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Back on par: Deep brain stimulator keeps retiree active despite Parkinson's disease

	Neal Wilson is back in the swing of things now that his tremors are controlled.

Neal Wilson loved his work as a radiology administrator. So much so that he worked 16-hour days just because he enjoyed the people and the challenges of his job. But theWashington state native and father of four also enjoyed spending time with his family, sharing various hobbies, including hunting and golf. When he moved his family to Florida, Wilson bought a home next to the second fairway of a golf course and spent many sun-kissed days hitting the links with his sons.

In late 1996,Wilson's left foot began to drag as he walked. Although he worked at Mayo Clinic, he says he didn't recognize it as a symptom. When other people noticed his irregular gait, he would tell them that he'd sprained his ankle or twisted his foot. During a routine physical the following year, he mentioned it to his doctor.

"I said that sometimes my left foot would drag on the floor," says Wilson. "He knew right away what it was and scheduled me for a neurological exam."

Wilson saw Mayo Clinic neurologist Dr. Ryan Uitti, who confirmed that he had Parkinson's disease, a progressive disorder named after the doctor who documented the "shaking palsy" in 1817. The disease affects nerve cells in the part of the brain that controlsmuscle movement.

Following his diagnosis, Wilson kept up his typical routine, making rounds between radiology departments and talking with staff and patients. But over time,despite medication, the uncontrolled trembling that is the hallmark of Parkinson's began to impact his lifestyle.

"Because of my foot, it was becoming more difficult to walk and make my rounds," he says. "I also had tremors in my left hand, and I couldn't stop my head from moving."

Then there was the added stress of driving. Wilson, whose work hours began at 6:15 a.m. and would go to 8 p.m., would get up at 4 a.m. to drive to work on empty streets because he was becoming fearful of driving.

During a 2005 checkup with Uitti, Wilson learned about deep brain stimulation, which had been successful in suppressing tremors by blocking brain signals with mild electrical stimulation.

"Stimulation can produce all the beneficial results of the medication without the medication," says Uitti. "It allows many patients to significantly reduce their medications and avoid side effects from higher doses."

Wilson opted to give it a try, and in October 2005, neurosurgeon Dr. Robert Wharen implanted a thin, insulated wire lead with four electrodes at the tip into the thalamus area of Wilson's brain. Another wire was inserted under the skin and connected to a battery-operated generator implanted near his collarbone. Then, with Wilson awake to communicate during the 90-minute operation, doctors positioned the electrodes in different areas of his brain to test for effectiveness in suppressing his symptoms. Once they received positive results, the generator was programmed to send continuous electrical pulses to the brain.

"By stimulating this area of the brain, we can relieve tremor, relieve rigidity and relieve bradykinesia, which is the slowness or inability to move that Parkinson's patients have," says Wharen, who has performed more than 400 procedures since 1997, when the clinic began conducting research trials using deep brain stimulation for Parkinson's. The FDA approved the procedure for widespread use later that year.

"It's been a proven success with a relatively low risk," says Wharen, noting the primary risks are infection, device failure and bleeding, which can lead to a stroke. He estimates that the risk of a stroke is less than 1 percent.

Despite the delicate nature of the procedure, Wilson says he wasn't worried.

"Fate puts you in the right place at the right time," Wilson says. "I knew things could go wrong, but I had faith and trust in the staff. They have the highest regard for medicine and patient care."

The stimulation can be done on one or both sides of the brain,depending on the disorder and the patient's problems. Unlike older techniques, deep brain stimulation does not adversely affect other cells, and it can be modified over time, allowing doctors to influence larger amounts of tissue if necessary.

"How it works is a bit of a mystery, but we're not putting the electrical stimulation in areas of the brain that are already damaged but in areas that are downstream from those that have damage," says Uitti.

Deep brain stimulation will not prevent the progression of Parkinson's disease. It's possible that Wilson may eventually need a second implant to manage future symptoms.

In the meantime, he's enjoying his retirement. Since his surgery, he has regained control of his limbs. He has written two books, been practicing his golf swing and hopes to return to hunting if Wharen can relocate his generator. The battery pack and controller are right where the shotgun sits.

"I can't shoot," Wilson says, smiling. "So I would like to find out if he can move it over a little bit."

According to the National Institute of Neurological Disorders and Stroke, at least 1 million people suffer from Parkinson's disease, and about 50,000 new cases are reported each year in the United States.

Info:
Department of Neurology
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