Deep brain procedure makes debut locally

A local doctor recently performed a procedure which, while new to the valley, has massive implications in the field of neuroscience

Dr. Joseph Sramek, a neurological surgeon at Kalispell Regional Medical Center’s Neuroscience and Spine Institute, led a team performing a deep brain stimulation procedure Nov. 8. It was believed to be the first such procedure in Western Montana.

Deep brain stimulation is a process by which a neurosurgeon inserts electrodes deep into the brain. The diodes emit an electric pulse into parts of the brain such as the thalamus (a sort of switchboard in the brain that relays sensory information) that can lessen the effects of neurological disorders such as Parkinson’s or essential tremor.

“It’s like the diameter of a strand of spaghetti,” Sramek said of the electrode. “I had been doing these procedures for 13 years down in Casper, Wyoming.”

Sramek and his team member Rob Griffin were the first to perform the deep brain stimulation in Wyoming, and it had only been done in Billings before the doctors moved to the Flathead in August.

According to Sramek, if deep brain stimulation is performed early enough, it can treat symptoms more effectively than any other known treatment.

“There is an 88 percent abolition of tremor with the stimulator on,” he said in a presentation at Kalispell Regional Medical Center. “And there is 70 percent long-term abolition or significant reduction in tremors.”

For the 1 million Americans with Parkinson’s disease, deep brain stimulation could dramatically reduce debilitating symptoms. But not everyone is a good candidate for the relatively invasive surgery.

“There is a window of opportunity that this will be most effective,” Sramek said. “When we do the procedure, we don’t treat the disease, just the symptoms. The disease kind of marches on.”

However, the effects in day-to-day life can be dramatic.

Sramek has a video of the patient on whom he performed the procedure. An elderly man, he is told to raise his hand to his mouth as if he is eating soup. His tremors shake violently near his mouth and render eating with dignity difficult.

Then the electrodes are switched on and the man becomes steady. Those with mixed tremors could benefit from the procedure as well.

The electrodes running the current in the brain are left there, sort of like a pacemaker, and carry an electrical current through four points of contact to stimulate the ventral intermediate nucleus of the thalamus.

Sramek said this helps right a sort of missed connection in the brain.

“It’s like this circuitry of on/off switches,” he said. “Somewhere along the line that balance is thrown off. We put that electrode in an area to try and normalize it downstream.”

This line of procedures was advanced in the early 20th century when Parkinson’s patients showed noticeable improvements after suffering strokes. Doctors then tried inducing strokes to alleviate symptoms in other patients.

Unlike what those early doctors did, Sramek and Griffin’s procedure is reversible. No permanent damage is left behind by the deep brain stimulation, which can help reduce symptoms for five to 10 years.

The procedure must be performed while the patient is awake so doctors can gauge if the electrode is in the right spot. The procedure is popular enough that it was spread to the Flathead so interested patients do not have to travel to Seattle, Billings or Casper.

Approved for the first time by the Food and Drug Administration in 1997, deep brain stimulation has spread the last several years to more rural areas from its epicenter in Chicago.

“For things like Parkinson’s and essential tremor, this is the best thing we have at this point,” Sramek said. “The benefits from a quality-of-life point are tremendous: Going to a restaurant, writing a letter, paying bills.”

While deep brain stimulation is used mostly as a tremor-reduction aid at this point, the medical implications could reach farther.

Sramek said research institutions such as the University of Washington Medical Center are studying how deep brain stimulation could be used to treat seizures and obesity.

“It would be a reversible-type therapy,” he said. “And not permanent. We aren’t burning any bridges here.”

Reporter Ryan Murray may be reached at 758-4436 or by email at rmurray@dailyinterlake.com.