McLEOD REGIONAL MEDICAL CENTER 3 AUGUST 2023

By Dr. Tripp Hines
Neurosurgeon

Treatment Options for Movement Disorders: Parkinson’s Disease, Essential Tremor and Dystonia

Tremors, muscle spasms, stiffness, slow movement, difficulty speaking and swallowing, as well as poor balance and coordination, can be symptoms of a movement disorder. Living with a condition such as Parkinson’s disease, essential tremor or dystonia can make daily life challenging.

Parkinson’s disease is a progressive brain disorder that affects a person’s muscle control, balance, and movement. An estimated one million people in the United States are living with Parkinson’s disease, and nearly 90,000 new cases are diagnosed every year, according to the American Parkinson’s Disease Association. The symptoms of Parkinson’s disease develop gradually over time and can be movement-related, cognitive, and physical.

Essential tremor is a movement disorder that causes uncontrollable shaking of the hands, arms, trunk, or legs, and sometimes even the voice. Often confused with Parkinson’s disease, essential tremor is the most common type of movement disorder — estimated to be eight to 10 times more common than Parkinson’s disease.

Another movement disorder is dystonia which causes involuntary muscle contraction or muscle spasms that trigger slow, repetitive movement or twisting of the affected body part. It can affect one muscle, a group of muscles, or the patient’s entire body and can be quite painful.

Medication, rehabilitative therapy, and tremor control devices are a few treatment options available to help patients manage the symptoms of Parkinson’s disease, essential tremor, and dystonia. Another option is a surgical treatment performed by a neurosurgeon called Deep Brain Stimulation, also known as DBS.

Using electrical stimulation, DBS aids in the treatment of movement disorders and can even be used to help control the symptoms of epilepsy and obsessive-compulsive disorder. DBS works by regulating abnormal signals in the brain.

During the medical procedure, thin wires called electrodes are placed in the brain. A pulse generator, a programmable device that is like a heart pacemaker, is inserted in the chest area just under the skin. The pulse generator sends mild electrical impulses to the electrodes in the brain. The electrical impulses stimulate the areas of the brain that control movement.

At McLeod, deep brain stimulation is performed in two stages. The first stage is an outpatient surgical procedure to place the pulse generator device in the chest and lead extensions. The second stage, which takes place a few days to a week later, is the placement of the electrodes and connecting the pulse generator to the electrodes. The electrodes are placed in designated areas of the brain that are identified according to the patient’s diagnosis, symptoms, and other factors.

This surgical treatment continuously helps control symptoms, and the intensity of the electrical stimulation can be adjusted by the neurosurgeon and/or movement disorder team. Most generators are rechargeable and last for approximately 15 years, with non-rechargeable generators lasting on average from three to six years.

Deep brain stimulation is not for every patient, and it is not a cure for movement disorders. Patients are very carefully evaluated by the McLeod Neurosurgery team to determine if they are a candidate for DBS. When used with the right patient, DBS can be highly successful.

Movement disorder patients may be considered for DBS when:

• Medication does not control or no longer improves symptoms
• Medication causes severe side effects
• Tremors cause significant function disability and interfere with daily life activities such as eating, drinking, and writing
• Other forms of treatment are unsuccessful

Benefits of DBS include:

• Reduction in the severity of tremors and stiffness
• Decrease in the amount of medication needed to manage symptoms
• Increase in mobility
• Improved quality of life

Although deep brain stimulation may not eliminate a patient’s symptoms, it can significantly help patients become more active, resulting in an improved quality of life. With DBS, the team at McLeod can restore function and give patients a chance to return to living and doing the activities they enjoy.

Dr. Tripp Hines is a Neurosurgeon caring for patients at Florence Neurosurgery and Spine at McLeod Health. Dr. Hines received his medical degree from East Tennessee State University Quillen College of Medicine in Johnson City, Tennessee. He completed a Neurosurgery Residency and a Deep Brain Stimulation Surgery Fellowship at the University of Kentucky College of Medicine in Lexington, Kentucky. Dr. Hines has a special interest in Deep Brain Stimulation, Parkinson’s disease, essential tremor, epilepsy, brain tumor surgery, pituitary/transsphenoidal surgery, trigeminal neuralgia, and spine surgery.