“Are you familiar with dyskinesia?” asked Steve Fouche, referring to the involuntary movement people with Parkinson’s disease sometimes experience with long-term use of the medication levodopa. “I say it’s kind of like dancing, but you’re the only one who hears the music. It’s disco-nesia.”
Steve, diagnosed with Parkinson’s 15 years ago at age 46, knows firsthand how powerfully the condition can affect a life. However, he’s not one to let things get him down. “I’ve always handled things with humor,” he said. “It’s certainly easier than crying.”
Steve, a retired minister, and his wife, Cynthia, were living in Phoenix when he noticed he was having trouble at his computer keyboard. “My left hand got rigid,” he said. “I thought maybe I had a pinched nerve. Learning it was Parkinson’s scared the you-know-what out of me.”
A progressive nervous system disorder, Parkinson’s symptoms include rigidity, tremor, slowed movement, changes in speech and a loss of control over automatic movements like blinking or swinging your arms while you walk. Steve was prescribed a combination of medications but experienced side effects.
“Over the years, the Parkinson’s progressed and his doctors in Arizona kept increasing the medicine,” Cynthia said. When she and Steve relocated to Wisconsin in 2008, they connected with Karen Blindauer, MD, neurologist, movement disorders specialist and Medical College of Wisconsin faculty member.
“We went to Froedtert Hospital because it’s a research institution,” Cynthia said. “Dr. Blindauer successfully balanced all the different medications Steve needed.”
Deep Brain Stimulation
By 2015, Steve’s condition affected both sides of his body and his dyskinesia became so bad he had to give up driving. Looking for options, the couple attended a seminar presented by the Froedtert & MCW Parkinson’s and Movement Disorders Program and learned about deep brain stimulation (DBS).
With DBS, surgeons implant electrodes in the brain, which are connected to a neurostimulator under the skin in the chest, much like a pacemaker. Once programmed, the neurostimulator delivers electrical signals to the brain to help reduce a patient’s symptoms.
“We hadn’t heard of DBS before, and we discussed it with Dr. Blindauer,” Steve said. “But the idea of someone drilling holes in your head while you’re awake, well, it took us two years to think it over before I went ahead with surgery.”
Prior to DBS surgery, each patient receives a comprehensive evaluation to ensure they are a good candidate for the procedure.
“Parkinson’s is a diverse disease and patients experience symptoms and respond to treatments in individual ways,” said Ryan Brennan, DO, neurologist, movement disorders specialist and MCW faculty member. “We do a lot of counseling about what’s realistic to achieve and what’s not. We carefully consider if a patient is likely to benefit from DBS and the best time to intervene.”
Neurosurgeon and MCW faculty member Peter Pahapill, MD, along with Dr. Brennan, performed Steve’s surgery.
“I was involved in some of the pioneering work in DBS in the mid-90s,” Dr. Pahapill said. “We knew it helped with tremors and then began to see promising results in the treatment of Parkinson’s. This is a reversible, adjustable therapy. We are not changing the anatomy in any way. Some patients have experienced improvement for 25 years.”
Keeping Symptoms at Bay
"Steve has had a fabulous outcome,” Dr. Blindauer said. “He has substantially reduced his medications. He had been dosing every couple of hours and would have downtime between when one dose wore off and the next one kicked in. Now, he functions more consistently throughout the day. It is liberating for patients to know their symptoms are controlled for the whole day.”
“This surgery was the scariest thing I’ve ever done, but I would do it again in a heartbeat,” Steve said. “I think Dr. Pahapill and Dr. Brennan have a time machine because they took me back 15 years. At 61, I’m doing things I had to give up at 46, like riding my bike. It sure improved my quality of life.”