Penn Neurosurgery

Penn Neurosurgery

Wednesday, April 23, 2014

Deep Brain Stimulation: A Life-Changing Trip to the Gallery

Please note: This is part two of a four-part series. 

One summer day, while strolling through an art gallery in Cape May, NJ, Steve Zabielski’s mother asked a friend for advice. She knew her friend understood how debilitating Parkinson’s disease could become and was hoping that she could offer some guidance, on answers where there had been few.

An individual, who happened to be a neurologist, overheard them talking and offered to introduce Steve to his practice partner, who specializes in movement disorders.

After going through the standard barrage of tests and an extensive examination, Steve heard the same things he had heard from several specialists over the past few years: “You are in the late stages of Parkinson's and you’ve maxed out your meds.”

Then the neurologist added, “You need to go see Gordon Baltuch.”

When Steve met Gordon Baltuch, MD, Director of the Center for Functional and Restorative Neurosurgery, he remembers a term the physician used almost immediately in their conversation.

Gordon Baltuch, MD
Deep Brain Stimulation.

“Right from the start, Dr. Baltuch said he was going to implant wire leads into both sides of my brain, which would emit electrical signals on command and stimulate certain areas of my brain so that it would function in ways that it hadn’t functioned in years.” Steve stops to take a breath in wonder even now as he recalls their first conversation. “He said the stimulation would mitigate the major effects of the disease, allowing me to live day to day much more like I had earlier in life.

“He’s describing the procedure, running wires up into my brain and planting small electrode stimulators in my chest, and doing so in a tone that I'd use to describe something I've done a thousand times,” Steve recalls.

“When I say it now, out loud, it still sounds like science fiction to me. But the way Dr. Baltuch explained it was brilliant, and he was so confident, and at the same time so caring, that I made up my mind on the spot: If there’s anyone I trust to go into my brain and do all this, it’s this guy.”

Steve looks down for a moment, shakes his head, and then looks back up.

“I was nearing the end of the road. I had no place else to go. Dr. Baltuch represented hope.”



Tuesday, April 22, 2014

Deep Brain Stimulation: Battling Parkinson’s Disease

Please note: This is part one of a four-part series. 

There was something very important Steve Zabielski knew, which he decided not to share with his wife for the best of reasons. So he shielded her from the truth. For five years.

“I just couldn’t bring myself to tell anyone that I had Parkinson’s, not even my wife.” Steve says, nodding at the memory.

Parkinson's disease is a degenerative disorder of the central nervous system most commonly characterized by shaking and tremors and often accompanied by difficulty with walking, movement and coordination. Ultimately, the disease can lead to thinking and behavioral problems, the causes of which are still largely unknown.

Steve Zabielski
Historically, physicians have had some success in managing the symptoms of Parkinson’s with medication, which can supplement the lack of natural dopamine generation for a period of time.

It was medication, ironically, that led to Steve sharing his secret with his wife. “I had so many pills,” he recalls, “that they were spilling out of my pockets.”

When he finally told his wife, Yu chong, that he had Parkinson’s, she could not fight back the tears. But even before she had stopped crying, she promised him that together they would do whatever it took to fight the disease. And they would win.

His children were a different story. “They were young,” Steve says, in a voice just above a whisper. “They didn’t really understand. They couldn’t.”

“As I lay there at night, trying to figure it all out, I just kept wondering: How did this happen? Where did I go wrong? What caused this?”

There were no answers. And soon after that, there were diminishing benefits from the medications, as the sickness in Steve’s body began to overwhelm the effects of artificial dopamine in his brain.

The Zabielski family needed another solution. And soon.

Friday, April 18, 2014

DBS Patient to Appear on Woman’s Media Center Live

In recognition of Parkinson’s Awareness Month, Robin Morgan from Woman’s Media Center Live, will be interviewing Lori Katz, a patient of Gordon Baltuch, MD, Director of the Center for Functional and Restorative Neurosurgery.

The interview will be aired live at 11:00 am on April 19.

Lori, who was diagnosed with Parkinson’s disease in 2005, will discuss how her life has changed since undergoing deep brain stimulation in January 2014. She will also speak about her active role in the Parkinson’s community in South Jersey and Philadelphia.

To learn more about deep brain stimulation and Dr. Baltuch, who was instrumental in bringing this procedure to the United States, check out Gordon Baltuch, MD: A Pioneer in the Use of Deep Brain Stimulation.

About Parkinson’s Disease

Parkinson’s disease, a degenerative disorder of the central nervous system, has no known cause in most cases. Medically, Parkinson’s has been traced to the death of dopamine-generating cells in the midbrain, once again for causes that are largely unknown.

The relatively well-known symptoms are usually characterized at first by movement-related issues, including shaking, rigidity, and slowness of walk or gait. In time, cognitive and behavioral difficulties may occur, sometimes followed by sensory and emotional problems.

Unfortunately, there is no objective test, or biomarker, for Parkinson’s. Because of this, the rate of misdiagnosis can be high. There is also no preventive course to reduce the risk of its onset.

