canadian study, surgeons implanted wires in the brains of six Alzheimer's patients. CTV News reported in March that after two years, three patients' symptoms had worsened, based on their performance on a standardized cognitive test, but two others' scores remained the same, suggesting their disease had stabilized, and one man's scores actually improved.
    Doctors also performed MRI exams on the brains of the six patients, CTV reported. The area of the brain associated with memory tends to shrink in most Alzheimer's patients, but the electrical stimulus appeared to make that part of the brain grow in two of the six patients, including the one whose cognitive function improved.
    It would be years before the procedure could be approved for treating Alzheimer's. The Canadian study was a phase 1 trial. Phase 2 and 3 trials would also need to be conducted, and each of those would take at least three years, according to the CTV report. Researchers are currently seeking approval for a phase 2 trial that would involve 40 to 50 patients.
    Sullivan, who turned 70 on his last birthday, says working with DBS patients is one of the reasons he's still practicing medicine.
    "That's why I'm still going," he says. "I love taking care of movement disorders. It's so rewarding. It's kind of why we're doctors — being able to help people so dramatically."
    Bill Kettler is a freelance writer living in Rogue River. Reach him at bdkettler@gmail.com.
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