Janet Dowling, seen here with her husband Kenneth, says she feels "like a new woman" after Deep Brain Stimulation cured her Parkinson's disease tremors

Like all patients who have been diagnosed with Parkinson’s disease, Janet Dowling has struggled with tremors – the uncontrollable shaking of the legs, feet, hands or head – that are the neurodegenerative disorder’s most visible symptoms.

Ms. Dowling, 62, a district manager for a storage company who lives with her husband Kenneth in Deerfield Beach, developed symptoms of Parkinson’s disease at a relatively young age, in her 50s. “It started with the shaking in my left leg and then moved up to my hand,” Ms. Dowling says. Then her hand and fingers started to curl – a condition her family called “crab hand” – and she started swaying and having balance issues as well as stiffness.

A self-described “go-getter” and “overachiever” who likes to challenge herself and who says she always shoots for the stars “hoping I’ll grab the moon,” Ms. Dowling found that her condition was making life and work more difficult for her so she started seeing a neurologist in the area.

When that neurologist closed his practice in 2017, Ms. Dowling sought the care of Sameea Husain, D.O., director of movement disorder neurology at Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health.

What is Parkinson’s Disease, Exactly?

An estimated 1 million people in the U.S. are living with Parkinson’s disease, or PD. The disorder occurs when nerve cells in the brain, particularly those producing dopamine, a chemical messenger that helps transmit signals in the brain and nervous system, begin to degenerate.

The disease affects movement, cognitive function and mental health. As PD progresses, coordination, balance and posture worsen, and many patients need assistance with activities of daily living. There is no cure and many PD patients can go on to develop dementia.

According to Dr. Husain, the first symptoms of Parkinson’s disease can include constipation, loss of the sense of smell, sleep behavior problems (such as acting out dreams during sleep) and anxiety or depression. She says these can predate motor symptoms by as much as a decade or two.

Treating Parkinson’s Disease Symptoms with Oral Medications

Dr. Husain first saw Ms. Dowling in 2017 when she was in her 50s, relatively young for PD. “After a thorough clinical and physical evaluation, I diagnosed her with idiopathic Parkinson’s disease and started her on oral medications to bring her tremors and other symptoms under control,” Dr. Husain recalls.

The daily ‘cocktail’ of medications Ms. Dowling was taking made a difference in her life but required frequent fine-tuning, according to Dr. Husain. “She was doing extremely well but this therapy by design becomes more layered and complicated as the disease progresses and medications need to be adjusted regularly.”

Over the years, Dr. Husain could see that the number of different medications her patient was taking were becoming an increasing burden for her. She believed Ms. Dowling would be an excellent candidate for Deep Brain Stimulation (DBS), an innovative surgical procedure available at Marcus Neuroscience Institute as well as at Baptist Health Miami Neuroscience Institute.

“Some patients I recommend a one-side implant only while others I recommend doing implants on both sides,” says Dr. Husain. “Because Ms. Dowling had Parkinson’s disease for so long, I felt she was an excellent candidate for bilateral DBS implants – having both sides done at the same time.”

Ms. Dowling eventually was referred to neurosurgeon Timothy Miller, M.D., director of functional neurosurgery at Marcus Neuroscience Institute. He and Dr. Husain work closely together and trust each other completely when it comes to treatment recommendations. “She’s the brains. I’m the technician,” Dr. Miller says modestly, as if surgical skill isn’t essential to a successful outcome, too. “If she says her patient is a candidate for Deep Brain Stimulation, I don’t question it.

How Deep Brain Stimulation Stops Parkinson’s Disease Tremors

DBS uses a neurostimulator – a small device not unlike a pacemaker used for cardiac patients. The device is a miniature power plant that delivers electrical signals to the exact spot in the brain that governs the patient’s symptoms.

Implanting a DBS device is a fairly straightforward operation done in two different stages, according to Dr. Miller. First, in a procedure performed under local anesthesia, one or more insulated wires – called leads, or electrodes – are placed deep into the brain, in a precisely targeted location. While the patient is awake, the electrodes are connected to a temporary battery so the neurosurgeon can see exactly what the results will be later when the device is actually connected to the leads and activated.

The second stage of DBS, performed under general anesthesia, involves implanting the neurostimulator, or internal pulse generator (IPG) under the skin below the collarbone and running an extension wire under the skin that connects the device to the electrodes in the brain.

Three weeks after implantation, the IPG is activated and programmed so that it delivers the desired level of stimulation, Dr. Miller explains. Once connected, tiny electric pulses travel from the IPG to the electrodes in the brain, blocking the electrical signals that cause tremors associated with PD as well as Essential Tremor (ET) and other movement disorders. One to two additional follow-up visits may be required to tweak the programming.

Many people who have had DBS report significant improvement in their symptoms and quality of life. “Success is somewhat subjective but almost every one of our DBS patients has seen at least some improvement and often dramatic improvement,” says Dr. Miller. Most people still need to take oral medications, but fewer of them than before and at a lower dosage, he adds.

Increased Energy and No Tremor After Deep Brain Stimulation

Following her DBS, Ms. Dowling saw a significant improvement in her PD symptoms. She says that the results were “pretty amazing” and she feels “terrific.” “One minute my hand was trembling and as soon as they turned it on, the tremor stopped,” she says. “I feel like a new woman.”

Ms. Dowling says before, because of her symptoms, she didn’t want to leave the house or go anywhere but that changed after she had DBS. “I get out and walk more now, I’m more active, and my energy level has increased – that’s been the biggest change,” Ms. Dowling says. “I enjoy things I couldn’t before. And I’m only at the beginning. I want to exercise more. I really want to travel more, so we’re going to Aruba in April because I love the islands, and I also want to visit my daughter in Chicago.”

She calls Marcus Neuroscience Institute a “great institution” and feels grateful for the care and compassion she received from Dr. Husain and Dr. Miller. “I feel like if I could travel anywhere and take them with me, I would take them with me,” says Ms. Dowling. “Dr. Husain has such compassion and understanding, and she’s not just looking at prescription medications as the only solution. She also made a point of involving my husband, who has been an active part of my treatment.”

Says Dr. Husain, “Ms. Dowling is young-onset and has so much life to live. She always has a smile on her face. I’m thrilled we were able to help improve her quality of life. And she has a very loving husband – it warms my heart to know she has his support.”

Ms. Dowling says that while being diagnosed with Parkinson’s disease is certainly life-changing, it’s not something you need to be afraid of. “PD isn’t a death sentence – it can be managed with the right combination of medications and with procedures like DBS.”