{"id":40475,"date":"2021-07-12T11:22:05","date_gmt":"2021-07-12T17:22:05","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=40475"},"modified":"2021-07-12T11:22:05","modified_gmt":"2021-07-12T17:22:05","slug":"remote-dbs-programming-saves-money-and-miles-for-patient-with-parkinsons-disease","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/remote-dbs-programming-saves-money-and-miles-for-patient-with-parkinsons-disease\/","title":{"rendered":"Remote deep-brain stimulation programming saves \u2018money and miles\u2019 for patient with Parkinson\u2019s disease"},"content":{"rendered":"
<\/div>
\"Craig
Craig Overman, who uses deep-brain stimulation for his Parkinson’s disease, talks with his granddaughter. Photo courtesy of Overmans.<\/figcaption><\/figure>\n

When Craig Overman\u2019s Parkinson\u2019s medications no longer kept his symptoms under control, he became a textbook candidate for deep-brain stimulation or DBS.<\/p>\n

Then, he benefited from treatments so new that they\u2019re not even in medical textbooks yet.<\/p>\n

Remote deep-brain stimulation for Parkinson’s disease<\/strong><\/h2>\n

That cutting-edge technology, approved by the U.S. Food and Drug Administration in March, enables remote programming and adjustment of the electrical stimulation that makes deep-brain stimulation work.<\/p>\n

For Overman and his wife Susan, who live in Wyoming, a five-and-a-half-hour drive from UCHealth University of Colorado Hospital<\/a>\u00a0on the Anschutz Medical Campus<\/a>, fewer trips to the hospital have been a particular blessing.<\/p>\n

\u201cIt has saved me time and money,\u201d Craig said.<\/p>\n

The deep-brain stimulation itself has saved him much more than that.<\/p>\n

The Overmans live in Newcastle, Wyoming. Craig, now 62, had operated heavy equipment in open-pit coal mines for 37 years as of 2015. That\u2019s when a friend noticed that Craig\u2019s left arm wasn\u2019t swinging when he walked. A visit to a neurologist brought the diagnosis of early-stage Parkinson\u2019s disease. Craig went on with his life until Parkinson\u2019s made that hard to do.<\/p>\n

In his case, the symptoms were mainly manifesting in fluctuations of muscle rigidity and involuntary movements of the arms and legs, which is known as dyskinesia. The go-to Parkinson\u2019s drug, levodopa, helped, but as time passed, the fluctuations were more frequent and unpredictable. That led to higher and more frequent doses of levodopa until Craig was taking 20 pills a day \u2013 more than twice as much of the drug as patients typically take.<\/p>\n

\"\"
Photo courtesy of Craig Overman.<\/figcaption><\/figure>\n

Parkinson’s disease symptoms creep in<\/strong><\/h2>\n

Meanwhile, Craig\u2019s health deteriorated. By 2016, his ability to operate equipment that makes full-sized pickups look like Tonka trucks was no longer possible, and he went on disability. Walking became increasingly difficult, to the point that a walker, and, later, an electric wheelchair, came into play. An expert archer and bowhunter, Craig found himself unable to handle his bow. Other activities he loved \u2013 camping, four-wheeling in the Black Hills, fishing with his grandson Hayden \u2013 suddenly seemed out of reach. Fatigue and sleep problems, common Parkinson\u2019s symptoms, crept in. Making matters worse, the levodopa played havoc with his digestive system.<\/p>\n

\u201cHe couldn\u2019t eat, wouldn\u2019t eat,\u201d Susan recalled.<\/p>\n

As so often happens, physical challenges brought psychological barriers, and justifiably. Craig couldn\u2019t walk into a store and be entirely sure he would be able to walk back out of it because, as he put it, \u201cmy muscles would just stiffen up.\u201d Craig started skipping his grandson\u2019s youth baseball and basketball games \u2013 games he loved to watch \u2013 for the same reason. He increasingly ended up watching a lot of TV by himself.<\/p>\n

\u201cI had no ambition. Things I really enjoyed, I didn\u2019t want to do anymore,\u201d Craig said.<\/p>\n

Susan, working full-time as the treasurer of Weston County, never quite knew what to expect upon returning from work.<\/p>\n

