With the push of a button, Dr. Mark Burnett switches off the deep brain stimulation system in his patient Jairo Molina. The tremors from Parkinson's disease quickly return. They go up from Molina's fingers until, within seconds, his whole body is moving. Then Burnett turns the system back on and Molina's tremors start to ease until they are almost gone.
Burnett, a neurosurgeon at NeuroTexas, placed the system into Molina last month at Baylor Scott & White Medical Center Lakeway and started seeing results 48 hours later. He placed two leads into the Parkinson's-affected place deep in Molina's brain. The leads are at the tip of wires that travel underneath the skin down behind the ear, down the side of his neck to a computer mouse-size stimulator under the skin in his chest. The stimulator sends electronic pulses through those wires to the leads in the brain to control the tremors.
While similar systems have been around since the early 2000s, Burnett says, the difference with what Molina has and what other patients have received is the way the systems get there. Molina was the first patient in Texas to have the stimulator inserted in one surgery while asleep using a robot. A second patient has since had the surgery, with a third in the works, Burnett says.
Before, patients had to have two different surgeries _ one to place the leads and the second to put in the stimulator. The patients also had to be awake for hours and strapped into a device while the sensors were being placed and tested to make sure doctors were in the right place. Previously, doctors knew where to place the leads based on listening to the structures of the brain to find out where the tremor was coming from. Patients also would have to go off their medication for the surgery, and the whole process would take six to eight weeks from first surgery to turning the stimulator on.
Now doctors know exactly where to place the leads by taking finely sliced MRI scans of the brain a few weeks before the surgery. The scans are then fed into a computer to create a 3D scan of the brain. This process allows doctors to see the Parkinson's-affected area that is about the size of a Rice Krispie, Burnett explains. On the day of the surgery, doctors use a robot about the size of a soda can and a CAT scan to place the leads exactly where they need to go. During that same surgery, doctors also are able to place the stimulator in the chest and connect the lead wires to the stimulator.
All of this is done while the patient is asleep, and the patient doesn't have to stop taking his medication in preparation for the surgery. Patients usually spend a night in the hospital and go home. About 48 hours later, the stimulator is turned on and the tremors go away.
For Molina, 49, who served in the Navy as a gas turbine electrician, including two tours in Iraq, the old way of installing a stimulator was too scary to consider. He worried about post-traumatic stress disorder from having to be awake and strapped down for hours while doctors listened to the signals in his brain to locate the affected area. "I was afraid," he says.
"I rejected it," he says of when the idea was first proposed to him.
Molina was not alone in his fear, Burnett says. "This surgery has gotten people scared," he says. "It's a really safe procedure, even the old way."
Like in Molina's case, it's the idea of being awake while doctors are operating on the brain that Burnett believes is why patients weren't signing up for the older version.
Molina first noticed his tremor about 12 years ago, but it would go away. Then it came back permanently in 2010 and continued to get worse. His tremors would be so active that he would hurt all over, especially in his joints. It would take him an hour to go downstairs, he says. He had trouble falling asleep but would have only about two hours a day when he was really alert, he says, because he was so exhausted.
"Just to eat," he says. "I couldn't enjoy my food."
Molina wasn't responding to medication. The last six months, he stopped being able to work as a heating, ventilation and air conditioning technician and as an HVAC instructor at Austin Community College. His mother, Mary Santander, has had to help him with everything, including showering and getting dressed.
"It was so sad for me," Santander says through a translator. "I couldn't say anything to him to make him feel better. To see your child like that ... it's terrible."
She also has been helping him take care of his 7-year-old son, Dylan.
Molina stopped seeing friends, only relying on a handful of people to drive him places when he could no longer drive a car. "When you have Parkinson's, you start building a wall," he says. "You don't want anyone to see you."
He would tell friends, "I don't want you to see me like this," he says.
When he returned home from the surgery, it was the first time his son saw him without a tremor. He tears up as he says, "It was like he was in shock. He didn't know me."
When the tremors stopped, his problems with speech and his frequent falling stopped, too. Before, he would play soccer with friends, and they would have to pick him up off the field over and over again until he could no longer play.
Last week, he ordered a protective helmet and chest gear to protect the DBS system. He plans to return to indoor soccer with his son.
And now, Molina can eat. He can enjoy his food. "Now I can eat a soup," he says.
Last week, a friend shot a video of Molina mowing the lawn. He was practically running with the lawnmower.
The surgery is not a cure; it just treats the symptoms, Burnett says. But Molina, he says, "has years of life ahead of him. It's a quality-of-life improvement."
"I don't know how to thank you, Doctor," Molina tells Burnett.
Burnett is thankful to Molina for being the first one in Texas to try this version of deep brain stimulation surgery.
"It's pretty unbelievable, even for me," Burnett says. "It's pretty emotional for me to see the difference."
