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Peacetime

Patient VideoArmy veteran Ernest Spengler finds relief from severe Parkinson's tremors through Deep Brain Stimulation

Seventy-five-year-old Ernest Spengler was a radio operator in the Army during the Korean War. He faced a new enemy 40 years later – the slow, insidious attack of Parkinson's disease.

Ernest Spengler

Ernest Spengler

Diagnosed with the condition ten years ago, Ernest began to experience increasingly debilitating symptoms. He would rise from a chair only to begin falling, grasping at countertops and chairs to keep from hitting his knees or face. Even if he managed to break his fall, he broke most of his fingers repeatedly as he clutched at objects on the way down.

He struggled with times his body would turn rigid, while the tremors in his hands and feet worsened. "I couldn't hold a pen to write," Ernest recalls. "Every time I tried to eat, most of the food shook off my spoon before it ever reached my mouth."

Daughter Laura Spengler has been his strongest, loving advocate. Especially since her mother passed away. "Originally, dad's neurologist prescribed the standard medications for Parkinson's," she recalls. "But they stopped working over time."

Ernest's speech became slurred. He trembled too much to navigate the stairs of the home he shares with Laura. Once-loved hobbies like fishing were out of the question.

Like most Parkinson's sufferers, Ernest began experiencing related depression. His quality of life had become so impaired that his neurologist referred him to Abington's Neurosciences Institute for advanced intervention.

Neurosurgeon Michael S. Yoon, M.D., evaluated Ernest. He believed the man would be a good candidate for Deep Brain Stimulation (DBS). This minimally invasive surgical technique enables Abington specialists to target and arrest the electrical impulses that generate tremor signals to the body.

Dr. Yoon explains, "Deep brain stimulation is most beneficial to those who suffer from the symptoms of Parkinson's or other movement disorders — tremors, rigidity, and related problems with walking and balance. While there is no cure for these disorders, we can often reduce the severity of patients' conditions."

On December 8, 2008, Ernest underwent the procedure.

Dr. Yoon says, "We begin DBS by fitting the patient with a stereotactic headframe and obtaining a CT scan or MRI. We target the affected area based on the images, and then make a small burr hole in the patient's skull.

"Next, we pass a small wire containing an electrode into the brain. The patient is awake the whole time. This electrode measures the frequency of cells as they're firing. As it moves through different parts of the brain, each cluster of cells sounds a different frequency. I've heard it said it's like going through Europe — each country has a different language."

The neurosurgeon, along with an electrophysiologist, find the target based on the correct frequency. They also depend on the patient's own words and interactions. Ernest described seeing red and blue and feeling tingling in his toes.

Then the surgeons asked him to hold a cup of water. "As we approach the site of tremor activity, we can see the patient's hand grow steady. It's quite dramatic," Dr. Yoon adds.

Once the specialists have found the right spot, the patient is placed under general anesthesia. They tunnel under the skin and connect the electrode to a small, batterypowered neurostimulator. It sits under the skin near the collarbone. The neurostimulator is much like a pacemaker for the brain, creating electrical interference to block or reduce the intensity of the wayward tremors.

Today, Ernest is fishing again. "The difference has been so amazing," says Laura. "Before this procedure, I was told I would have to place dad in a home, and that he would be wheelchair-bound.

"The main change is how much better his tremors are," she notes. "We just realized he can remove his hearing aid, clean it, and reinsert it by himself! He's shaving on his own. He still needs some balance assistance from a movable walker, but he's walking around the house, up and down stairs. We can even go out to the movies now. His outlook is so much better.

"It's just a miracle to see."

As for Ernest, he's started to forget how much the deep tremors affected his quality of life. It's a tremendously peaceful feeling.


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