Regaining Control

April 01, 2012

Providence’s Expertise in Movement Disorders Helps Patients Get Their Lives Back

Even the most experienced neurosurgeons will tell you that we’ve only just begun to understand the brain’s inner workings. And to treat such a complex organ, you need a great deal of knowledge and skill. That’s why when it comes to neurological care, many people turn to the experts at the Hycy and Howard Hill Neuroscience Institute at Providence Saint Joseph Medical Center.

In addition to a Stroke Center and Neurovascular Center, the institute features a new Outpatient Neuroscience Center that’s essential to diagnosing neurological disorders. There’s also a full-service Movement Disorders Center that takes a family-centered approach.

“Our environment allows for a kind of intimacy that creates connections between clinicians and patients, which is something you don’t see everywhere,” says Roberta Greenberg, R.N., clinical manager of the Movement Disorders Center. “Forming those connections helps improve outcomes.”

Treating Movement Disorders

Movement disorders comprise a set of neurological conditions, says Michael M. Marvi, M.D., M.S., a neurologist with a subspecialty in movement disorders. These conditions include Parkinson’s disease, essential tremor and dystonia. Although each is unique, they all cause involuntary movements or shaking that can make daily activities difficult—or close to impossible.

Therefore, the goal of the Movement Disorders Center is to provide a single, comprehensive resource for treatment, says Ronald F. Young, M.D., a neurosurgeon and medical director of the program.

“I mean ‘treatment’ in the broadest sense of the word,” he says. “People can receive neurological and psychological evaluation, medication treatment, rehabilitation services and surgical treatment.”

The Movement Disorders Center provides both medical and surgical treatment options to patients including deep brain stimulation (DBS), which uses an implanted device to reduce tremors, similar to how a pacemaker regulates heart rhythm.

“All of the treatments are focused on decreasing the severity of symptoms,” says Dr. Marvi. “We tend to use a combination of these treatments to improve patients’ function—but especially with DBS, wonderful changes can occur.”

Once involuntary movements and shaking are controlled, many patients are able to engage in activities they couldn’t before—sometimes tasks as simple as holding a glass of water or buttoning a shirt.

“Restoring mobility and function to someone who thought it was lost to them is an incredible gift to be able to give,” Greenberg says.

Understanding DBS

Generally, nonsurgical options are tried before a procedure like DBS is recommended. But there is a window of opportunity when DBS is most effective, which means patients should be evaluated as early as possible.

DBS involves the implantation of thin wires deep into specific areas of the brain. The wires are connected to a battery-operated device implanted in the patient’s chest that provides electrical stimulation to the brain.

“No one is exactly sure how DBS works, but there’s some thought that it blocks certain excessive kinds of electrochemical activity in the brain,” Dr. Young says. “But what we do know is that it does work.”

Using a combination of surgical techniques and imaging technology, surgeons insert the wires into very specific targets in the brain. Patients are awake, but kept very comfortable, during part of the procedure so that the surgeon can refine the target based on observations of the symptoms being treated.

After surgery, programming the stimulator is essential to getting the desired results, and it often requires repeat visits and ongoing fine-tuning.

“With most surgeries, the closing stitch is the end of the story,” Greenberg says. “With DBS, the closing stitch is just the beginning of the journey.”

Patients are seen about every six weeks at first, then for maintenance as needed. Greenberg works with patients and their families, both before and after surgery, to educate them on the process. It’s especially important that they can recognize changes, so the stimulator can be adjusted accordingly over time.

“DBS can completely eliminate symptoms in some cases, but it’s not a magic wand, which is why we provide such comprehensive resources,” Dr. Young says. “We achieve the best results by everyone working together.”