April 25, 2012
Mixed among the stack of letters, circulars and junk mail in Mike Perretta's mailbox was a postcard that would change his wife's life. Judith, like her mother, father, sister and brother, suffered from familial tremors. Tremors, as explained by the National Institute of Neurological Disorders and Stroke (NINDS), are unintentional, rhythmic muscle movements that involve to-and-fro movements of one or more body parts – most often affecting the hands, arms, head, face voice, trunk and/or legs.
The tremors began when Judith was in her early 30s, but early on were manageable and most obvious only when she tried to focus on detailed work with her hands. As she aged, the tremors became more severe and interfered with her ability to eat or drink. In recent months, she had been forced to increase her tremor medications until she had very little quality of life.
“The medicine just took everything out of her. I had begun to think she was dying,” says Mike. “If she didn't take the medicine, her hands trembled until she could not use them. On the medication, she was sedated until all she could really do was lie on the couch.”
“When I saw the postcard in the mail, I knew I should show it to Judith,” he says. “I told her I thought we should check it out.”
The postcard announced an upcoming seminar on Deep Brain Stimulation (DBS) to be held in Cornelia, not far from the Perrettas’ Martin, Ga., home. John Gorecki, MD, a neurosurgeon with Northeast Georgia Physicians Group (NGPG) Neurosurgery, was there to answer questions about the new treatment in whicha medical device is implanted in the brain to send electrical impulses to minimize tremors.
“I was curious,” Judith says. “So we drove to Cornelia and gathered with about 75 other people to learn more about the procedure. A Parkinson’s sufferer told us about the tremendous difference DBS had made in his life. I decided to make an appointment to see if I was a candidate.”
At Judith’s first appointment, Shaena Blevins, MD, a neurologist with NGPG Neurology and medical director of Neurophysiology at Northeast Georgia Medical Center (NGMC), performed several tests to study Judith’s tremors and create a treatment plan.
“I had MRIs, a CAT scan and blood work. She had me draw circles and try to follow a straight line while she monitored my tremor,” Judith says. “The harder I tried to focus and perform a detailed task, the worse the tremor became.”
Six days before her surgery, Judith visited NGMC for an outpatient procedure in which small holes were placed into her skull. These openings created a way for the neurosurgeon to stabilize a halo, or plastic frame, atop Judith’s head during the surgery.
“The deep brain stimulation system sends electrical signals to an area in the brain that controls movement,” explains Dr. Gorecki. “These signals block some of the messages that cause the tremors. We use the imagery and mapping from the MRI to create a halo device that is specific to each patient. The halo and MRI guide us like a personalized GPS for each patient.”
Mike and Judith got up early the day of her procedure, and Mike shaved off Judith’s hair.
“I was anxious to get it over with, but not terribly emotional,” Judith says. “I knew they were going to be probing around in my brain, but I also knew I was in good hands.”
During her surgery, Judith was sedated, but alert.
“Patients are awake throughout the surgery so that we can make certain that the electrodes are in exactly the right location and to ensure that there are no side effects,” explains Dr. Gorecki.
“During the surgery, they asked me questions and had me do things like write my name as they tested the successful placement of the electrodes. I could feel pressure but no pain at that stage.”
The night of her surgery, Judith stayed in the Intensive Care Unit at NGMC, where she was monitored continually; she was able to go home the very next day. Two weeks later, she returned for the third step in the process. A small battery was implanted under the skin just beneath her collarbone, and a wire was run under her skin from the electrodes in her brain to the battery.
“The pain following that step was significant,” says Judith. “But I refused to take the pain medication or it probably would have been manageable. Even as painful as that was, it was worth it.” She takes a small device and places it against her chest to turn off the electrodes in her brain. She lifts her right hand and it trembles uncontrollably. She smiles as she turns the battery pack back on and lifts a steady, gracious hand into the air.
“She’s a live wire again!” says Mike, smiling at his bride across their living room.
For more information about deep brain stimulation, visit www.nghs.com/deep-brain-stimulation or call 770-219-3840.