Written by VICTORIA CLAYTON
Excerpted from “Saving Brains” in Providence Health Magazine
At Providence Saint John’s Health Center in Santa Monica, neurologist Melita Petrossian, MD, and neurosurgeon Jean-Philippe Langevin, MD, have opened a new movement disorders program that includes deep brain stimulation (DBS)—an innovative surgical treatment for patients with Parkinson’s disease, essential tremor, dystonia and many other brain and movement disorders. Medication is still the first-line treatment for most neurological and movement disorders. As Parkinson’s disease progresses, medications may lose efficacy and/or patients may begin to experience more bothersome dyskinesias (abnormal, involuntary movements). That’s where DBS comes in.
DBS is best described as a pacemaker for the brain. Surgeons implant a battery under the skin near the collarbone. Leads or wires are then tunneled under the skin, in the neck, behind the ear and into deep regions of the brain such as the subthalamic nucleus or the globus pallidus interna. “The exact placement of the electrodes depends on the patient. It’s a very fine tuned, personalized procedure—we’re often working on regions no bigger than 5 millimeters,” says Dr. Petrossian. The paradox with DBS is that stimulating the STN or GPi regions with the electrodes actually reduces abnormal electrical over-activity, improving mobility and calming the involuntary movements experienced by patients. “For the right patient, a successful DBS procedure can be life-changing. And I’m not saying that lightly,” says Dr. Petrossian.
“However, DBS isn’t a cure or even a treatment that prevents progression of the diseases. But it does provide a better quality of life, sometimes lasting for many years.” On average, patients with Parkinson’s disease who undergo DBS gain five valuable hours per day of productive, dyskinesia-free time. Tremor is also reduced by about 75 percent compared to prior to the procedure. “Not all patients with Parkinson’s, essential tremor or other diseases are candidates for DBS,” says Dr. Petrossian. “But many, many are. Recently, the Food and Drug Administration approved DBS for use earlier in the course of Parkinson’s disease. So DBS should not be considered a last resort for patients and should be considered if a patient with Parkinson’s disease has dyskinesias or fluctuating response to medications for four months.”
At the movement disorders and deep brain stimulation program, Dr. Petrossian also treats a full spectrum of neurological and movement disorder patients with medications as well as Botox injections. “People are always really surprised that Botox can be used in a non-cosmetic way,” she says. Botox, a neurotoxin that temporarily disrupts communication between the nerves and muscles, allows the muscles of patients with spasms in the face, eyelid, neck, arms and legs to relax. And every year more medications and different treatment options become available for movement disorders, giving Dr. Petrossian, who admits to being an optimist, plenty of reasons to believe in a brighter future for movement disorders.
“Very often we see people who have suffered for years with a tremor, for example, and they think there’s nothing that can be done because that’s what they were told many years ago. The message I really want to get out is that there may be plenty we can do for you right now to drastically improve your quality of life,” she says. The key, though, is seeing a neurologist trained in the movement disorders subspecialty. “The vast majority of cases are clinically diagnosed, which means the doctor has to have a trained eye. Being a specialist in the area also means you’re aware of the most recent treatments and advances in the field.”
The full article about neurological services expanded to cover a range of serious disorders can be found in Providence Health Magazine Fall 2016 Fall issue.
The Pacific Movement Disorders Center at Pacific Neuroscience Institute is located at Providence Saint John’s Health Center. Our specialists see patients with a wide range of movement disorders including Parkinson’s disease, dystonia and essential tremor.