Thursday, April 17, 2014

A Pioneer in the Use of Deep Brain Stimulation

“Our mission is to innovate, to constantly find new answers. And no one is doing that better today than the people at Penn Medicine.” - Gordon Baltuch, MD

The Calling

Many people describe Gordon Baltuch, MD, Director of the Center for Functional and Restorative Neurosurgery, as a man of vision. This is not surprising, considering the fact that he’s been developing this skill since he was a boy.

“When I was a child, I was very close to my grandfather, who was a physician in a very different time and place,” Dr. Baltuch says, his eyes twinkling at the thought. “Sometimes he would go to patients’ houses. Sometimes patients would come to our house. On busy days, the living room became the waiting room. It was, at the end of the day, a very social experience.

“It was there that I first realized I could see myself going into medicine.”

Gordon Baltuch, MD
Gordon Baltuch, MD
With this goal in mind, he pursued an undergraduate degree at Harvard, knowing all along what the next step in his path would be. In medical school, he gravitated at first towards neuroscience, then towards the more unknown world of neurosurgery, which just happened to be “a good fit.” The wisdom of his choice of medical specialization was confirmed by his early experience working at the Montreal Neurological Institute and Hospital in the late 1980s, where he was fortunate to be able to witness firsthand and later take part in some of the leading-edge work of the day at the intersection of neuroscience and medicine.

Then, once again, he had a vision of new and greater possibilities in his chosen field. So, in 1994, he packed his bags and headed for Europe, where Professor Alim Louis Benabid was pioneering deep brain stimulation (DBS) therapy for Parkinson's disease.

The cause of Parkinson’s disease, a degenerative disorder of the central nervous system, was at that time and is to this day unknown. The death of dopamine-generating cells in the substantia nigra part of the brain leads to the motor symptoms that traditionally characterize Parkinson’s, beginning with shaking, rigidity and other movement-related manifestations. Cognitive and behavioral problems, even dementia, are associated with advanced stages of the disease. The accumulation of rogue proteins called alpha-synucleins, combined with the lack of healthy dopamine generation and activity, causes the circuitry of the midbrain to function in abnormal electrical patterns and sometimes, in severe cases, to cease functioning at all.

The Advancement

When Dr. Baltuch first arrived at the Grenoble Institute in 1990, the most advanced, last-resort surgical solution of the day for patients with Parkinson’s focused on an effort to eliminate or at least minimize the accumulation of the rogue proteins.

“At the time, the popular neurosurgical treatment for Parkinson’s disease was making lesions at the point of distress in the brain,” Dr. Baltuch remembers.

“Dr. Benabid discovered that when you used stimulation to locate the exact right place for creating the lesion, the patient’s tremors would temporarily go away. So he said, ‘Let’s stop making lesions and instead let’s implant electrical wires into the distressed part of the brain, so we can make the benefits of stimulation available to the patient on a permanent basis.’

“Thus, I had the great privilege of working at the feet of an absolute pioneer, someone who was creating a whole new paradigm. And thus, the usage of DBS as a treatment for Parkinson’s was born.”

Dr. Baltuch smiles as he holds up a book wrapped in a black-and-white jacket with a photograph of his mentor on the cover, celebrating the brilliance of his professor’s discovery.

“A different kind of thinking – and problem solving – led to restoration of a basically normal lifestyle for people whose lives had been physically and emotionally compromised for years. Think about that.”

Modesty prevents him from speaking easily of how he and his team have taken the science of a breakthrough surgical solution to another level in the last 15 years.

“In the late 90s – when I first began performing the procedure – I would describe the process to potential patients. They would shake their heads, protest and sometimes walk out of the room,” he recalls. “They would say, no, you’re not drilling holes into my head.”

To calm the anxieties of would-be patients in the early days of his career, Dr. Baltuch would show them videos of other patients. First, they saw footage of patients suffering from the effects of Parkinson’s disease, with at-best diminishing benefits from a long regimen of medications. Then they saw footage of the same patients after they had received DBS.

Apparently, seeing was – and is – believing.

“Today, after over 900 DBS surgeries, what my team and I do is infinitely more refined, more tried and true.”

That being said, what they do is no less amazing now than it was when Dr. Baltuch first began performing the procedure.

“Now, we’re basically using M.R.I.s to achieve new levels of accuracy in running wire leads on a precise path around healthy tissue and into a part of the brain that’s about the size of a Rice Krispy.” Dr. Baltuch slightly separates the tips of his thumb and forefinger to make his point. “It’s more efficient, it’s safer, it minimizes the potential infection rate, and it makes everything far easier for the patient.”

Perhaps surprisingly, the experience is customized for the varying needs of every single patient. “If the indications are clearly that we only need to stimulate one side of the brain, we run the lead into just one side. However, most Parkinson’s patients need a bilateral procedure to optimize the benefits of the stimulation. Here at Penn, we believe in the advantages of performing the surgery on both sides at once. Some hospitals divide the process into two separate procedures, but we’re committed to providing for the needs of the patient as quickly as possible with as little recovery time as possible.”

