Rick Schena, of Alexandria, Virginia, and his doctor at MedStar Health, in McLean, have begun using the latest technology 鈥� adaptive deep brain stimulation 鈥� in his treatment for a neurodegenerative disorder.
“Mr. Schena has had Parkinson’s disease for 17 years,” said , a movement disorders neurologist. “With abnormal activity we see a slowness of movement, a lot of rest tremors, they’re very rigid and stiff 鈥� these are the classic motor symptoms of Parkinson’s.”
Until recently, Schena’s treatment was based on a variety of medications.
“I was getting to the point with the drugs that they weren’t as effective, and then to take more of them was going to start causing different problems, like hallucinations,” Schena said.
Last September, Schena had brain surgery at MedStar Georgetown University Hospital, using a cutting edge Intraoperative MRI System.
“He now has a pulse generator right here,” said Pagan, pointing toward Schena’s right clavicle. “It’s a very small device, rechargeable, connected to two electrodes in the brain, called the subthalamic nucleus” 鈥� the portion of the brain that can help suppress unwanted movements.
The implanted neurostimulator senses brain activity 24 hours a day.
“Cardiac pacemakers have been way ahead of us 鈥� this deep brain stimulator for the brain is basically a pacemaker for the brain,” Pagan said.
The effects of deep brain stimulation, known as DBS, “mimic the effects of medication, so we were able to have about a 60% reduction in his oral medications with implantation of the DBS,” Pagan said.
Schena said the combination of DBS and medication “has made all the difference in the world,” in control of his tremors and other symptoms.
“I’d say they’ve been about 98% gone,” Schena said.
‘Welcome to the 21st century’
Friday, Schena’s treatment was elevated to the next level.
“Just last month, the FDA approved the use of adaptive DBS,” Pagan said. “It’s an AI-driven program that helps us personalize the settings that he was on.”
In the months since he’s had the implanted device, Schena has been able to tweak the settings with a smartphone app when needed. For instance, eating protein weakens the effect of his medication, “so I can turn up the amplitude and bring it down, within a very, very tiny range.”
Now, the adaptive DBS, or aDBS, can monitor brain signals, and automatically change in response to those brain signals.
“It provides the best symptom control for whatever activity he’s doing 鈥� it’s different when you’re sleeping, reading a book or exercising,” Pagan said.
Schena, a former military and commercial pilot, is the first Parkinson’s disease patient in the D.C. area to be using the recently-approved aDBS.
To apply the latest technology to Schena’s treatment, a representative for , the company that makes the aDBS system, was present in a lunchroom crowded with doctors, research fellows and Schena’s wife.
The parameters Pagan programs are based upon what Schena’s brain activity has been in recent weeks.
Huddled around an iPad display of Schena’s brain activity, Pagan and other doctors confer with Prak Muppidi, a field technical consultant, who instructed the doctor on how to capture and implement the settings.
After analyzing the data, the group set parameters for the amplitude and frequency to be applied.
When low end settings were set 鈥� for instance, when he’s sleeping 鈥� Schena didn’t feel any difference. However, when the high end settings were set, Schena’s head tilted back, and he smiled, recognizing a jolt of therapy.
Pagan asked Schena to open and close each fist as quickly as possible, to gauge his ease of movement.
“Say ‘today’s a sunny day,'” Pagan requested. “Today’s a sunny day,” Schena repeated.
“Say ‘Massachusetts,'” Pagan continued. Schena’s version was a bit slurred.
Pagan said too much stimulation can affect speech, so he lowered the amount of therapy reaching Schena’s brain.
After a few more tweaks, Pagan was done setting the parameters, and turned to Schena.
“You now are officially the first patient in the D.C. metro area with adaptive deep brain stimulation,” said Pagan, shaking hands warmly with Schena, who responded, “Thank you, Dr. Pagan 鈥� I love you, brother.”
“Welcome to the 21st century,” joked Pagan, as the roomful of doctors and observers offered well wishes.
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