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For many with Parkinson's, treatment offers relief

Wednesday December 29, 2010

Lisa Iannucci

Poughkeepsie Journal - Marian Zitzelsberger once dreamed of retiring and pursuing her love of gardening and photography, but she couldn't even hold a camera steady because of tremors in her hand caused by Parkinson's disease.

Today, thanks to a surgical procedure called deep brain stimulation, this spunky 72-year-old Staatsburg resident no longer suffers from tremors and is looking forward to pursuing her hobbies and enjoying life with her husband, Paul Zitzelsberger.

According to the National Institute of Neurological Disorders and Stroke, deep brain stimulation (DBS) is a surgical procedure developed in the 1990s to treat a variety of disabling neurological symptoms, but most commonly those from Parkinson's disease, such as tremor, rigidity, stiffness, slowed movement and walking problems.

The surgeon implants a battery-operated medical device called a neurostimulator — think of it as a pacemaker that electrically stimulates areas in the brain that control movement and blocks nerve signals that cause tremors and other Parkinson's symptoms.

"You have to have advanced Parkinson's, be cognitively intact and respond well to medications in order to qualify to have this surgery," said Dr. Fabio Danisi, a neurologist with Kingston Neurological Associates. "Any problems with memory or confusion may become worse after surgery."

Zitzelsberger first noticed her symptoms 10 years ago when she was working as a registered nurse. She was put on medication, but after her condition worsened over the next few years, she retired.

"I couldn't do the simplest things like work, use a camera or do artwork or painting," she said. "I decided to see a different neurologist who told me, 'You're 72 and you can still have a lot of quality time left,' so he sent me to a neurologist who knew DBS."

She learned about the risks, which include seizures and infections, going in. "The scariest part of the surgery is the threading of the electrodes that can nick a vein and cause a hemorrhage," said Dr. Michele Tagliati, director of movement disorders in the Department of Neurology at Cedars Sinai Medical Center in Los Angeles.

"The second type of problems you can have are hardware complications. We are implanting a device, a foreign body, in the brain and under the skin, and that can break or malfunction or erode the skin. They don't threaten the life of the patient, but it causes interruption of the stimulation of the therapy and maybe another surgery to replace the device."