Well, yes, it actually IS brain surgery...

The story of a man who had a hole drilled in his head to fight Parkinson's disease symptoms

by Scott Orr | News2

NOTE: When my doctors and I decided that we would treat my Parkinson's Disease symptoms through Deep Brain Stimulation in the Spring of 2008, I realized it would be an opportunity to show the whole experience to those who might wonder what it would be like. News2 anchor / reporter Vida Urbonas took on the job of putting together a thirty-minute documentary about the surgery and, along with photographer Dave Wertheimer, has chronicled the journey.

This, however, is my version of the events:

March 28:

They are going to drill a hole in my head, drive a probe into my brain, then run a wire from that to a control box implanted under my skin.

They say I am a prime candidate for the procedure, known as Deep Brain Stimulation, because, although I was diagnosed with PD four years ago, at 38, the only symptom that significantly affects me thus far is the tremors, and, happily, that's the part of Parkinson's that DBS can fix.

By "they," I mean a highly-skilled surgical team led by surgeon John H. McVicker, MD, FACS, and my neurologist, Rajeev Kumar, MD, the Medical Director of the Colorado Neurological Institute at Swedish Medical Center in Denver.

I have gone through the whole list of drugs intended to control the tremors, and none did the job before I needed dosages high enough to cause nasty side effects. One, we believe, was responsible for sending me to the hospital with atrial fibrillation. You know how you've seen the TV doctors and paramedics shout, "Clear!" and defibrillate someone with an electric shock? The ER staff did that to me.

Damned shame, that side effect--it was a result of the only drug that appeared as if it might control the tremors even a bit.

I even ended up trying the big L--Levodopa, the drug that doctors would rather reserve until nothing else works. (Nothing else did, so...) But by the time I'd increased it to a dose that might have had an effect, it created dyskinesia, that is, it caused my left leg to shake violently, which, in turn, shook my entire body.

That was worse than the tremors, which, by the way, had not diminished.

Kumar finally tossed in the towel and said surgery would make the most sense in this case.

DBS has been around since the late 1980s, but was only approved by the FDA for treating PD symptoms in 2002. Since then, thousands have had the surgery. The concept is easy enough to explain, but takes part art, part science to accomplish. The patient literally has a hole drilled into the side of his skull opposite the side experiencing tremors (or two holes, one on each side, if the tremors exist on both sides of the body), and a probe with electrodes is inserted into the subthalamic nucleus to send an electrical pulse to that part of the brain. The probe is connected by wires, which run under the skin, to a small, battery-powered computer buried under the skin of the patient's chest. This pacemaker for the brain (as it is often called) can be adjusted by remote control until it is sending exactly the type of pulses necessary to stop the shaking.

Yes, there are potential side effects to having something implanted in your brain. Some are serious, some not so much. Neuropsychological side effects can include apathy, hallucinations, compulsive gambling, hypersexuality, cognitive dysfunction, and depression. Not to mention suicidal tendencies. Or, on the other end of the scale, I may have trouble with simpler things, like speaking.

Because of this, I have also seen CNI psychiatrist Alison Krawiecki, PsyD., who did a complete evaluation of my mental status before the surgery and will compare it to what she observes afterwards. Thankfully, she found little evidence of cognitive problems caused by the PD.

Now I am ready to have the first part of the procedure done: McVicker will drive three screws. called fiducials, into my skull, and then I'll have an MRI and CT scan. The two-fold objective is to create markers that can be used as coordinates during the surgery so the probe can be placed accurately, then create a computer model of my head and also to make it possible to mount a lightweight frame to my head instead of using the older "halo" frame. Once upon a time, the patient had to be placed in a frame--the "halo"--to keep his head absolutely immobile, which is an uncomfortable way to spend four hours of surgery. The screws placed in the skull make movement possible.

Oh, I almost forgot: I'll be awake for the brain-surgery part.

The patient has to be able to interact with the team so they can be certain that everything is working as planned. This means answering questions, moving in various ways, and so on. Luckily, there are no pain receptors in the brain. I have seen this sort of thing done in person, years ago: I shot a story in the late-90s that involved a woman having "awake brain surgery." It was eerie; she was on her side on the table, with a curtain along the side of her head. From the front, she was normal, even smiling. Behind the curtain, the surgeons had removed the back of her skull and placed small adhesive numbers on her brain. As they touched it in different places, she reacted accordingly. One touch affected memory, another speech ability.

I am thankful brain surgery has advanced beyond that stage, at least as far as this procedure is concerned. A hole in my head is bad enough--the real-life version of Steve Martin's "Cranial Screw-Top Technique" would not be my idea of fun.