Your DBS Questions Answered – a Conversation with Dr. Helen Bronte-Stewart and Dr. Soania Mathur is a webinar hosted by The Davis Phinney Foundation, and sponsored by Medtronic. It is a gift to Parkinson’s people who have had DBS, or people who are thinking of having Deep Brain Stimulation (DBS). The webinar, free to the community, is a helpful review of what’s new, and possible in DBS. In a one-hour presentation Dr. Helen Brontë-Stewart, MD, MSE, discussed DBS which she described as “the first generation of a brain pacemaker” with Dr. Soania Mathur.
Dr. Brontë-Stewart is the John E. Cahill Family Professor in the Department of Neurology and Neurological Sciences at the Stanford University School of Medicine, Stanford, California. She received her bachelor’s degree in Mathematics and Physics at the University of York, England and a Master of Science in Bioengineering (MSE) from University of Pennsylvania School of Engineering in Philadelphia, Pennsylvania. Dr. Brontë-Stewart received her MD degree and Neurology training from University of Pennsylvania School of Medicine. She did her Movement Disorders Fellowship and Post-doctoral training in primate electrophysiology at UCSF.
Dr. Mathur is a family physician outside of Toronto, Ontario who resigned her clinical practice twelve years following her diagnosis of Young Onset Parkinson’s Disease at age 27. Now she is a dedicated speaker, writer, educator and Parkinson’s advocate.
Dr. Brontë-Stewart’s research goal is to understand how the brain controls movement. Her research includes investigations into the neural signatures of bradykinesia, balance and gait disorders and her Lab is performing some of the first closed loop DBS studies for Freezing of Gait. She explained that quality of life, and non-motor symptoms can be improved by DBS. DBS boosted by a lower dose of medication can work better than medication alone.
The first part of her talk concentrated on the importance of accuracy in positioning the lead into the tiny subthalamic nucleus (STN), an area of the brain targeted for DBS that is only 6 millimeters wide by 6 millimeters long. Think of the tiny little hole of space when you make a pinprick of a hole created by squeezing your first finger with your thumb. No wonder Dr. Brontë-Stewart called it “the well-placed lead!”
Over the years, researchers have discovered that tremor predominant patients do not always respond to medication whereas tremor does respond to DBS. This fact is not always published in DBS qualifications that list one of the reasons for getting DBS is when your medications no longer work.
A fascinating slide that accompanied the presentation (see above) illustrated how the symptoms of Parkinson’s disease increase over the years, and how some of them can be improved with DBS. The symptoms circled green were indications that could be helped. The symptoms circled red were signs that would not be helped. The symptoms circled yellow were issues that needed more research to make an assertion. During the slide projection my head was bent to the side trying to figure out the time frame for each set of symptoms, although there are days when I think I have all the symptoms listed!
Dr. Brontë-Stewart was describing all of us in the Parkinson’s community when she explained that DBS is “such individual surgery.” The webinar ended with Dr. Brontë-Stewart’s suggestion that when you are considering DBS make sure that you have a comprehensive motor and non-motor evaluation by a fellowship trained Movement Disorders specialist. When you see the neurosurgeon, make sure that they have a lot of experience with DBS. Ask them for their outcomes, just as you would to any surgeon in any field.