Dad asked if he could write a guest post on Parkinson’s and here it is. I hope you find it interesting!
One of the interns at the Mayo Clinic had a well-thumbed paperback in his pocket entitled “Guide to Neurology.” We joked about how confidence-building that was and that only “Brain Surgery for Dummies” would have been a more reassuring book for him to have. For awhile I have been thinking about how to explain Parkinson’s disease and the strategies used to combat it simply so a dummy like me could understand it. Here goes:
The brain is an incredible organ. Your brain fires hundreds of signals without you being aware that messages are sent to your muscles each time you stand, walk or take a sip of coffee. The brain produces dopamine, a substance that essentially amplifies the signal to get it through. In people with Parkinson’s, the cells that produce the dopamine are dying. In most cases, the cause is unknown. Think of the brain as an AM radio station sending messages; if the signal isn’t strong enough then static or other noise distorts or blocks it from getting through. When this happens the muscles hear the wrong thing, causing tremors or spasms or no signals at all, causing “freezing,” something that has been more common for Jan.
In the 1950’s two artificial forms of dopamine were developed and remain the foundation for the treatment of Parkinson’s. In the early stages of the disease, one takes Sinemet three times a day and everything is fine but after about five years, something strange starts to happen. The brain figures out that something foreign is affecting it and blocks it, first sporadically, then on a more and more regular basis. Virtually all the pharmaceutical advances in the last fifty years have been to fool the brain into letting the Sinemet in and to prevent the body digesting it until the drug has a chance to get to the brain. It is like a battle- each of the new drugs help for a while, then the brain figures out how to block them.
Remember the radio? All the medical emphasis has been to increase the signal’s strength to overcome the static. But what if you could decrease the static? Turns out that just about all the noise or static that impedes the signals getting through come from a pea-sized area on each side of the brain. In the 1990’s they did surgery to nuke (cauterize, really) the part of the brain that created the static. Michael J. Fox had this surgery. Again, it worked for about five years, until static came from other parts of the brain.
So what if you fought noise with noise? Imagine being in a crowded restaurant. You can’t hear your dining partner across the table so you stand on your chair and scream “shut up” at the top of your lungs. I guarantee that the place will silence instantly. However, in a few minutes (possibly even before you are thrown out) the ambient noise will return. The surgery Jan had was to put an electrode into the middle of that pea-sized area on each side of her brain to fight noise with noise about 300 times a minute for the next five years, until she needs to have the battery replaced.
Jan was awake for the eight and a half hours of the surgery. One of the devises that the surgical team has listens to the static as each probe is implanted. She said that when the probe hit the pea-target, the static was so loud that she thought it had started to rain heavily. They turned on the electrode, and the sound stopped.
Jan’s battery-powered brain hasn’t been turned on for good yet, but she is already having remarkable results. She had the surgery Wednesday, came home Thursday, took it easy Friday, but then went out to lunch Saturday, did a few errands and then saw the new George Clooney movie. All of this improvement is called a honeymoon effect—Jan is getting benefits similar to the earlier cauterization surgery that will wear off over the next couple of days and weeks.

Chihuly sculptures at the Mayo Clinic.
I can’t close without some comments about the Mayo Clinic. They have been on Newsweek’s “Ten Best Hospitals” list since they started writing one. They claim to be the largest integrated medical facility in the world and I for one believe it. They have 50,000 employees in Rochester, Minnesota, a town with a population of 85,000 two hours south of the Middle of Nowhere. They have more important art (Miro, Chihuly) than many museums. The day of Jan’s surgery, hers was one of 118 surgeries at St Marys, one of the two hospitals that are part of the Mayo Clinic. St. Marys has four nurses whose job is to keep families informed while their loved ones are in surgery. I got six status calls from them during the day. Dr. Kendall Lee, the god who performed Jan’s surgery, met with me after the surgery and he was beaming, just radiating. He used the word “terrific” four times… and he has done this surgery about four hundred times before, he was that pleased. Dr. Lee, like everyone at Mayo, is on salary. He would have been paid the same for playing golf that day as he was for making an incredible improvement in Jan’s quality of life.
Jan’s battery-powered brain will be programmed in a few weeks. Each implant actually has four electrodes from which the technicians can select for the best result. They also will experiment with power levels and frequencies for the best result. Then we will see how brain surgery for dummies was really smart.
Thanks, Jordie, for letting me add to your blog.