Kevin Kelly thought that his family’s tradition of an annual ski trip to Canada would be impossible after his Parkinson’s disease diagnosis in 2011. But 14 years later, he is skiing, playing hockey and golf, and speaking publicly about the remarkable treatment called deep brain stimulation (DBS) that allows him to stay active.
“DBS surgery changed my life,” said Kevin.
He underwent DBS surgery following a recommendation by Mya C. Schiess, MD, a neurologist with UTHealth Houston Neurosciences Neurology – Texas Medical Center and director of the Movement Disorders and Neurodegenerative Diseases Program.
Parkinson’s disease
A chronic, progressive movement disorder, Parkinson’s disease is related to the decrease of dopamine-producing cells in the brain.
“Dopamine is a critical chemical for movement,” said Schiess, a professor and the Adriana Blood Chair in Neurology at McGovern Medical School at UTHealth Houston. “Low dopamine levels cause abnormal signaling in the brain.”
Estimated to affect 10 million people worldwide, Parkinson’s disease impacts men more than women and is an age-related disease, typically diagnosed in older adults.
“We correlate the relationship to age with changes in the immune system as we get older,” said Schiess.
Symptoms and diagnosis
Known for changes in physical movement, Parkinson’s disease actually has a variety of symptoms, some of which can begin 10-20 years before diagnosis, like loss of smell.
“Looking back, it seems that loss of smell was my initial symptom, and that happened long before the tremors,” said Kevin.
Other common early symptoms are constipation and rapid eye movement (REM) sleep disorder, where individuals physically act out vivid dreams.
“As the disease progresses, motor symptoms will begin to appear, and that’s when patients usually seek a diagnosis,” explained Schiess.
Kevin was diagnosed with Parkinson’s disease after noticing his left hand shaking. He was 52.
“I was devastated,” said Kevin. “My grandfather had Parkinson’s, so I knew what was ahead, and I had a 1-year-old daughter at home. A lot was racing through my head about our future together.”
Motor symptoms of Parkinson’s disease include tremors, slow or stiff movement, and muscular rigidity. These symptoms impact walking and balance. They may only impact one side of the body for five to 10 years before both sides are involved.
As the disease progresses, hypophonia may also set in. This is the loss of speech volume. Hypophonic speech can make the voice sound soft, monotone, and unclear. Cognitive function can also be impaired later in the disease, and multitasking may be difficult.
Treatment
There is no cure for Parkinson’s disease, but there are many medications and treatment options for symptoms.
After years of managing his symptoms with medication, Kevin’s disease progressed.
“I was walking very slowly and had to think about each foot placement,” said Kevin. “I began hunching over as I concentrated on walking.”
His abilities on the ice rink, a passion of his, had significantly declined, and his wife had to help him with buttons on his shirt.
In 2017, he opted for DBS, a surgical intervention.
Deep brain stimulation treatment for Parkinson’s disease
First approved by the Food and Drug Administration as a treatment for Parkinson’s disease in 2002, DBS harnesses the electrochemical nature of the brain to reduce symptoms.
One or two electrodes are implanted into the brain. They are connected through insulated wires, called leads, that run under the skin to a stimulator device, similar to a pacemaker, near the heart.
The stimulator produces mild electrical pulses that travel through the leads to the electrodes in the brain.
“By sending continuous electrical signals to targeted areas of the brain, the impulses that cause neurological dysfunctions can be blocked,” said Schiess.
DBS is not a cure for Parkinson’s disease and does not slow its progression, but it can greatly improve overall motor function by reducing tremors, slowness, and stiffness.
DBS procedure
The implantation for DBS is minimally invasive and completed in two stages. The first step is to place the electrodes into the brain through small holes in the skull. The electrodes are implanted into areas of the brain that coordinate muscle control. During this procedure, the patient remains awake and may be asked to move their arms and legs to test the placement. The leads are also placed under the skin at the back of the head. Patients typically spend one night in the hospital for observation following this procedure.
The second stage, implanting the stimulator device under the skin on the chest, is conducted two weeks later. During this short outpatient procedure, the leads are also connected to the stimulator.
Risks from DBS surgery include surgical complications, unsuccessful therapy, or worsening of symptoms. DBS treatment is not for everyone, and results can vary.
“More than 150,000 people worldwide have undergone DBS surgery. This is a very effective, long-lasting treatment, with most patients experiencing a 70%-90% suppression of tremor and other motor symptoms,” said Schiess.
A team-guided path to better outcomes
Using a team approach, doctors tailor DBS treatment to meet each patient’s needs. A neurosurgeon completes the surgery, and a neurologist establishes the electrical parameters of the stimulator, such as amplitude, frequency, and pulse width.
“We use a series of intraoperative electrophysiological data and functional testing in the clinic to program the electronic pulses to deliver the best therapy. This may take several appointments over the course of eight weeks to fine-tune,” said Schiess.
Recouping quality of life
Kevin’s recovery from the two surgeries was straightforward and, in fact, following his second procedure, he was on the soccer field with his daughter the same day.
“I met my wife at my daughter’s soccer game. When she arrived, she was surprised to see me on the field kicking the ball with the kids for the warmup. I remember her saying to me, ‘You are back!’ It was a very touching moment for us all,” said Kevin.
While he has significantly reduced symptoms thanks to DBS, Kevin remains on low-dose medication. He can button his shirts and is back to being a formidable hockey player.
“Before my surgery, my hockey team used to just deal with me and my slowness. I was the first one in the dressing room to suit up and the last one on the ice,” said Kevin. “After the surgery, my speed returned. I’m now scoring goals and skating fast. DBS was a lifesaver for me.”
“Eight years into his deep brain stimulation treatment for Parkinson’s disease, Kevin is doing amazingly well,” said Schiess.
Outlook following DBS
Kevin’s journey with Parkinson’s disease isn’t over. He attends stretching classes to stay limber and speech therapy to address the symptoms now impacting his voice.
“Parkinson’s doesn’t stop trying to mess with you. When there is a treatment like DBS available to you, take it,” said Kevin. “I knew there was a 1% chance something could go wrong in the operating room, but I also knew there was a 100% chance I was going to get worse without it. I’ve never looked back, and I can’t thank the team enough.”
