Penn Neurosurgery

Penn Neurosurgery

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.”

1 comment:

  1. Glorious to read about this remarkable light at the end of the tunnel. Thank you.

    ReplyDelete