TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 7 28 T he uncontrollable twitching began in Steve Sawyer's big toe, on his right foot, about nine years ago. Sawyer, then 49, went to see a neurologist, who thought it might be early-onset Parkinson's disease, a degenerative brain disorder that ini- tially affects motor skills, causing trem- ors, stiffness, slowness of movement and impaired balance. As the disease progresses, patients may develop cog- nitive problems, psychiatric alterations and dementia. Sawyer was referred to Joseph Jankovic, M.D., director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine, who prescribed the typical regimen of medication, starting with a couple of pills a day. But Sawyer quickly discovered that as the disease progressed, more and more medication was required to con- trol his tremors. "Plus, the medication gives you sides effects, like drowsiness, so you have to take a medication to offset that," Sawyer said. "It is a bad spiral you go Treating Parkinson's Brain stimulation and early detection B y C h r i s t i n e H a l l Solutions: TMC Innovations down. Initially, it is a slow hill, but it seemed like overnight that it got pretty bad." Indeed, things got so bad that Sawyer began to refer to Jankovic not as his Parkinson's doctor, but as his "pill doctor." Though it is hard for him to admit, Sawyer considers himself pretty lucky with the disease, because he only has bad tremors on his right side—in his leg and hand—and he can mask them by keeping his hand in his pocket. He was so good at hiding the symptoms of Parkinson's that he didn't reveal his diagnosis to his grown children until a year ago, around the time he decided to pursue a new treatment. "They were getting started in life, and I didn't want them to be burdened," Sawyer explained. "I didn't want people knowing and looking at me any differ- ently. When I decided to do the new treatment, I started letting people know, like my family and neighbors. It was interesting to have them ask what I was up to, and to tell them I was going to have brain surgery." It was Jankovic who told Sawyer about an opportunity for a new treat- ment with Joohi Jimenez-Shahed, M.D., an assistant professor of neurology and director of the Deep Brain Stimulation Program at Baylor. Sawyer became the first CHI St. Luke's Health-Baylor St. Luke's Medical Center patient to receive an updated form of deep brain stimulation, a surgery reserved for patients with movement disorders who are no longer responding well to medications. The deep brain stimulation surgery occurs in two stages. In the first stage, wires outfitted with electrodes are inserted into the brain. In the second stage, the wires are hooked up to a battery pack—a pacemaker-like device Run for their lives. 2017 Donate Life Texas 2nd Chance Run 5K and 1-Mile Saturday, April 22, 2017 Constellation Field Sugar Land More than 120,000 people across the country are waiting for lifesaving organ and tissue donations. Lace up your running shoes to show the community how easy it is to give those people hope for a second chance. Register at 2ndChanceRun.org inserted into the chest—that controls the stimulation, Jimenez-Shahed said. This type of procedure has been done for more than 20 years, but a new device from St. Jude Medical makes it possible to control the stimulation from the doctor's office using a wireless iOS software platform on an iPad mini device. Doctors had not been able to do this before. Patients can also use an iPod Touch device controller to dis- creetly manage their symptoms. "The device allows us more pro- gramming capabilities, like adjusting the stimulation to steer the electrical current right where we need it to go," Jimenez-Shahed said. "That is import- ant, because if the current is too close to adjacent brain structures, it might also deliver stimulation there and cause unwanted side effects." Sawyer liked the idea of a treatment that targeted the areas where his trem- ors occurred. The problem was that the device did not yet have U.S. Food and Drug Administration approval, so even though he had met the criteria to be a candidate, he had to wait. But not for long. Last October, the deep brain stimulation system received FDA approval. Today, five months after the device was implanted, Sawyer and his doctor continue to figure out how best to adjust the equipment settings. Jimenez-Shahed said the battery pack will eventually need replacing, but can last between three and five years, depending on the amount of current. Sawyer has cut back on all his medications, taking just one tablet four times a day. He used to take three tablets four times a day and one tablet at night to sleep. The deep brain stimulator allows patients to better control their symp- toms, reduce the "off" time when the drugs aren't working as well and

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