PHOTO BY FL MORRIS / FMORRIS@STARBULLETIN.COM Patrick Reilly has undergone surgical procedures that have reduced the symptoms of Parkinson's disease, which he has. He was with his wife, Jackie, at their home on Sunday.

Pulses put Parkinson’s
in its place

A new surgery uses electrical
pulses to stimulate the brain
and nullify symptoms

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By Helen Altonn
haltonn@starbulletin.com

After deteriorating physically for 10 years, a 46-year-old sailor is able to swim and run again, play volleyball and sleep through the night thanks to a revolutionary new treatment for Parkinson's disease.

Called deep brain stimulation, the procedure involves sending electrical pulses from a generator in his chest, similar to a cardiac pacemaker, to electrodes implanted in his brain.

Patrick Reilly, a master chief petty officer with the naval submarine support command at Pearl Harbor, had surgery to have the generator and electrodes put into his body and head in March. Although he is still going through some adjustment, the surgery has given him "a lot better control," he said.

PHOTO BY FL MORRIS / FMORRIS@STARBULLETIN.COM Barely visible is scar on Patrick Reilly's head from the surgery.

In the past, he had to stop and rest every five steps if he was walking anywhere because of bad cramps in his feet, but that doesn't happen anymore, he said. Rigidity also is gone from his right side, he said.

"Most patients have a significant level of improvement in functioning and can decrease medications," said neurosurgeon Leon Liem.

He and neurosurgeon Michon Morita began performing the surgery last August at St. Francis Medical Center and the Queen's Medical Center with neurologist Leo Maher, neuropsychologist Tanya Swartz and neurologist Stuart Pang.

Their team has performed the surgery on about 20 patients with good results, Liem said. The breakthrough treatment was approved in January by the Food and Drug Administration.

It is the first new therapy for Parkinson's in more than 31 years. The procedure is not a cure but may reduce debilitating symptoms and the need for medications in advanced cases, Liem said.

Parkinson's somehow disrupts the circuitry in the part of the brain that controls movements, and deep brain stimulation counteracts the abnormal wiring, Liem said.

"Exactly how it works, we're not sure. There are a lot of theories. The brain is so complex, we're only scratching the surface," he said.

"Prior to now there were no real good alternatives," Maher said. "Some people thought it was a no-hope situation, a dead end. Now we can give them options, and many people are returning to life. It is really rewarding."

CINDY ELLEN RUSSELL / CRUSSELL@STARBULLETIN.COM Neurological surgeons, from left, Michon Morita and Leon Liem and neurologist Leo Maher, right, are helping patients suffering from tremors and Parkinson's disease with an innovative surgery technique called deep brain stimulation.

Reilly, who has lived in Hawaii for 26 of his 28 years in the Navy, had stopped smoking and was working out and running until "one day I just started falling down. I went through three years of trying to figure out what was wrong until finally a tremor developed. That was the telling point of Parkinson's," he said.

The cause of Parkinson's is not known.

The disease affects more than a million Americans, including about 10,000 in Hawaii, Liem said. Most patients are 50 or older, but some are in their 40s.

Symptoms include tremors, rigidity, slowness or absence of movement, and impaired posture, balance and coordination.

Reilly's neurologist at Tripler Army Medical Center referred him to the deep brain stimulation doctors.

This is how the procedure is done, they said: An insulated, spaghettilike wire with four electrodes at the tip is extended through a small opening in the skull to the target area. "The trick is to put it in the right spot," Liem said. "The target is only a few millimeters in size."

Doctors' new technique stops the trembling The procedure involves inserting electrodes deep in the brain to receive electric signals from a pacemakerlike generator implanted in the chest:

The electrode is connected by a thin wire running under the skin to the small battery-operated generator, implanted in the chest in separate surgery. Since Parkinson's involves movement on both sides, two electrodes and two pacemakers may be necessary.

Highly sophisticated imaging and recording equipment is used to map the brain's structure. The patient's head is positioned in a head frame, and a preliminary electrode is placed through a small hole in the skull to record activity in the brain cells. The target area has a characteristic signal, Liem said.

A trial stimulation done after surgery with a hand-held generator often has "very dramatic" results, Morita said. A shaking hand holding a glass of water will stop shaking when the electrical signals are delivered, he said.

A slight tingling sensation may occur with the electrical pulses, but Reilly said the only time he feels anything is when he is getting a haircut. "The girl will hit the area kind of hard and cause a little pain."

He said the generators can be seen through his skin. "When my wife lays her head on my chest at night, she can feel them on her ear, but they're pretty dormant."

He said he was previously taking five different drugs five times a day, covered by military insurance at a cost of about $26 a day.

Now he takes one type of medicine five times a day for a daily cost of $1.50.

He said he is trying to get back to a normal life, but he has not had the energy or desire to do some things he really enjoyed, like working on the roses in his garden.

The surgery costs about $50,000 and is covered by Medicare and most insurance plans. Doctors point out the surgery is generally reserved for those who cannot tolerate or do not respond to drugs or for younger working people.

"I think if we can keep them active and working, we've done a great service," Liem said.