To say Steve Brown was hesitant about the idea of deep brain stimulation therapy to treat his tremor would be more than a mild understatement.
The 67-year-old teacher’s immediate reaction was no way, not going to happen.
Steve Brown, who suffers from essential tremor, was among the first patients to undergo deep brain stimulation therapy at UTMC, which has significantly reduced his tremor and improved his quality of life.
However, with one key anti-tremor drug doing nothing to stop his involuntary movements, and another causing nearly every side effect listed on the medication’s warning label, Brown reconsidered.
A little more than three months after having the procedure done at The University of Toledo Medical Center, the now steady-handed Brown has no regrets.
“I knew what the tremors were doing to my body, but I didn’t realize how depressed I was,” he said. “It’s been a world of difference. I finally kind of got my mojo back and instead of feeling 80, I’m feeling 60. I’m able to write cursive all the sudden. I couldn’t even print my name before. I would do it again in a heartbeat.”
An advanced neurosurgical option to address movement disorders associated with Parkinson’s disease and essential tremor, deep brain stimulation works by modulating the brain’s electrical signals.
During the procedure, a neurosurgeon carefully places tiny electrodes deep in the brain. Those probes, connected by wire to a pacemaker-like device that’s implanted in the patient’s chest, supply small amounts of electrical current that can significantly reduce tremors and improve some of the physical symptoms associated with Parkinson’s disease.
UTMC is the first and only hospital in the region to offer deep brain stimulation therapy.
Though it might sound like science-fiction, the procedure has been approved for use in the United States for more than two decades.
“It’s not the experimental treatment that a lot of people think it is,” said Dr. Jennifer Amsdell, a neurologist and movement disorder specialist at UTMC who treats Brown. “Deep brain stimulation is a well-tested, well-established option for certain patients suffering from essential tremor or Parkinson’s disease.”
While Parkinson’s is a progressive disorder affecting the central nervous system that can cause serious, sometimes life-threatening complications, essential tremor is not harmful itself.
Because of that, Amsdell said treating it is not always seen as a priority.
“Sometimes patients are told it’s just essential tremor, it’s benign, it only causes tremor,” Amsdell said. “But it affects people’s ability to carry out their activities of daily life, their ability to write, their ability to use tools, their ability to feed themselves in many cases. It can affect your balance. Even though it’s ‘just a tremor,’ it really impacts people’s lives.”
Brown’s tremor began when he was in his 40s. At first, it was mostly triggered by anxiety but as time went on, his tremor progressively got worse.
Between the tremor and the medication he took in an attempt to control it, he was exhausted. An avid photographer, he now had to brace himself to get a clear shot. He refused to eat around others and took to drinking his coffee through a straw. He had to give up woodworking.
“It’s easy to laugh now, but I was miserable. I really was,” Brown said. “You realize how things have been taken away from you. How little, by little, by little it’s robbing you of your life.”
In about half of cases — including Brown’s — there is a family history of tremor. Symptoms can show up in a patient’s 20s or 30s but are more likely to impact quality of life when a person enters their 60s or 70s.
“Essential tremor is actually really common as people age,” said Dr. Alastair Hoyt, a UTMC neurosurgeon who operated on Brown. “About 1 in 20 people over the age of 60 have essential tremor. Not all those people have it so badly they need to think about surgery, but if it’s interfering with activity, there’s no reason we need to wait. If it’s causing problems with your life, it’s time to treat, regardless of someone’s age.”
Most typically, the shakiness brought on by essential tremor affects both hands, though often it also affects their head and sometimes their voice. Some people have full body shaking or feel an internal sensation that they’re shaking even when they’re not. Medication is the first line of treatment, but only about a third of patients get good control of their tremor without experiencing significant side effects.
For those who don’t respond to medication, or who choose to discontinue medication because of side effects, deep brain stimulation therapy can be life changing. Statistically, patients usually see around an 80% reduction in tremor, Hoyt said.
The deep brain stimulation procedure is the same whether being done to treat Parkinson’s or essential tremor.
Under sedation, two small holes are made in the skull through which probes are inserted into the brain. The patient is then woken up and asked to do a series of tests while the device is powered on to help the surgeon zero in on precisely the right spot. After the patient is put back under general anesthesia, the surgeon fixes the electrodes in place and inserts the control and power module under the skin in their chest.
“A big part of our job in surgery is trying to put the electrodes in just the right spot where a little stimulation treats the tremor and we never have to turn up the stimulation so high that people get side effects they don’t like,” Hoyt said.
About 85% of patients, Hoyt said, are discharged the day after surgery. They’ll then return a week and half later to get their stiches out and continue meeting with a neurologist over the following weeks and months to program the device.
In Brown’s case, it took just two adjustments for he and his physicians to be happy with the result.
Today he’s able to work more efficiently on his tablet, get back into hobbies and again do simple things like bringing his wife a full cup of coffee in the morning.
“As I’ve told many people, the only thing scarier than having this surgery was not having it,” he said. “Every aspect of life that you can think of was impacted by the tremor. It’s not fully back to normal since the surgery, but every day I’m discovering I can do that with my right hand again. It has been life-transforming.”
