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Innovative Care for Essential Tremor

Neurology patient Kevin Dickerson.

When uncontrollable trembling affected his arms and hands, Kevin Dickerson, an electrician, feared for his ability to continue to work. When the trembling worsened, even performing everyday tasks like eating and drinking became a significant challenge.

Kevin has a neurological condition called essential tremor, which can cause rhythmic shaking of the hands, head, voice, legs and trunk. Frequently confused with Parkinson's disease, essential tremor is about 8 times more common. Kevin wasn't unfamiliar with it, as his mother had been diagnosed with it years before, but the disease seemed to affect him more severely and at a younger age.

"I noticed the symptoms 10 to 12 years ago, but they grew much worse in the last 4 or 5 years," he says. "It became really tough to do anything involving fine motor skills. The day to day, like eating and drinking was difficult, and working as an electrician became downright risky. If you cross wires, cross a positive and a negative, that can make for a real mess."

Kevin – who lives in Topeka, Kansas, with his wife, Debbie, son, Riley and daughter, Elizabeth – visited his local doctor. He tried a variety of medications, but wasn't satisfied.

"By the time I was taking enough that I was feeling relief from the tremors, I had too many side effects," he says. "I was extremely drowsy and fatigued. I didn't even feel like myself. I thought the tremors were just something I was going to have to live with."

But then Kevin discovered another option.

New technology, new hope

Kevin saw a television commercial that introduced him to a new possibility. The commercial described a procedure called deep brain stimulation (DBS) offered at The University of Kansas Health System. The DBS system delivers electrical pulses to the area of the brain that causes the symptoms of essential tremor. A neurosurgeon implants wires called leads into the brain. They connect to a generator implanted in the body. The generator sends pulses to the leads, which stimulate the affected area of the brain, blocking the signals that cause involuntary movement.

"When I saw this, I was eager to learn more," Kevin says. "I'm getting older, I suppose, but I'm only 50. I'm not that old! It was extremely encouraging to find out there was something I could do."

Kevin scheduled a visit with a neurologist who conducted a thorough evaluation, including testing Kevin's ability to perform various functions like writing his name and bringing a cup to his mouth.

"He said we would try additional medicines or proceed to surgery," Kevin says. "I was game to move forward with the DBS."

Kevin received a DBS implant in November 2016, a procedure on the left side of his brain to control the right side of his body. He remained awake and aware during the surgery – an option he chose over general anesthesia – as his response to various instruction such as raising his arm helped neurosurgeon Jules Nazzaro, MD, precisely pinpoint the ideal locations for the DBS leads. Dr. Nazzaro performed more of this type of DBS surgery than almost any other physician in the country.

"While DBS has been in use for more than 20 years, the latest technology with its additional leads allows us to be more exact than ever in placing leads into the brain," explains neurologist and movement disorder specialist Rajesh Pahwa, MD, program director of The University of Kansas Health System's nationally recognized Parkinson's Disease Center of Excellence. "We used to view the brain in 4 quadrants, but the new technology allows us to view it in 8 sections, better targeting the area of the brain causing the tremor and avoiding delivering electricity to healthy tissue. We have unprecedented control and focus."

Kevin says it was a unique experience to play an active role in the success of the procedure.

"Being awake during surgery was strange, but there was no sensation and no pain," he says. "It was very interesting to actually help the team determine exactly where to place the electrode to give me the greatest benefit." At the time, Dr. Nazzaro had performed more of this type of DBS surgery than almost any other physician in the country.

Clear benefits

Following a period of rest to allow the surgical sites to heal, Kevin visited his neurologist to activate the DBS technology and personalize the levels of stimulation to best suit his needs. This is done via an iPad interface, another more modern approach to DBS treatment. Upon activation, Kevin noticed immediate improvements, evident in the dramatic contrast between his ability to trace a spiral before activation and following it.

"I have noticed big changes in my day-to-day life," Kevin says. "I can hold a cup of coffee. I can eat without losing most of the food between the plate and my mouth. I can use a screwdriver and a cordless drill. It has made a night and day of difference in controlling and testing electronics, so I can again do my job safely and effectively. As I'm learning to rely on my right hand again, I look at my left hand and think, 'How did I ever get by with that?'"

Kevin expects he will explore a second surgery to address his other side in the future, but for now, the impact of DBS is significant, meaningful to himself and to loved ones.

"It really got to me to see him put his hand out, and it didn't shake," Debbie says. "Essential tremor was keeping him from living a normal life. Now, he won't have to face the daily troubles of how to eat or how to drink – the things most of us take for granted."

The modern interface used to program the DBS device offers conveniences for both physician and patient. The level of stimulation is easily adjusted, and Kevin can use his smartphone to turn the device off at night, conserving the battery while he sleeps.

The wireless platform makes it more convenient for the patient and easier for us to do the programming but the real advantage is the directional lead, which allows us to steer the electrical current in the brain.

The right care team

Kevin recommends the experts at The University of Kansas Health System to those seeking new options in controlling the symptoms of essential tremor.

"I have had great luck with this team," he says. "The doctors and nurses have gone out of their way to do everything they can to make my surgery and ongoing care smooth and successful. Always start with your local doctor, but know that you can be referred to expert specialists when you're ready for the next level of care."

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