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Selectman Brian Chadwick undergoes remarkable surgery
"Today I did it all myself," he said Tuesday. "I couldn't even hold a newspaper in the morning. Getting dressed was an issue. What this means to me is to be able to have a more normal life and focus on things that are important to me." Chadwick, now 46, was only 41 years old when he began noticing that sometimes his fingers twitched which made it difficult to write. When he underwent an examination by a neurosurgeon Chadwick was diagnosed with early onset Parkinson's Disease, a motor system disorder resulting from a loss of dopamine-producing brain cells. Parkinson's is usually found in people over the age of 50.
Until 2002 when the U.S. Food and Drug Administration approved deep brain stimulation for use in Parkinson's Disease, which has no cure, the only method of treatment was through a regimen of medications. Though the medications can provide some symptomatic relief, when their side effects outweigh their benefits, patients and doctors can now consider deep brain stimulation, a dramatic but highly effective treatment that for most people reduces the need for medication by 50 to 70 percent. Chadwick's journey started three weeks ago when his neurosurgeon at Massachusetts General Hospital, Dr. Emad Eskandar, surgically implanted a battery powered device called a neurostimulator under Chadwick's skin beneath his right collarbone. An insulated wire extension attached to the device was threaded through his shoulder, up his neck and into his brain. Small holes were bored on each side of the front top of Chadwick's skull to provide access to two electrodes positioned within his brain that are connected to the device. On Monday, after a healing period, Chadwick returned to Boston for activation of the device which generates a pulse to the electrodes to prevent his tremors. Though he was anesthetized when the device was placed, Chadwick was conscious during the rest of the operation. "During the surgery I was awake. I was actually playing video games," he said. "They need to be able to check your motor functions during the surgery." Side effects of Parkinson's medications can include dyskinesias, an uncontrollable jerking of the body, and dystonia, a reaction causing the body to become rigid and which requires treatment with other medications to calm the body. Prior to the procedure, Chadwick's tremors had gotten so bad he was up to taking more than 20 pills a day. "[Parkinson's] has affected every facet of my life. Everything I do revolves around the medication I take to get through the daily grind," he said. As of Monday's activation, Chadwick began seeing relief from that tether. He initially reduced his medications by one third and yesterday he was instructed to cut his intake even further. Over the next six weeks Chadwick will travel to Boston every two weeks to have the balance between his medications and the rate of brain stimulation checked. Eventually, he will receive a small device he likens to a garage door remote opener he will carry with him and use to adjust his implant settings, if necessary, and will only require check-ups twice a year. The surgery does place some restrictions on Chadwick. For example, he cannot have an MRI and cannot pass through security metal detectors because they could shut down his battery pack and device. He has an identification card to carry explaining the procedure he had and why he must be screened by hand. Still, those limitations are negligible compared to the personal freedom and comfort Chadwick is experiencing after his five-year ordeal. In fact, he feels thankful in many ways. "If you have to have a neurological disease, Parkinson's is the one to have, in my opinion. There is treatment for it and there is progress being made in the disease. It's not today, but it's coming," he said. "My wife [Charlene] has been unbelievable in this whole thing - not only as a nurse; as a spouse she was incredible. She started a Parkinson's support group which meets monthly. She has really studied this disease. She's soon to be published by "Nurse's Journal" for a paper she wrote on Parkinson's Disease. "You are only as good as your support group, and I have a wonderful support group on Nantucket," Chadwick added. "Because Nantucket is so small and people know you, you really have better treatment." I WHAT IS DEEP BRAIN STIMULATION Deep brain stimulation is a surgical procedure involving implantation of a battery operated medical device called a neurostimulator, similar to a heart pacemaker. The device sends electrical stimulation to specific areas of the brain that control movement. Because the procedure blocks abnormal nerve signals that cause tremors, it has been successful in treating Parkinson's Disease when medications do not adequately relieve symptoms of the condition.The system is comprised of three components: the neurostimulator, an extension wire and electrodes. The device is implanted under the skin beneath the collarbone. Previously two devices were used to provide stimulation to both sides of the brain, but the newest models, such as the Activa produced by Medtronics, services the left and right brain at once. The insulated extension passes beneath the skin of the shoulder and neck and into the head. The extension connects the device with the electrodes which are placed in the brain. Prior to the surgery, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans are performed to identify the precise locations in the brain causing tremors and other symptoms. These locations are where the electrodes are placed. Unlike previous surgeries for Parkinson's Disease, deep brain stimulation does not damage healthy brain tissue, is easily adjustable and is reversible if superior treatment methods are developed. This procedure allows for significant reduction in the number of medications used to treat Parkinson's Disease. |
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