IU To Perform State's First Thalamic Implant For Tremors

INDIANAPOLIS-- A Fort Wayne man will undergo a new procedure at Indiana University Hospital Wednesday, Nov. 19, designed to suppress uncontrolled tremors. The procedure, called deep brain stimulation, received FDA approval in June for some tremor disorders. It also has implications for treatment of Parkinson disease.

Kenneth Reichert, 78, suffers from essential tremor, a condition that impairs his ability to control shaking in his hands. He will be the first patient in Indiana to undergo the tremor control therapy with a new implant system developed by Medtronic. Essential tremor can cause uncontrollable shaking in patient's hands, head or voice.

The deep brain stimulation therapy also is FDA approved for treatment of tremor in Parkinson disease, a degenerative disease of the central nervous system which is characterized by uncontrolled tremors, rigidity or slowness of movement. Deep brain stimulation also may be helpful in treating the rigidity and slowed motor functioning of Parkinson disease, but its use for that condition requires a slightly different placement in the brain. The IU School of Medicine may begin using this procedure for treating Parkinson disease patients as early as January.

On Wednesday, Robert M. Worth, M.D., Ph.D., associate professor of neurosurgery, Thomas Witt, M.D., assistant professor of neurosurgery, and Eric R. Siemers, M.D., associate professor of neurology, all at the IU School of Medicine, will perform the surgical implant procedure on Mr. Reichert, who will be alert during the majority of the 7-hour procedure while surgeons strategically place an electrode in the nucleus of his thalamus. Patients must be able to respond to commands while physicians analyze the exact location for placement of the electrode.

Surgeons attach the electrode to a "lead" which connects to a pacemaker-like device called a pulse generator. The pulse generator is placed under the patient's skin below his collar bone and can be turned on and off with a hand-held magnet. The patient is anesthetized for the implantation of the pulse generator.

Generally, patients turn the pulse generator off when sleeping to conserve the battery. The battery must be replaced approximately every 5 years, but the electrode and lead, which also are implanted under the patient's skin, remain in place.

It is anticipated that Mr. Reichert will be hospitalized overnight and released on Thursday.

"This procedure adds to the armamentarium that we can offer patients affected by Parkinson disease and essential tremor from a surgical point of view," said Dr. Worth. "The procedure is for patients who fail to respond to medication for control of their tremors."

Another procedure used in the treatment of Parkinson disease involves making a destructive lesion in a portion of the brain which is overactive due to the disease. This procedure, called a pallidotomy, was first performed in Indiana at Indiana University Hospital in the fall of 1995. The pallidotomy was, and remains, a breakthrough in the treatment of Parkinson disease for some patients. In the past two years, physicians have performed 66 pallidotomies at IU.

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