\u201cYou never knew if you were going to come home to him lying on the floor,\u201d she said. \u201cOne time, the ambulance had come. There were several trips to the ER because he wasn\u2019t feeling good and having issues with different things.\u201d<\/p>\n

\"Craig,
Craig Overman and his grandson. Photo courtesy of Craig Overman.<\/figcaption><\/figure>\n

Enter deep-brain stimulation for Parkinson’s disease<\/strong><\/h2>\n

Craig was aware of deep-brain stimulation or DBS, but wasn\u2019t enthusiastic about the notion. YouTube wasn\u2019t helping.<\/p>\n

\u201cI went to the internet and started the videos of the surgeries, and I couldn\u2019t finish watching them,\u201d he said.<\/p>\n

By April 2020, though, he knew something had to change. Craig\u2019s neurologist in Rapid City, South Dakota, referred him to Dr. Drew Kern<\/a>, a University of Colorado School of Medicine and UCHealth movement-disorders neurologist.<\/p>\n

After an in-depth discussion with Kern on advanced therapies, Craig and Sandy made the decision to pursue deep-brain stimulation. Determining who is a good candidate for DBS is vital and involves comprehensive testing over two days. During this time, Craig also met with Dr. Steven Ojemann, a fellowship-trained stereotactic functional neurosurgeon at UCHealth University of Colorado. Ojemann has 20 years of experience in DBS, the most in the region. The entire DBS team, including nearly 20 clinicians and other providers, reviewed Craig\u2019s candidacy the following week.<\/p>\n

And, they determined that DBS would work well for him.<\/p>\n

\"Remote
Remote DBS-programming telehealth from the patient\u2019s perspective. Image courtesy of Abbott.<\/figcaption><\/figure>\n

Craig\u2019s Parkinson\u2019s disease manifested in the sorts of motor complications \u2013 in particular, dyskinesia and muscle rigidity \u2013 that DBS works best on. Also, Craig\u2019s stark \u201con-off\u201d fluctuations as the levodopa pills wore off were a sign that DBS should work well. Further, when the levodopa was \u201con,\u201d it drastically improved Craig\u2019s motor skills.<\/p>\n

\u201cThe benefits of DBS can be predicted based on the effects of medication,\u201d Kern explained. \u201cHe had a 70% improvement of his motor performance with medication; however, the duration was shorter than ideal and he had bothersome dyskinesias.\u201d<\/p>\n

Importantly, Parkinson\u2019s disease hadn\u2019t affected Craig\u2019s cognitive state, which DBS doesn\u2019t improve. And he was still young, had no serious comorbidities, and had strong family and social support, as the CU DBS saw it. DBS was a go.<\/p>\n

Precise placement during DBS surgery<\/strong><\/h2>\n

But the procedure would have to wait. The coronavirus pandemic shut down elective surgeries across Colorado, then throttled them back later in 2020. It would be January 2021 until the procedures took place.<\/p>\n

Deep-brain stimulation surgery for Craig involved three procedures. During the first and second, doctors implanted the electrodes on the right and left sides of Craig\u2019s brain. During the third procedure, the specialists placed the battery under the skin just below the collarbone.<\/p>\n

Three subspecialists collaborated prior to and in the operating room for placement of the DBS electrodes: \u00a0the movement-disorders neurologist ( Kern), the neurophysiologist who aides in determining the location of the electrode based upon hearing and watching brain cells fire (Dr. John Thompson))<\/a>; and the stereotactic functional neurosurgeon (Ojemann<\/a>). University of Colorado Hospital is among a select few U.S. medical centers bringing such a comprehensive array of skills to the DBS operating room.<\/p>\n

\"Craig,
Dr. Drew Kern, left, with Dr. Steven Ojemann<\/figcaption><\/figure>\n

During those first two surgeries, the trio precisely placed DBS electrodes in Craig\u2019s subthalamic nucleus. Craig was awake for both: his movements and responses improved targeting and helped avoid adverse effects. During these surgeries, the DBS team combines intraoperative imaging, neurophysiology, and clinical response to accurately position the electrodes. In the event that the patient can\u2019t be awake for surgery, the team also does DBS under anesthesia using an MRI-assisted system called ClearPoint<\/a> that combines real-time MRI guidance in the implantation of DBS electrodes.<\/p>\n

