Monday, December 16, 2019
Leaders of the Owatonna Parkinson's Support Group, Sandi Tobin, left, and Ardis Woods, right, visit with Mayo Clinic neurosurgeon Dr. Kai J. Miller at a recent Support Group meeting at the Owatonna Public Library. Miller is one of two neurosurgeons at the Mayo Clinic in Rochester.

Parkinson Support Group learns more about Deep Brain Stimulation

An expert in Deep Brain Stimulation (DBS), a treatment for Parkinson's disease, essential tremor, and dystonia, spoke to members of the Owatonna Parkinson's Support Group at a special meeting on Monday, Nov. 25 at the Owatonna Public Library.

Sharing his thoughts about DBS was Dr. Kai J. Miller, a neurosurgeon from the Mayo Clinic in Rochester.

Miller joined staff at Mayo this past July. He came to Mayo after studying at Stanford University in California. He earned medical and PhD degrees from the University of Washington. He is one of two neurosurgeons at Mayo who perform DBS.

Individuals with Parkinson's and their caregivers attended the informative meeting.

DBS, Miller said, is one of many recent advances in technology used to treat patients with Parkinson's disease.

"My incentive with the surgery is to do what is best for my patients," remarked Dr. Miller.

He said 1 million people, or 1% of the nation's population, have Parkinson's disease.

Dr. Miller said medications help treat Parkinson's, providing a Dopamine replacement for patients.

DBS is optimal surgery that delivers electric current to separate parts of a patient's brain in order to deal with symptoms.

Some of the PD symptoms include tremor, rigidity, fatigue and bladder function.

The goal of DBS is to re-establish a therapeutic range for the patient, said Miller.

Dr. Miller said DBS is recommended for people who have PD with motor fluctuations and tremor inadequately controlled by medication, or to those who are intolerant to medication, as long as they do not have severe neuropsychiatric problems.

The DBS system, Miller stated, consists of three components: the implanted pulse generator (IPG), the lead, and an extension. Colleen Crane of Boston Scientific was present for Dr. Miller's talk and provided insights about the surgical leads.

Miller said benefits of DBS include: tremor reduction, increased mobility, medication reduction and improved quality of life.

Not many side effects are present with DBS, said Miller. One that does sometimes occur is infection, he said.

A goal of DBS is to accurately target therapy and avoid unwanted side effects.

Dr. Miller used a Power Point presentation to show the steps of surgery, which include a frame that is placed over the head. "It looks like a medieval torture device," he honestly said. Miller said he is working on a design of a different type of frame that would not be as bothersome.

Deep Brain Stimulation was brought to America in the 1990s, Dr. Miller said.

 

The surgery takes about four hours and the patient is awake during the entire surgery. Explicit testing is done during surgery, thus requiring communication between the surgeon and patient.

Surgical steps include placing the leads into the brain. The patient comes back in 5-7 days for a re-check. The device is turned on in three weeks.

He showed a video of a patient after DBS. When the electrode wave was turned on, the patient's tremor was diminished.

Dr. Miller said the current can be moved around by neurologists who shape the current.

"It's a great therapy provided by Mayo, a magical institution," said Miller.

He recommends DBS over ultrasound, which is more directed to an essential tremor.

No Parkinson's genes exist, meaning no blood tests can determine if an individual has Parkinson's disease.

Dr. Miller, also a physicist, said he became interested in studying how the brain computes information. "I am constantly learning how the brain works," he said.

In addition to making DBS surgery the best therapy possible, Miller says his goal is also to make surgery comfortable for the patient.

Miller thanked the Owatonna Parkinson's Support Group for inviting him to speak on DBS. "It's nice to see people in their natural environment," he said

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