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Linda Richeson missed her husband's smile.
Linda's husband of 53 years, Ray, was slowly succumbing to Parkinson's disease. He shuffled when he walked, tossed and turned at night, and his face was robbed of expression.
Then, on the day of the Great American Eclipse last year, Ray Richeson underwent deep brain stimulation surgery at Littleton Adventist Hospital, where a robot precisely sited a pair of electrodes in his brain, setting back his Parkinson's symptoms by nearly a decade.
Richeson, 74, got his smile back, and was almost as glad as his wife.
“I'm a salesman — good grief, I want to be able to smile at people,” Richeson said.
Richeson might not have undergone the procedure if it hadn't been for a revolutionary new method developed by Dr. David VanSickle, a neurologist at Littleton Adventist, whose techniques have eliminated much of the fear and hassle from an old surgery that can mean a surge in quality of life for sufferers of several neurologic diseases.
Where prior versions of the surgery took many hours and required the patient to lie awake while doctors operated on their brains, VanSickle's new method allows patients to sleep through the whole thing while a robot cuts down on guesswork in the delicate procedure.
Deep brain stimulation surgery can treat Parkinson's, tremors, dystonia — a disorder that causes body parts to twist the wrong way — and even obsessive compulsive disorder, VanSickle said, but traditional methods scared off many people who could potentially derive great benefit from it.
Deep brain stimulation, or DBS, has existed in some form since the 1960s, VanSickle said.
“It works by inhibiting an area of the brain that's overreacting,” VanSickle said. “With Parkinson's, for instance, a lack of the neurotransmitter dopamine causes brain circuits to overreact, causing tremors and other symptoms. We install electrodes in a precise location, which fires faster than the neurons can respond. They wear out, get tired, and it slows them down.”
The earliest form of the surgery essentially killed off a part of the brain, VanSickle said, but the most widespread version practiced today requires patients to lie awake on an operating table while surgeons drill into their heads and seek out the right spot to install the electrodes.
“A lot of people don't want to do that,” VanSickle said. Under this method, the patient needs to be conscious so doctors can test responses to different spots where they might install the electrode in the brain. Though the spots are evident on a brain scan, they're so small — often only millimeters wide — that even a minor deviation can negate the procedure's effectiveness, or even cause new symptoms like more tremors or decreased eyesight.
Even with the patient awake and able to respond to doctors, surgeons couldn't fully trust they were hitting the sweet spot.
“There are only a few things you could test for while the person's head was bolted down to the bed,” VanSickle said. “You can't test walking, facial expression, long-term response, or obsessive-compulsive symptoms.”
What's more, the surgery could take upwards of eight hours — per side of the brain.
“There weren't a lot of people signing up for this,” VanSickle said.
VanSickle brought a newer method to Littleton Adventist, in which the patient goes under general anesthesia, cutting down on the fear factor.
“I liked the method, but it wasn't precise enough to hit the target every time,” VanSickle said. “I adapted a robot called MAZOR to the surgery. It looks like a Coke can that straps to your head, with arms coming off of it. I did the first surgery with the patient asleep and using the robot in 2014. It just took off from there. I've got it down to where I can be done in an hour and a half.”
The surgery can set back symptoms of neurologic disorders back by upwards of seven to 10 years, VanSickle said, which means a huge jump in quality of life for sufferers, who may be losing their ability to write, use computer keyboards, or feed themselves.
Of the disorders approved for treatment by DBS, only obsessive-compulsive disorder is not covered by insurance, VanSickle said.
“There's no reason for that other than mental health bias,” he said. “Nobody's marching in the streets for that. What's even more painful is that OCD patients are often more intelligent than the average person. They know the prison they live in.”
Without insurance, the surgery can run upward of $80,000, VanSickle said.
Word has gotten out about VanSickle's method, and he now performs nearly 100 such procedures a year, with patients travelling from around the country to receive it. VanSickle said he's trained a surgeon at Stanford on the method, and would like to see it spread worldwide.
“Only about 4,000 people a year get any form of DBS,” VanSickle said. “It should be 40,000. A clinic set up for this in a place with great need, say in China or India, could do six surgeries a day.”
In the meantime, patients like Richeson are thrilled with the results.
“I can't tell you how happy I am to be able to walk along a golf course again,” Richeson said, a big smile stretching across his face.
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