To this day, even Dr. Baltuch himself is amazed by the confluence of scientific disciplines involved in bringing Parkinson’s patients relief, health and restoration of day-to-day life, all through the process of DBS.

“It’s all a consequence of the electrical pulses,” he says, sharing his infectious enthusiasm for the subject. “Sometimes the goal is to interfere with what has become normal neural activity for a Parkinson’s patient, which is not the same as normal activity for most of us. By inhibiting hyper-excited circuits, you start to promote more traditionally normal activity.”

The Vision

Dr. Baltuch glances up at the framed photos of his mentors on the shelf above his desk.

“A lot of advancement in medicine comes from first figuring out what works, then figuring out how it works.”

Inspired by the constant evolution of his craft, Dr. Baltuch has a message for all patients suffering from Parkinson’s disease:

“If the effects of your medication are diminishing, if you’re medication intolerant, if you’re on that roller coaster of motor fluctuations, even if you’re over a certain age, you may be a good candidate for the benefits of DBS.”

He bounces out of his chair and points to a framed photograph hanging on the wall, a shot of a former patient who is now a friend, 15 years after his own successful surgery.

“Our mission is to innovate, to constantly find new answers. And no one is doing that better today than the people at Penn Medicine.

“That’s why I’m still here.”

Tuesday, April 15, 2014

2014 Brain Health Fair in Philadelphia

Patients, families, caregivers and members of the public are invited to stop by Penn Medicine’s booths at the Brain Health Fair on Saturday, April 26 at the Philadelphia Convention Center, hosted by the American Brain Foundation as part of the 2014 American Academy of Neurology Annual Meeting.

The Brain Health Fair is a FREE, exciting day of activities connecting thousands of families, patients, caregivers, and other members of the general public with neurologists and other important resources and information to bring awareness to brain diseases.

To learn more about this event, please visit  BrainHealthFair.com.


Friday, April 11, 2014

Awareness Month: Parkinson’s Disease

April is National Parkinson's Awareness Month.

Parkinson’s disease, a degenerative disorder of the central nervous system, has no known cause in most cases. Medically, Parkinson’s has been traced to the death of dopamine-generating cells in the midbrain, once again for causes that are largely unknown.

According to the Parkinson’s Disease Foundation, this chronic and progressive movement disorder affects nearly one million people in the United States alone. Men are one and half times more likely to get the disease than women.

The relatively well-known symptoms are usually characterized at first by movement-related issues, including shaking, rigidity, and slowness of walk or gait. In time, cognitive and behavioral difficulties may occur, sometimes followed by sensory and emotional problems.

Unfortunately, there is no objective test, or biomarker, for Parkinson’s. Because of this, the rate of misdiagnosis can be high. There is also no preventive course to reduce the risk of its onset.

Treating Parkinson’s

Although there is no cure, physicians have had success in managing symptoms with medication and various treatments. These medications and treatments help to supplement the lack of natural dopamine generation for a period of time.

Penn neurosurgeons are pioneers in the use of deep brain stimulation (DBS). This life-changing procedure can greatly reduce motor symptoms that accompany Parkinson's disease or other conditions and improve patients' abilities to perform daily activities. More than 900 patients have received DBS treatment at Penn, making it one of the largest treatment centers in the United States.

Learn more about Parkinson's Disease


Tuesday, April 8, 2014

Penn to Serve as Flagship Sponsor for Brain Tumor Walk

Penn Neurosurgery is proud to serve as a flagship sponsor for this year’s Delaware Brain Tumor Walk. Hosted by the National Brain Tumor Society on Saturday April 26, 2014, this 5K Run/Walk is a fun and inspiring way to team up and fight against brain tumors by raising funds for research. This event offers individuals and teams a chance to honor and remember loved ones, as well as connect families, patients, and survivors affected by brain tumors.

Nadia Dahmane, PhD, talks about brain tumor research at
Penn Medicine during the Delaware Brain Tumor Walk kick-off event.


Learn how you can help the fight against brain tumors by either donating or joining the race by visiting the Delaware Brain Tumor Walk website.

Event Details

Date: Saturday April 26, 2014
Time: 10:00 a.m.
Location: Dravo Plaza at Riverfront,
               Wilmington, DE

About the National Brain Tumor Society

The National Brain Tumor Society is the largest nonprofit dedicated to the brain tumor community in the United States. It is “fiercely committed to finding better treatments, and ultimately a cure, for people living with a brain tumor today and those who will be diagnosed tomorrow.”

Brain Tumor Facts

  • Nearly 700,000 people in the United States are living with a primary brain tumor. 
  • Brain tumors strike men, women, and children of any race, and at any age.
  • About 120 types of brain and CNS tumors have been identified to date, and some have multiple subtypes. Each tumor type/subtype is genetically distinct, making the search for treatments or a cure extremely difficult.