- The Washington Times - Monday, January 16, 2006

Ray Farkas narrated one of the toughest moments of his life — undergoing brain surgery — as it happened. When Mr. Farkas, now 69, received deep-brain stimulators to treat his Parkinson’s disease in October 2003, he created “It Ain’t Television, It’s Brain Surgery,” a movie that chronicled his operation at Georgetown University Hospital, where he was awake for the entire procedure.

He runs his own company, Off Center Productions, in Northwest.

“I wouldn’t be talking to you, I wouldn’t be working right now without the surgery,” the Northwest resident says. “Some problems still exist, but to a much lesser degree.”

As medical experts search for a cure for Parkinson’s disease, a neurodegenerative condition, deep-brain stimulation has enabled many people with the illness to have better control of their neurological symptoms. The FDA approved deep-brain stimulation in 2002 for patients with Parkinson’s disease. Research also continues in the areas of drugs, genes and stem cells.

The devices implanted during deep-brain stimulation can vastly improve the quality of life of patients with Parkinson’s disease, says Dr. Christopher Kalhorn, assistant professor of neurosurgery and co-director of the Georgetown Movement Disorder Center at Georgetown University Hospital.

He performed the procedure on Mr. Farkas and, more recently, on James Kitsoulis, 77, also of Northwest. Candidates must be healthy enough to tolerate the surgery and be responsive to the drug Sinemet, which treats the symptoms of Parkinson’s disease.

Because Parkinson’s patients don’t produce adequate levels of dopamine, a chemical that transmits signals between nerve cells, the cells fire abnormally, which leads to motor symptoms, such as tremors, slowness, rigidity and abnormal muscle contractions and movements. The deep-brain stimulators help block the abnormal nerve impulses in the brain.

Electrodes, which can be implanted with a platinum wire on one or both sides of the brain, are placed in the subthalamic nucleus. The patient is awake during the entire procedure.

Risks include bleeding and infection and possible additional surgery to reposition the electrodes, Dr. Kalhorn says.

After the electrodes are in place, another surgical procedure is performed a few days later to connect them to an implanted pacemaker, which is placed underneath the skin and collarbone. It delivers electrical impulses to the electrodes in the brain through an insulated wire that is under the skin, connecting the electrode to the pacemaker.

The pacemaker is adjusted frequently through a hand-held device that looks like a personal digital assistant, he says. The pacemaker may need to be changed every five to seven years. The deep-brain stimulator doesn’t alter the natural progression of the disease; instead, it masks the patient’s symptoms, providing a better quality of life.

Although the device doesn’t take the place of medical management, medications such as Sinemet usually can be cut back after the instrument is working, Dr. Kalhorn says.

In the past, the only surgeries doctors could perform to improve motor symptoms were lesioning procedures, in which a heat probe eliminates a small section of brain tissue that is abnormally active.

“There are some real disadvantages to them,” Dr. Kalhorn says. “They are completely irreversible and aren’t adjustable. We would see patients back years and months after surgery, and their symptoms would come back.”

Finding a drug or a combination of drugs that would protect people from developing Parkinson’s disease is a goal for researchers, says Diane Murphy, program director of neurodegeneration at the National Institute of Neurological Disorders and Stroke in Bethesda.

“Some people take an aspirin to protect against heart disease,” Ms. Murphy says. “We are looking for the ‘aspirin’ for Parkinson’s disease.”

Coenyzme Q10, creatine and minocycline are being tested in pilot studies as possible ways to slow the illness. Molecular therapies such as gene therapy and stem-cell research are other areas of investigation, she says.

“I don’t know that we’ve proven that stem cells can replace the dopamine neurons in the brain,” Ms. Murphy says. “We have a ways to go. We can make dopamine neurons in a dish for sure, but the brain is extremely complex.”

While searching for new ways to treat the condition, researchers also are considering its causes. The effects of herbicides and aluminum are being examined, says Dr. Paul Maestrone, director of scientific and medical affairs at the American Parkinson Disease Association in Staten Island, N.Y.

“Unfortunately, we are not sure of the cause of Parkinson’s disease,” Dr. Maestrone says. “We are trying to understand the relationship between the genetic component and the influence of the environmental factors.”

Although complicated research may provide a more complete answer for patients with Parkinson’s disease, treating any symptoms of depression should not be overlooked, says Dr. Laura Marsh, associate professor of psychiatry and neurology at Johns Hopkins School of Medicine in Baltimore. She will take part in the World Parkinson’s Congress in the District next month.

“People mainly think about the motor problems associated with Parkinson’s disease,” Dr. Marsh says. “They forget about the cognitive problems and psychiatric problems. I’m working on improving better recognition of depression in Parkinson’s disease patients.”

Approximately 50 percent of patients with the illness also suffer from depression, she says. Depression is a distinct syndrome, separate from Parkinson’s disease, she says.

“Many people say they can deal with Parkinson’s disease, but not with Parkinson’s disease and depression,” Dr. Marsh says. “It is not normal to feel like life is not worth living if you have Parkinson’s disease. It’s not normal to get no pleasure in life.”

Anybody with Parkinson’s disease should fight the illness, says Bill Ruff, 77, of Frederick. He is president of the Central Maryland Chapter of the American Parkinson Disease Association. He founded the chapter in 2000, organizing annual fundraising walks in Baker Park in Frederick.

He was diagnosed with the illness in September 1998. More than 1.5 million persons in the United States suffer from it, he says.

“Don’t be a ‘poor me’ type of individual,” Mr. Ruff says. “Accept the challenge. Otherwise, it will get the best of you.”

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