Rewired
Posted on December 16, 2024 by Marketing and Communications
HARRY LANCASTER’S livelihood had always rested in his hands. As an electrical technician, he relied on them for a paycheck. Until he couldn’t.
“I went to a neurologist because my hands were shaking so bad, and I was about to the point where I couldn’t feed myself, not without making a huge mess,” says the 80-year-old Thomasville, Alabama, resident.
His once-steady hands had begun to move uncontrollably, prompting a shift to desk
work and eventually to retirement.
At first, Lancaster attributed the shaking to age. But when he couldn’t button a shirt
or enjoy a cup of coffee, he and his wife, Carol, knew it was time to seek help.
Their search ultimately led to USA Health and Dr. Hanna Czarkowska, a neurologist and assistant professor of neurology who specializes in movement disorders.
Lancaster has essential tremor. It causes involuntary, rhythmic shaking or trembling, usually in the hands and arms. It has no cure, and its cause is unknown. Medication was ineffective and left him nauseated.
The next option was deep brain stimulation, a surgical procedure that corrects faulty brain signals that cause shaking. Lancaster was a good candidate.
“He was quite debilitated by his tremor and determined to have it fixed,” Czarkowska says. “He understood the steps involved in the procedure and that it may take a while to see its full benefit. He also had a great cheerleader in his wife. The importance of a strong support system should never be overlooked.”
The decision to move forward with deep brain stimulation, offered in Mobile only through USA Health, also involved USA Health neurosurgeon Dr. Andrew Romeo, assistant professor of neurosurgery.
The process begins with an MRI under general anesthesia. It shows the surgeon where in the brain to place the electrode, which is 1.27 millimeters wide (slightly thicker than a medium-size safety pin) and 40 centimeters long — of which 7-8 centimeters (about 3 inches) extends into the brain. The next day, when the electrode is implanted through a small incision in the scalp, the patient is awake.
Why keep the patient conscious? For testing, Romeo sys. The surgical team sends electricity through the electrode to make sure the patient doesn’t exhibit or report side effects that could indicate improper positioning.
A week later, a battery-powered implantable pulse generator is placed under the skin. It sends electrical stimulation to the electrode, blocking abnormal nerve signals.
“We do not turn the stimulator on for another month or so,” Czarkowska says. “This
is to allow the brain tissue surrounding the electrode to recover from the surgery
and assure that we do not program the device while the brain is still healing. When
the system is finally activated during an office visit, we go through several combinations
of stimulation settings to find one that offers best symptom control with no side
effects.”
Lancaster had the first surgery on one side of his brain in October 2023 and another
to address the other side of his body in February 2024.
Like Lancaster, most patients are satisfied with the results. For 80%-90%, deep brain stimulation can reduce tremors by 80%.
The treatment restored Lancaster’s independence and allayed his fears about the future.
“If I get to a point where I can’t feed myself and something happens to my wife, what
am I going to do?” he asks.
Follow-ups with Czarkowska fine-tuned the device.
“The visits are initially fairly frequent, every few weeks or so, as we are testing the adjustments following the first big programming session in real-life situations,” she says. “They eventually extend to every few months. Not only do we tweak stimulation to match the disease demands and progression, but in the case of nonrechargeable stimulators, we also keep an eye on battery life.”
Romeo says the ability to adjust stimulation according to the patient’s needs elevates the procedure above other treatments for essential tremor.
“It’s a relatively low-risk, minimally invasive procedure, so there aren’t a lot of patients who I feel like are not healthy enough for it,” he says. “It’s very effective, and patients are generally happy with the results, so I think there’s a lot of upside to it. There’s not a lot in neurosurgery that has that kind of effect.”
These days, Lancaster can start his day with coffee again. He can button a shirt without frustration. He cooks and takes up computer repair now and then.
“Oh, it’s made all the difference in the world,” he says. “I can sign my name now, and I can eat without spilling everything on my plate. I still shake a little bit for an old man, but nothing — nothing — like what I was going through before.”