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Deep Brain Stimulation Brings Hope to Patients with Movement Disorders

When medications can no longer control muscle tremors or spasms, deep brain stimulation therapies offered by the University of Miami Miller School of Medicine’s Movement Disorders Center bring hope to patients with Parkinson’s disease, dystonia, Tourette Syndrome and other disorders.

Dr. Jonathan R. Jagid, center, performing surgery.

“Our multidisciplinary program is a national leader in deep brain stimulation (DBS) therapies, offering the latest devices and programming applications, along with decades of neurological surgery experience,” said Ihtsham ul Haq, M.D., professor of neurology and chief of the Division of Movement Disorders. “We focus our research and clinical care on delivering personalized treatments that improve quality of life for each patient.”

DBS is a safe, FDA-approved procedure that involves implanting electrodes in the brain with a remote control unit to manage the stimulation, like a pacemaker manages abnormal heart rhythms.

“We have deep experience in implanting and programming devices for maximum effectiveness,” Dr. Haq said. “We use innovative techniques in surgical planning, brain imaging and microelectrode recordings to obtain excellent outcomes with low complications.”

One Patient’s Story

For Dan O’Brien, a professional musician from Boca Raton, the DBS procedure resulted in a significant improvement in nine-year struggle with Parkinson’s disease symptoms. “My surgery was performed at the University of Miami Hospital, and the care I received at this prestigious facility was second to none,” said O’Brien, who wrote about his experience in a book, “DOB does DBS.”

After taking medications for several years, O’Brien and his wife Karen realized his condition deteriorated during the COVID-19 period of isolation. After a thorough evaluation, O’Brien had the DBS device implanted in January 2021, followed by a second surgery to implant the controller in his chest. “I was shown how to adjust the stimulator with a remote device that looks much like a TV remote,” said O’Brien. “About a month later, we went again for some fine tuning. During that time between visits, friends and family remarked on how much better I looked. Also, my guitar playing began to improve!”

Now, O’Brien says that his confidence is returning and the joy of playing music is back.

“For the most part, this surgery had been life changing,” he said. “If you are considering DBS surgery, my personal advice is to do it as soon as possible. Parkinson’s disease is a progressive, incurable disease and DBS, given my experience, has the best chance to give you back your life.”

New Developments

For the past decade, the three manufacturers of DBS devices — Abbott, Boston Scientific and Medtronic — have turned to Miller School specialists for guidance, in keeping with the University of Miami’s role as a National Parkinson’s Foundation Center of Excellence.

“We have conducted clinical trials that led to FDA approval of new devices,” said Corneliu Luca, M.D., Ph.D., associate professor of neurology and director of the Deep Brain Stimulation Program. He has served as principal investigator in more than 30 clinical trials for Parkinson’s disease, and is an active member of Parkinson Study Group, a world recognized clinical trial network for movement disorders.

“We have a comprehensive research program, as well as the longest-running clinical program in South Florida with more than 1,100 implants to date,” said Jonathan R. Jagid, M.D., professor of clinical neurological surgery, neurology, orthopedics, and rehabilitation; director of functional and epilepsy neurosurgery, and director of neurotrauma at the Miller School and Jackson Memorial Hospital.

 Dr. Jagid recently collaborated with clinicians at The Miami Project to Cure Paralysis to implant DBS devices in several patients with spinal cord injuries suffering from chronic neuropathic pain. Another patient with Parkinson’s disease was implanted with a DBS to address medication-resistant freezing of gait, with good results.

The DBS professionals are also working with clinicians in the Department of Psychiatry and Behavioral Sciences to treat obsessive compulsive disorders (OCD), Tourette Syndrome and other behavioral conditions. The Tourette Association of America has designated UM as a Center of Excellence, led by Barbara Coffey, M.D., department chair and professor.

Implanting Devices

Patients with Parkinson’s disease or other movement disorders are initially treated with medications, Dr. Jagid said. But after several years, the medication’s effectiveness can wane or lead to complications in come patients.

“At that point, it’s time to think about DBS, which is the only FDA-approved standard of care to help these patients regain some quality of life,” he said. “The results can be quite remarkable in terms of keeping movement symptoms in check.”

 Every DBS candidate is evaluated by the multidisciplinary team at the Movement Disorders Center, Dr. Haq said.

“The ability to bring together different specialists in a group conference on behalf of the patient is one of the assets of our program,” he said.

Advanced Imaging

Once a patient has been determined to be a candidate for a DBS implant, Dr. Jagid uses 3D imaging and advanced Brainlab software to determine the precise placement of the electrodes.

“We can identify the location in each patient, rather than looking at average locations,” Dr. Haq said. “The also share data from our clinical work with other institutions to advance research and drive better outcomes for more patients with movement disorders.”

Remote Programming

After the implantation, Dr. Luca focuses on programming the device for maximum effectiveness.

“We analyze the electrical signals from the brain and adjust the levels of stimulation accordingly,” he said. For instance, more stimulation might be needed at times when symptoms are worse. The Movement Disorders Center is also implanting new “closed-loop” devices that can track information from the electrodes to determine appropriate stimulation automatically.

Another recent development is the ability to adjust the stimulation remotely without the need for an office visit, Dr. Luca said. Using a tablet in his office, Dr. Luca contacts the patient using a secure, encrypted video signal and changes the programming through the Bluetooth connection in the patient’s smartphone or tablet.

“These telehealth sessions are particularly helpful to patients and families in the COVID-19 environment,” said Dr. Luca, adding that many of the steps in the pre-implantation process can also be done remotely.

Reflecting on the leading-edge care provided by the Movement Disorders Center, Dr. Haq said, “We have one of the few programs in Florida to provide advanced surgical intervention. For patients who need deep brain stimulation, our program can change their lives for the better.”

Tags: Deep Brain Stimulation Program, Dr. Barbara Coffey, Dr. Corneliu Luca, Dr. Ihtsham ul Haq, Dr. Jonathan R. Jagid, Movement Disorders Center, The Miami Project to Cure Paralysis