In early April, the Overmans were back at the hospital for Kern to program the DBS device. This was one of the several 330-mile trips he had already made. Programming involves adjusting the amount and location of electrical current flowing to Craig\u2019s subthalamic nucleus. Susan took cell phone videos of her husband walking down a hallway before and after the roughly 90-minute session. Before, he shuffles slowly and stiffly with baby steps; after, his strides are healthy and his gait appears nearly normal.<\/p>\n

On the way home, a snowstorm hit, and as the Overmans followed a snowplow the last 35 miles up U.S. 85, they both looked forward to not doing this drive too many more times.<\/p>\n

Remote programming of deep-brain stimulation<\/strong><\/h2>\n

The Deep-brain stimulation team at University of Colorado Hospital involves its patients in the choice of hardware to be implanted: Medtronic, Boston Scientific, or Abbott. Each of these device companies offers excellent products but there are some differences, which would make an individual choose one over the other being specific for this person\u2019s lifestyle.<\/p>\n

\"Abbott
Abbott received FDA approval for its DBS telehealth and remote-adjustment technology in March. Here\u2019s the physician\u2019s perspective. Image courtesy of Abbott.<\/figcaption><\/figure>\n

For Craig, he chose Abbott as it was not rechargeable and at the time may have the ability to be programmed remotely. Between the DBS surgeries in January and the initial programming in April, Abbott did receive FDA approval for a system enabling the remote programming and adjustment of Craig\u2019s controller.<\/p>\n

Craig could use an iPhone or iPad to connect<\/a> with Kern or a nurse. Using secure video links over Wi-Fi or cellular networks, UCHealth providers could do telehealth visits, observing as Craig did finger taps, toe taps, walked, and so on, and make programming adjustments just as if he was in the same room with the physician. Kern even received a medical license in Wyoming to be able to do such remote consultations.<\/p>\n

The Overmans made two more trips to Aurora, neither of which involved snowstorms. By then, Kern was satisfied that they could do the next visit at a distance. In mid-May, Kern and Craig video chatted, Craig did some prescribed movements, and Kern made some minor adjustments. Craig was the first patient in the region to receive remote DBS programming. Kern and Craig have had subsequent remote programming appointments and will continue to do so going forward.<\/p>\n

Remote programming and adjustment could work just as well for someone 300 miles or even three miles from Aurora, Kern says, and other patients have since chosen the telehealth option. He offers it to everyone, he says. But there are some minor limitations: It\u2019s harder to gauge gait over a video link, and it\u2019s not possible for him to feel for muscle rigidity. Some patients, particularly ones closer to Aurora, may continue to prefer onsite visits. But many others will surely opt for remote adjustments.<\/p>\n

Craig Overman is back at his grandson\u2019s games, and his health has returned in time to support another grandchild\u2019s youth-sports endeavors: granddaughter Payton is getting into soccer and basketball. Craig is also looking forward to fishing, hunting, and four-wheeling. He\u2019s cut his levodopa dosage by about 75%, has his appetite back, and is feeling a whole lot more energetic.<\/p>\n

\u201cI mean, he\u2019s been doing everything,\u201d Susan said. \u201cThe other day, he power washed the deck and he stained it, and we\u2019re getting new windows, and he\u2019s out mowing the lawn.\u201d<\/p>\n

Craig marvels at what DBS has done for him.<\/p>\n

\u201cIt\u2019s changed my life for the better, and it\u2019s only been three months,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"

When Craig Overman\u2019s Parkinson\u2019s medications no longer kept his symptoms under control, he became a textbook candidate for deep-brain stimulation or DBS. Then, he benefited from treatments so new that they\u2019re not even in medical textbooks yet. Remote deep-brain stimulation for Parkinson’s disease That cutting-edge technology, approved by the U.S. Food and Drug Administration in […]<\/p>\n","protected":false},"author":23,"featured_media":40481,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[563,184,4624,215,750],"class_list":["post-40475","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-deep-brain-stimulation","tag-neurology","tag-neurosciences-outcomes","tag-neurosurgery","tag-parkinsons-disease"],"acf":[],"yoast_head":"\nRemote deep-brain stimulation for Parkinson's disease - 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