Frustrating Hand Tremor Controlled By Deep Brain Stimulation
When a hand tremor consistently interrupted everyday tasks, a Sentara patient turned to deep brain stimulation technology to control shaking and improve his quality of life.
"It had gone on for years and had gotten to the point where I couldn't read my own handwriting," says Virginia Beach resident Fred Gutermuth, 63 and a retired Navy corpsman. "Carrying a cup of coffee from the kitchen was a mess."
Mr. Gutermuth suffers from what is known as an "essential tremor," in which a part of the body, generally the hands, voice and or head, shakes involuntarily.
For Mr. Gutermuth, a water treatment operator for the City of Chesapeake, testing water samples and writing the results are an important part of the job. Between that and the increasing difficulty he found completing household tasks, such as using a screwdriver, Mr. Gutermuth needed a solution.
"It was getting very frustrating," he says. "My life was not what it should have been with the shaking."
Looking For A Solution
Mr. Gutermuth was an established patient of Dr. Karen Thomas' Movement Disorders Clinic at Sentara Neurology Specialists, who after medication trials failed, suggested Deep Brain Stimulation (DBS) and referred him for neurosurgery. It was then that Dr. Shannon Clark, a neurosurgeon with Sentara Neurosurgery Specialists, met with Mr. Gutermuth to explain the benefits and risks of the procedure.
During the first stage of DBS, surgeons implant leads into an area of the brain called the thalamus, which regulates neural impulses causing tremors. The leads are then attached to a transmitter under the skin in the chest that regulates tremors.
Mr. Gutermuth, checked into Sentara Norfolk General Hospital in February 2018 for the procedure. During the surgery, which lasted four hours, Dr. Shannon Clark implanted a lead on each side of the brain (to control the left and right sides of the body).
Mr. Gutermuth was lightly sedated during the surgery. Once the leads were implanted, the anesthesiologist adjusted the sedation so he could awaken more and the tremor could be assessed. Based on the feedback from the patient and their responsiveness to the temporary electrical stimulation, the lead can be repositioned and fine-tuned to confirm precise placement for optimal tremor control.
In the past, patients undergoing deep brain stimulation surgery wore a stereotactic head frame or "halo" around the head that attached to the bed to prevent them from moving during surgery. Dr. Clark uses a "frameless" technique, which is a more patient friendly brace that stabilizes the head. Surgeons use high-tech computer software and a camera system to guide them to the desired area of the brain, according to Medtronic, the device manufacturer.
Mr. Gutermuth spent a day in the hospital and returned one-week later for a short outpatient surgery to implant the neurostimulator, a "pacemaker-like device" that emits the electrical stimulation. A 2-by-2-inch device that is less than a half-inch thick was placed under his chest.
Turning the Device On
About a month after his first surgery to place the brain leads, Mr. Gutermuth returned to his neurologist, Dr. Thomas at Sentara Neurology Specialists for the "reveal" – to see how the device would work to control his tremors and find the optimal settings for him.
In the case of essential tremor, doctors have to strike the right balance to decrease tremors but not affect speech, as the areas of the brain that control both are closely related.
Mr. Gutermuth noticed an immediate difference in his tremors when the device was turned on. He can make minor adjustments at home using his patient programmer, which is about the size of a pager.
Mr. Gutermuth sees his neurologist periodically and will not need another procedure until the battery in the neurostimulator needs to be replaced. "It's been life-changing," says Mr. Gutermuth, who can now carry coffee without it spilling and write without any problems. "My wife describes it as miraculous, and I agree with her. It's really something."