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Deep Brain Stimulation

For an artist, having control of your hands means everything. So when Don, a retired art teacher, started experiencing shakiness in his right hand, it threatened to put his lifelong love on hold. Don was diagnosed with essential tremor, a neurological disorder that causes uncontrollable movement. He tried to ease his shakiness with medication.

Despite the medication, Don's tremor persisted. Soon, not only was painting out of the question, but his tremor was becoming so bad it was increasingly difficult for Don to do things on his own. Simple things such as cutting his food and eating required his wife Sandy's help. The active couple, who split their time between Sylvania, Ohio, and Florida, started avoiding social situations. They even ate in the far corner of their favorite Florida restaurant to avoid embarrassment.

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Medication was not the answer

"It got to the point where I had to do something."

From the beginning, Don's neurologist recommended he consult with The Ohio State University Wexner Medical Center about their successful deep brain stimulation (DBS) therapy. DBS is an advanced procedure that involves surgically implanting a battery-operated device, similar to a pacemaker, into the body to deliver electrical stimulation to the brain.

Although it sounded impressive, Don was apprehensive and scared of the idea of someone operating on his brain. Instead, the couple decided to keep trying medication to treat Don's tremor. But after a few years of taking different combinations of more than 30 medications with no relief in sight, Don realized no pill was going to alleviate his tremor.

DBS Surgery provided the solution

"I was a little apprehensive about the surgery."

Don's essential tremor continued to interfere with his quality of life, and it was becoming clear medication wasn't the answer. So the couple followed Don's neurologist's recommendation and went to talk to Ohio State's Wexner Medical Center. As soon as they walked into the office, they felt completely at ease with neurologist Dr. Punit Agrawal and neurosurgeon Dr. Ali Rezai, who told the couple they thought Don was the perfect candidate for DBS.

They began testing soon after to make sure of Don's eligibility. DBS requires two surgeries. The first places electrodes into the brain, and the second implants the programmer into the chest. After a few days of assessment, Don was cleared for surgery.

Don's first surgery lasted less than six hours and was completely pain-free. It required Don to stay awake so they could assess the control of his hand throughout the procedure. Sandy was amazed when someone came out of the operating room halfway through to show off a perfectly sketched drawing Don had made.

He's back in control

"If I knew then what I know now, I would have done it right away and not put it off."

Now, Don can control his essential tremor with the click of a button. To stop the shaking, he simply holds the antenna near his chest to turn the programmer on. He returns to Ohio State every six months to see his nurse, Shannon, who helps him adjust the programmer's settings. Don's life is back in control. He's back to painting and is looking forward to going to Florida again. What's first on the agenda? Going to his favorite restaurant, getting a table right out in the open and eating without feeling embarrassed.

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Meet Don's Care Team

Behind every patient story we feature are the people who made it a success. Learn more below about Don's talented care team.

Dr. Ali Rezai

Dr. Ali Rezai

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Dr. Ali Rezai, Neurosurgeon at Ohio State

Dr. Rezai is the neurosurgeon who performed Don’s deep brain stimulation (DBS) surgery.

Dr. Rezai is the director of the Center for Neuromodulation and leads the DBS program at The Ohio State University Wexner Medical Center.

He has performed more than 1,600 DBS surgeries and is a world-renowned expert in the field.

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Dr. Punit Agrawal

Dr. Punit Agrawal

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Dr. Punit Agrawal, Neurologist at Ohio State

Don and Sandy instantly connected with Dr. Agrawal. From the beginning, he put their fears at ease and took the time to make sure all their questions were answered.

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Shannon Linder, CNP

Shannon Linder, CNP

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Shannon Linder, CNP, Certified Nurse Practitioner at Ohio State

Shannon is the nurse who helps Don reprogram his monitor when needed.

Although the couple could see a programmer in Toledo, Don and Sandy prefer making the trip to Columbus just so they can see Shannon and the medical staff at Ohio State.

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What is Neuromodulation?

Dr. Ali Rezai shares what types of cutting-edge therapies they are developing at Ohio State's Center for Neuromodulation.

Neuromodulation is among the most rapidly growing and promising areas in medicine and involves the use of advanced neurological pacemakers and microinfusion delivery devices to deliver calming electrical signals, medications and other therapeutic agents precisely into the brain, spinal cord and the nervous system. In the United States, a growing number of neuromodulation procedures are receiving FDA approval and are covered by insurance. These include:

  • Deep brain stimulation (DBS)/brain pacemakers for Parkinson's disease, tremor, dystonia and obsessive compulsive disorder
  • Spinal cord and nerve pacemaker implants for chronic pain, epilepsy and urinary incontinence
  • Microinfusion device implants for spasticity and chronic pain

What is DBS?

DBS is a cutting-edge surgical procedure that can improve the quality of life and physical disability for persons suffering from neurological disorders. DBS involves neurosurgical implantation of tiny electrodes into the brain that are connected to a small battery-like pacemaker device implanted into the chest wall. The electrodes deliver tiny electrical signals that calm abnormal brain signals. The result is to alleviate long-troublesome disabling symptoms and restore patients to better functioning.

