March 24, 2016

Deep brain stimulation program marks milestones

Vanderbilt Clinical Neurosciences is marking two milestones — the 20th anniversary of its deep brain stimulation (DBS) program and its 1,000th DBS procedure.

Vanderbilt Clinical Neurosciences is marking two milestones — the 20th anniversary of its deep brain stimulation (DBS) program and its 1,000th DBS procedure.

Steve Retterer and Linda Jones, here on a visit to Niagara Falls, had their respective deep brain stimulation procedures five years ago.

The program is poised for more growth with a recent decision by the U.S. Food and Drug Administration to approve the surgery for people with earlier stages of Parkinson’s disease.

The procedure entails implanting electrodes in the brain to continuously stimulate it and help control abnormal movements associated with Parkinson’s, essential tremor and dystonia.

A small electrical unit, a neurostimulator that is similar to a heart pacemaker, is implanted under the skin of the chest to power the DBS system.

“Vanderbilt has been implanting as long as anyone in the world, outside of the original center in France,” said Peter Konrad, M.D., Ph.D., professor of Neurological Surgery. “We have probably the largest number of patients that have come through. I don’t know of any center that is anywhere near 1,000 patients.”

The program is on track for the 1,000th patient to undergo DBS surgery at Vanderbilt University Medical Center by year’s end.

Patients already receiving DBS therapy are invited to a 20-year celebration from 11 a.m. to 1 p.m. on Saturday, April 2, at Nashville Marriott at Vanderbilt. Attendees will include a couple that had the surgery on the same day in 2011.

Linda Jones, a teacher from Kentucky, and Steve Retterer, a production press manager from Texas, met one another online in a chat room for people with Parkinson’s.

They met in person about two-and-a-half years ago at the Parkinson’s Unity Walk in New York.
Retterer moved to Kentucky to be near Jones in 2007. They worked together offering support to people affected by Parkinson’s, increasing awareness about the disease and raising funds for research. But by 2011 they were experiencing severe tremors and movement problems.

“It was at the point I couldn’t’ sleep three hours a night because my tremors were so bad,” Retterer said.

“He couldn’t sit down and I couldn’t get up,” Jones added.

Five years after the surgery, they say they have a good quality of life and often laugh when they talk about Parkinson’s.

“I can’t think of a world without DBS,” Retterer said. “I’m not going there.”

The DBS team at Vanderbilt includes two neurosurgeons and nine neurologists, who work collectively in the operating room to custom-fit a system for every patient. While Konrad, a neurosurgeon, does the surgery, neurologists, such as Fenna Phibbs, M.D., MPH, simultaneously monitor how patients respond to stimulations.

“We wouldn’t be the group we are if it wasn’t for the fact that everybody who is involved is a team player,” Phibbs said. “It is not one-person driven. It is not one-specialty driven. What drives us is giving the best therapy for the patient. Sometimes, it is not the surgery. Sometimes, we do more medical management first.”

Although the surgery is considered a routine procedure at VUMC because of the expertise and experience of the DBS team, many patients who would benefit from the therapy aren’t receiving it.

“There’s less than 10 percent penetration in the market in this area, and we’re the best penetrated market in the U.S.,” Konrad said.

The surgery has proven to be an effective and safe treatment for movement disorders associated with Parkinson’s and other diseases.

“If you ask patients, they will say to a T they regret not having it done sooner,” Konrad said.

The FDA’s recent decision expands DBS use for people with Parkinson’s disease of at least four years duration with recent onset of motor complications, or motor-complications of longer-standing duration that are not adequately controlled with medication. Previously, the surgery was approved only for people with advanced Parkinson’s disease.

Other FDA-approved indications for DBS surgery include essential tremor, dystonia and severe obsessive-compulsive disorder.