Deep Brain Stimulation

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For the first time in its history, the Barrow Neurological Institute at Phoenix Children’s Hospital performed an advanced form of brain surgery called deep brain stimulation on several children with dystonia. That’s a disease that produces chronic, involuntary contortions of the trunk and limbs. The procedure involves placing electrodes deep in the brain and then connecting them with a pacemaker-like device placed in the abdomen. The surgery has allowed children to walk again and perform everyday functions. Neurosurgeon Dr. Ratan Bhardwaj will discuss the procedure.

Ted Simons: The neurological institute at Phoenix children's hospital recently performed an advanced type of brain surgery called "deep brain stimulation" on several children with dystonia; it marked the first time the procedure has been used successfully to treat children in Arizona. The surgery has allowed the children to walk again and perform everyday functions. Neurosurgeon Dr. Ratan Bhardwaj joins us now to discuss the procedure. It's good to have you here. This is amazing - deep brain stimulation. What are we talking about?

Dr. Ratan Bhardwaj: It's a pleasure to be here. This is a pretty amazing technology that I've seen. It's very humbling from a medical point of view. Technically what we're doing is we're seeing children who are suffering from really bad movement disorders. What we're doing while they sleeping in the operative setting is we place electrodes, very precisely in the right location deep in their brain. Then we tunnel these leads into a battery Pack in the chest or the abdomen. Two weeks later we turn it on and amazing things seem to be happening.

Ted Simons: That's amazing. You go up into the brain. The wires go where? Just straight down the spine?

Dr. Ratan Bhardwaj: No. The spine is lower. We try to avoid that. There's an important part of the brain called the basal ganglia that's very important for how we move things. For instance for me to pick up the glass like this I have to use a lot of different muscles in my hand,different tension in my tendons to be able to pick it up. So that part of the brain is the basal ganglia, and that's precisely where we put it. It's specifically in a certain part of the --.

Ted Simons: Oh ok so that makes it clearer then. How precise if I have a problem doing what you said, lifting things, how precise can you be? Is it still -- I don't want to say guesswork. Are you approximating or can you fine tune this?

Dr. Ratan Bhardwaj: We have to be as precise as we possibly can. Millimeter or better. We're doing this while the patients are all sleeping. Children, it's very tough do while they are awake. It's all placement and location. I have an excellent operative team. I work with a lot of people, whether it's a frame that goes on the head or the highest technology of brain imaging to make volumetric models of the brain trajectory to safely avoid the blood vessels. We put so much care and thought into this and so far, so good.

Ted Simons: So far you have gotten children -- dystonia means, what, you can't control movement?

Dr. Ratan Bhardwaj: That's a great way to put it. These are very debilitated children. So the crazy thing is it's almost like somebody who could see and went blind. There normal until five or six, running around in the park playing in kindergarten, then they start getting worse. They get worse and worse and medications don't help. So these children who out of our first two or three were wheelchair bound children who used to be running and playing, now basically can maybe sometimes lift their head and watch TV. They can't eat, they can't type, they can't text, they can't run, they can't play. Their life has changed dramatically as well as the family's life. Medicine doesn't help. DBS is the only treatment for these children.

Ted Simons: And the treatment you say is successful what constitutes success?

Dr. Ratan Bhardwaj: It's a great question. I have a love for the brain. It's the most complicated thing in the universe. So when I started I wanted to treat children with brain problems. When I started a DBS program at Phoenix children's hospital, I didn't know, I said wouldn't it be great if these children could walk again. That to me was an amazing possibility. And once we did our first child, a lovely young girl, that was the million dollar question. Sure, she could open her hand, sure she could finally put her shirt on by herself, sure she could wash her hair, but she's looking at me saying I can't walk. That was at one month. Then at about three months she started walking and with a lot of physical therapy she's actually walking now.

Ted Simons: I believe we have video of a patient who is literally moving, doing things that, again, this was -- things were debilitating, deteriorating pretty fast in these kids.

Dr. Ratan Bhardwaj: But you asked me what success -- absolutely agree. What totally blew me away with this patient and is so humbling is that she told me in my clinic, doctor, you have made me more human. From a medical point of view I could never imagine a patient would tell me that. That means you have a 13-year-old girl who can't write, speak, who can't type, text, she can't communicate with the rest of the world. Now she's writing journals, now she's texting people, making Facebook friends. She's got her life back. This is so immensely more important than walking even, which is absolutely unfathomable.

Ted Simons: I imagine when you see something like this, see this little girl moving -- just to look in her face, this must be so fulfilling.

Dr. Ratan Bhardwaj: Magical smiles. I had a little boy who was basically wheelchair bound, rolling around in bed, losing weight and dying. Within three months he is playing tennis, although his mother says he doesn't play tennis very well. Tough mother.

Ted Simons: How does this differ from treatment and therapy for Parkinson's?

Dr. Ratan Bhardwaj: Great question. DBS has maybe been in over 100,000 patients primarily with Parkinson's. We can help these patients. I'm on the other side of the spectrum. I'm looking at children. So amazingly, children's brains are growing and changing as opposed to an adult's brain. How we're able to modulate the circuitry that governs their movement, their thinking, governs their mind, that's amazing. These are things we're trying to understand better. We're seeing dramatic improvements that I had no idea we would see when we started.

Ted Simons: But there was some concern, maybe caution -- you are dealing with developing brains. Developing bodies.

Dr. Ratan Bhardwaj: In that caution and concern hasn't left at all. To take the responsibility to operate on a child's brain we take that with immense responsibility. I'm a very conservative surgeon, however, sometimes the most conservative thing is to do surgery. It's horrible watching them whittle away and not do well. We had one child yesterday and he suffered from a problem where unless his parents were holding his hands he was striking himself and hitting himself very hard. We have turned the system on a couple days ago, and the parents were amazed that for the first time in years they didn't have to hold his hands. I pray and hope this keeps going in this direction, but we just, you know, it's amazing what the limits are.

Ted Simons: Last question here. You pray and hope it goes in this direction. These children will have to wear this and have this apparatus in them for the rest of their lives.

Dr. Ratan Bhardwaj: It's become a part of them of the most surgery we take things out. Here we're putting something in. It's a very small Pack. Children love superheroes, so do doctors. I tell them it's a little bit like ironman. They are not going to fly but if they can walk I'll certainly take that.

Ted Simons: Well you are doing fantastic work. This is very encouraging information. It's good to have you here. Thanks for joining us.

Dr. Ratan Bhardwaj: Thank you.

Dr. Ratan Bhardwaj:Neurosurgeon, Barrow Neurological Institute at Phoenix Children's Hospital;

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