Just two years ago, Napa attorney Rhonda Savitch felt trapped.
She could no longer work, socialize or continue her 30-year practice of yoga, due to advancing Parkinson's disease and the side effects from medication to control it.
"I was spending more and more time feeling like my body was in a box that wouldn't let me stretch out,' she said. Still, Savitch was surprised when her neurologist, Michael Aminoff at UCSF Medical Center, suggested it was time to consider deep brain stimulation (DBS) surgery.
"I'd anticipated that I would need surgery, but I didn't think it would happen so soon," she recalled. "But I just decided I had to do it or I wouldn't have a life. There really wasn't a choice."
In Parkinson's disease, the brain slows its production of a chemical messenger called dopamine, resulting in muscle stiffness, slowness, difficulty starting movement and tremors. About 1.5 million Americans have the disease.
Medication is the main treatment for Parkinson's but it can cause other problems. The side effects can include excessive movements called dyskinesias that cause the limbs and body to writhe or jump. Another side effect, called on-off fluctuation, is when the ability to move changes unpredictably between a mobile or "on" state and an immobile or "off" state when movement is very difficult.
DBS appears to have the most success in younger patients who at some point have responded well to medication, even if side effects later eroded its benefit.
Savitch, now 52, was 46 when her co-workers first noticed that she was limping slightly on her left side and holding her left arm and hand to her chest. "One day after lunch, I felt like the signals I was sending to my left side weren't getting there," Savitch said. "That's when I went to a doctor."
Savitch responded well to medication initially but the side effects eventually made her life unbearable. She was referred to doctors Philip Starr and William Marks, pioneers in developing deep-brain stimulation (DBS) surgery at UCSF Medical Center who have performed hundreds of DBS operations. UCSF has the largest treatment center for Parkinson's disease in Northern California. Savitch had two operations — one on each side of her brain — in May and November 2002.
During DBS, electrodes are surgically implanted into movement-controlling centers in the patient's brain and attached to a pacemaker-like device that delivers electrical pulses to those centers. These pulses counteract the abnormal brain activity that occurs in Parkinson's disease, resulting in restoring near-normal movement control. To maximize precision, Starr uses a "brain mapping" procedure in which fine microelectrodes record brain cell activity to locate the best target for the implant. The brain's electrical signals are played on an audio monitor so the surgical team can assess the pattern of signals. Meanwhile, the patient is awake so that strength, vision and improvement in motor function can be assessed. Later, the patient is anesthetized while the control device is implanted in the chest.
Since her operations, Savitch has made enormous improvement. She still takes medication, but the dosage has been cut back considerably — thereby reducing the side effects.
She's now able to continue her winery law practice, working part-time from her home, and can contemplate going out for a meal with friends and husband Michael Jones, an assistant winemaker at Hanzell Vineyards in Sonoma. In May, she and Michael took off for New York for their first vacation since her diagnosis.
"I have my life back," said Savitch. "I know the DBS just helps control symptoms and doesn't cure Parkinson's, but until there's a cure, this is it."
Story written in June 2004.