TMC PULSE

t m c » p u l s e | m a y 2 0 1 8 8 Deep brain stimulation has been shown to have a high success rate for patients whose condi- tions no longer respond to medication. "A lot of patients, unfortunately, go into denial and say, 'I don't need brain surgery for my tremor.' Every patient who has surgery says, 'I'm so glad that I had it.' But they have to overcome that early [hesitation]," Fenoy said. "All patients have success. Our goal is to greatly reduce their tremor. Will it be 100 percent gone? I don't guarantee that for any type of surgery, but the tremor will be 70 to 80 percent better than it is now. That is a vastly significant improvement." For Henry, deep brain stimulation was her final hope. She knew early in her childhood that she would inherit her father's shaky hands. He suffered from a disease called essential tremor, the most common movement disorder. Henry began experiencing tremors in her dominant left hand and fingers in junior high. It started with a slight quivering in her hand, but as the years went on, her tremors intensified to the point where she could no longer perform simple everyday tasks with her hand, such as writing her name, drinking soup or sewing. The combination of beta-blockers and an epilepsy drug prescribed by her doctors—propranolol and primidone, respectively—eventually stopped working and caused muscle weakness and eye problems. "It was frustrating to see that [control] disap- pear gradually and just to realize that my control wasn't what it used to be," she said. Worst of all, Henry's tremor prevented her from doing what she loved the most: playing the flute. Henry is the principal flutist in the Big Spring Symphony in West Texas and a music teacher who has been playing the flute since she was 11 years old. "The ability to express things through my music in a way that I'm used to isn't there any- more, no matter how hard I practiced," Henry said, before the surgery. "I've gotten to the point where I don't like practicing because I'm not getting anywhere with it. It's not making me improve like it always had." Henry's neurologist in Lubbock, Texas, approached her four years ago about the possibil- ity of treating her tremor with deep brain stimula- tion, but the idea of brain surgery frightened her. "At that point, I didn't want anybody poking a A nna Henry raised the flute to her mouth, took a deep breath and recalled from memory the notes of one of her favorite classical concertos. Her fingers flitted over the keys as she carefully played each note. After she finished the song, the room burst into applause. But this wasn't a typical concert performance. Henry, 63, was lying on her back on an oper- ating table surrounded by doctors and nurses. Part of her scalp was peeled back to expose her skull. Surgeons had drilled two nickel-sized holes into her skull and inserted a tiny 1.3 mm-thick electrode into each side of her brain where her thalamus is located. The surgical procedure, called deep brain stimulation, is used to treat the neurological symptoms of certain movement disorders. Surgeons implant tiny electrodes into the brain to deliver a constant electric current that significantly reduces involuntary movement and neuropsychiatric issues. "Deep brain stimulation is a really fantastic tool in how we can modulate a perturbed, dys- functional system in the brain and make it more normal," said Memorial Hermann-Texas Medical Center neurosurgeon Albert Fenoy, M.D., who specializes in the procedure. Although the exact science and mechanisms behind its therapeutic benefits are unclear, deep brain stimulation has proven to be highly effective in "resetting" the brain and eliminating tremor. "Why these patients have all these issues, like Parkinson's disease, is because a circuit is abnormally functioning. It's oscillating at a rate that, for whatever reason, which we still don't know, is wrong. It's causing the detriment that they're experiencing," Fenoy explained. "By overriding that abnormally oscillating circuit with high-frequency stimulation, you can override that dysfunction and train it to be a more normalized firing pattern." The U.S. Food and Drug Administration has approved deep brain stimulation to treat four con- ditions: essential tremor, Parkinson's disease, dys- tonia and obsessive compulsive disorder. Because of its effectiveness, researchers are studying deep brain stimulation as a possible intervention for chronic pain, post-traumatic stress disorder, major depression and other conditions. Making Music During Deep Brain Stimulation Surgeons at Memorial Hermann-TMC treat patient's hand tremor hole in my brain," Henry said. "As the symptoms got worse, the proposition of doing that got a little less daunting, especially when it came down to keeping the tremors for the rest of my life, letting it get worse and giving up playing—or going for it." She flew to Houston with her husband, Bob, on March 26. The following morning, she met with her surgical team and prepared for the operation. Henry, who arrived at the hospital with short, strawberry blonde hair, had her head shaved and was fitted with a stereotactic frame to secure her B y S h a n l e y P i e r c e I'm a happy camper. It's the first time I've been able to play a straight tone in years. — ANNA HENRY Memorial Hermann-TMC patient who received deep brain stimulation for hand tremors

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