Is DBS for Me?

Individuals interested in DBS undergo a detailed screening and evaluation by our multidisciplinary team to determine the likelihood of a successful response.

Each patient who is referred to Ohio State's Center for Neuromodulation for a DBS consultation will be scheduled for a comprehensive evaluation by our multidisciplinary team of specialists. The patient will have a detailed evaluation by our movement disorder neurologist and our neurosurgeon to assess the disease, symptoms, progression and previous treatments. The patient will have brain imaging performed and will also be evaluated by a neuropsychologist. The neuropsychological testing helps in understanding a patient’s cognitive (thinking, memory, concentration, attention) status and also provides a baseline for the team to monitor the patient over time. Finally, the team will have a detailed discussion with the patient and family about goals and expectations from surgery, plus review the benefits and side effects.

Once these evaluations are completed, the team will discuss each patient at a patient management conference. During this conference, a final recommendation by the entire group is made regarding surgery and other therapies, such as further medication adjustments and an individualized rehabilitation program.

Our team-oriented approach applies to all aspects and phases of patient care, through the initial evaluation, surgery, post-operative care and rehabilitation. Our goal is to work closely with the patient, family, caretakers and the referring physicians to develop a comprehensive and holistic care plan.

DBS for essential tremor is for patients with persistent and severe arm tremor with limited or no significant benefit from medications, and/or who are experiencing side effects from medications.

DBS for Parkinson’s disease is for patients with:

  • Debilitating hand and/or leg tremor that fails to respond to medications.
  • Idiopathic Parkinson's disease with disabling rigidity, slowness of movements, freezing, "on-off" fluctuations, intolerance to medication trials and/or reduced responsiveness to medications.
  • Problematic uncontrollable motor fluctuations including excessive involuntary movements (dyskinesia) and/or frequent end-of-dose wearing off.

DBS for dystonia is considered when a person has significant debilitating symptoms of primary dystonia and has failed to respond to oral medication, botulinum toxin therapy, and other treatment modalities.

Managing Expectations

It is also important that a person considering DBS have realistic expectations as to what symptoms may or may not improve. Additionally, family and support structure needs to be in place to help the patient with follow-up care and appointments. The decision as to whether or not to pursue DBS is difficult, and it is helpful to seek guidance from a team of experts in neurosurgery and neurology who have experience with DBS therapy.

What Are the Risks Associated With This Procedure?

No surgery is without risks. The DBS risks include possible bleeding, stroke, infection, device-related problems, and the general risk of anesthesia. In our program, we are very thorough in providing patients and their families with detailed information about potential risks and benefits so that they can make a clear and informed decision about surgery.

If you would like to learn whether you are a candidate for DBS, please contact your current healthcare provider for an initial evaluation. Your physician and other care providers can help determine whether you may benefit from a referral to our Center for Neuromodulation.

Ohio State is ranked among “America’s Best Hospitals” for neurology and neurosurgery by U.S.News & World Report. The success of our DBS program is due, in part, to the strong multidisciplinary teamwork and collaboration among our neurosurgeons, movement disorder neurologists, psychiatrists and psychologists, physical medicine and rehabilitation specialists, as well as our nurses, physician assistants and patient coordinators. This teamwork and our comprehensive evaluations ensure optimal selection of surgical candidates and enables us to make the best choices for patient outcomes.

Dr. Ali Rezai, a world-renowned neurosurgeon and neuromodulation specialist, is the director of the Center for Neuromodulation. Dr. Rezai is an internationally recognized DBS surgeon who has performed more than 1,600 DBS surgeries and thousands more neuromodulation procedures.

Learn More

If you need further assistance or would like to learn more about deep brain stimulation (DBS), please contact the Center for Neuromodulation patient coordinator at 614-366-6639.

Ohio State Expertise

The success of our DBS program is due, in part, to the strong multidisciplinary teamwork and collaboration among our neurosurgeons, movement disorder neurologists, psychiatrists and psychologists, physical medicine and rehabilitation specialists, as well as our nurses, physician assistants and patient coordinators. This teamwork and our comprehensive evaluations ensure optimal selection of surgical candidates, and enable us to make the best choices for patient outcomes.

Dr. Ali Rezai, a world-renowned neurosurgeon and neuromodulation specialist, is the director of Ohio State’s Center for Neuromodulation. Dr. Rezai is an internationally recognized DBS surgeon who has performed more than 1,500 DBS surgeries and thousands more neuromodulation procedures.

Under the leadership of Dr. Rezai, Ohio State's Wexner Medical Center is conducting groundbreaking DBS research that will literally redefine how we treat Alzheimer’s disease, severe alcohol or opiate addictions, traumatic brain injuries, and other neurological conditions in the future. Hear Dr. Rezai talk about the new therapies that Ohio State researchers are developing and the exciting future of DBS research.

This pioneering research, coupled with the staff's phenomenal DBS expertise, is why Ohio State’s DBS program is one of the most trusted in the Midwest.

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