Deep brain stimulation for Parkinson’s tremors [Music playing] Gail Hogan: Thank you for joining us for Health Talks. I'm Gail Hogan, and today we're talking with Dr. Zachary Jordan about neuromodulation, an innovative treatment for Parkinson's, tremors. And more Dr. Jordan, thank you so much for being here. Zachary Jordan, MD: Of course. Gail Hogan: Let's start with that explanation of what is neuromodulation. [Music fades] Zachary Jordan, MD: Sure. So neuromodulation describes a variety of techniques that allow us to change brain function through technology. This includes deep brain stimulation, focused ultrasound, and gamma knife. Gail Hogan: So what is deep brain stimulation, or you call it DBS? Zachary Jordan, MD: Sure. DBS is a surgical procedure in which we insert an electrode to the deep part of the brain. We connect this electrode to a battery that sits within the chest and delivers pulses of electricity, much like a pacemaker, such that we can change that structure's function over time and in a way that we can adjust continually and improve. Gail Hogan: How does this work for the patient? Zachary Jordan, MD: So typically once this is done, if this is for tremor, it can suppress tremor when it's turned on. It can suppress it above and beyond what medication's able to do typically. Gail Hogan: So visually you can see the change. It's that dramatic. Zachary Jordan, MD: You can see it almost immediately. Gail Hogan: How new is this? Zachary Jordan, MD: This has been done since the late nineties and early 2000s, but it still is something that we now have decades of experience with. Gail Hogan: What patients are good for DBS? Who do you target it to? Zachary Jordan, MD: So typically Parkinson's disease patients are good candidates generally when they have good response to the Parkinson's disease medication, but have difficulties with how long the medication lasts or with the side effects from the medications. Gail Hogan: What are the symptoms of Parkinson's and the symptoms of tremors? Zachary Jordan, MD: Sure. So Parkinson's disease commonly includes tremor, but also can have problems with muscle stiffness and slowness that makes it difficult to move and difficult to walk. Gail Hogan: And tremor. You can have tremors without having Parkinson's. Zachary Jordan, MD: Correct. There are other tremor disorders aside from Parkinson's disease. One of those is essential tremor. Gail Hogan: And you can treat both of these with DBS? Zachary Jordan, MD: Correct. Gail Hogan: Are there other treatment plans if a person isn't a candidate for DBS? Zachary Jordan, MD: Yes. If medication isn't working and a patient is not a candidate for deep brain stimulation, we can also consider treatments such as focused ultrasound or gamma knife, which are noninvasive techniques to modulate that part of the brain. Gail Hogan: Are there any patients that are better suited for DBS than others? Zachary Jordan, MD: Generally, for Parkinson's, it's patients who have great response to medication, but there's downsides to medication. And for tremor, it's patients who have severe tremor that interferes with what they do day to day, yet they've tried multiple medications that really hasn't helped their tremor. Gail Hogan: So when you implant this device in someone, is the effect immediate for the patient? Will they see results all of a sudden immediately? Zachary Jordan, MD: When the device is turned on, they do see effects right away. It may take some time for the correct settings to be figured out, to be optimized, but generally there's effect right away when the device is turned on. Gail Hogan: That has to be amazing for the patient. Zachary Jordan, MD: I think it's pretty life-changing. It can restore quite a bit of function that wasn't there before. Gail Hogan: Is this a 24/7 operation or does this device only work certain parts of the day? Zachary Jordan, MD: Generally, we can leave the deep brain stimulation device on 24/7. Gail Hogan: And these folks can resume normal activities. Zachary Jordan, MD: Correct. Gail Hogan: How long does it take after you've done the surgical procedure to when someone can come home and then they can adjust to this? Zachary Jordan, MD: So the surgery is done in a couple stages. When we place the electrode in the deep part of the brain, typically that requires an overnight stay in the hospital, but when we place the battery in the chest, that's usually they go home the same day. It takes some time to resume normal activities, but generally after a month, the brain has healed enough that we can turn on the device for the first time and patients can resume what they were doing day to day before. Gail Hogan: And follow up care in the months and years after this? Zachary Jordan, MD: Generally, they'll follow up with myself and my team of excellent nurse practitioners who are able to help manage the medication and program the deep brain stimulation device. Gail Hogan: So why should someone choose Ohio State for this? Zachary Jordan, MD: I think that we have a dedication to comprehensive care, and I think that we have a great way of taking care of patients in a multidisciplinary way, regardless of whether someone's a surgical candidate or not. Gail Hogan: What's the most important thing you'd like patients, the general public to know about DBS? Zachary Jordan, MD: Well, first that it exists, that it can work quite well, and that even though it requires a journey, it requires a surgery, it can be worth it and it can provide quite a bit of function. Gail Hogan: Once someone has the implant, are the results of DBS permanent? Zachary Jordan, MD: Generally they are permanent, that we can continually adjust the device over time. There can be worsening of tremor over time, but that's one of the advantages of deep brain stimulation is that we can increase and adjust how the stimulation is being delivered to improve the symptoms. Gail Hogan: Now, I want to read something here to make sure I get it correct. You recently earned the Comprehensive Care Center designation from the Parkinson's Foundation. What does that mean? And then what does that mean to you and your patients? [Music playing] Zachary Jordan, MD: And as I mentioned, I think one of the strong suits of Ohio State, one of the things that we have is that we offer a comprehensive care. We have a multidisciplinary comprised of movement disorder, neurologists, neurosurgeons, nurse practitioners, physical therapists, occupational therapists, speech therapists, among others. And I think this designation shows recognition of that dedication to a multidisciplinary approach. Gail Hogan: Well, congratulations to you and your staff for that. Zachary Jordan, MD: Thank you. Gail Hogan: Thank you Dr. Jordan for being here. Zachary Jordan, MD: Of course. Gail Hogan: And thank you for watching Health Talks. [Text on screen Ohio State Health & Discovery Health Talks health.osu.edu]