Regaining Control

Deep brain stimulation (DBS) procedure provides new hope by keeping Parkinson’s symptoms in check

For Bachir Flih (pronounced “Flee”), the symptoms happened out of the blue: a tremor in his right index finger accompanied by fatigue that lasted throughout the day. With a busy job as the dining service manager for a retirement community, and an even busier life at home with his wife and two sons, at first Bachir didn’t spend much time thinking about the changes in his health. But as time wore on, his symptoms grew worse, making it difficult to perform simple, everyday tasks.

“It became difficult to write, difficult to button a shirt and difficult to drive,” says Bachir, now 62.

Other things cropped up as well. Concentrating became an effort and he felt the constant weight of depression. A visit to his doctor followed by a series of tests revealed that Bachir had Parkinson’s disease, a neurological disorder caused by misfiring circuits in the brain. But no matter how diligently he took medications, the symptoms only grew worse.

Targeting Tremors

After a decade of living with Parkinson’s disease, Bachir’s wife, Carrie Grant, learned of a program at Inova Fairfax Medical Campus (IFMC) that could help her husband. Established a year and a half ago, the Inova Movement Disorders Program helps individuals with neurological conditions, such as Parkinson’s disease, essential tremor or dystonia (involuntary muscle contractions), regain their quality of life. The interdisciplinary team of fellowship-trained neurologists, neurosurgeons, neuropsychiatrists and neurophysiologists work with occupational, physical and speech therapists to alleviate disabling motor symptoms and get people back to the activities they enjoy.

In 2015, when Bachir met with Sean Rogers, MD, PhD, a neurologist and Co-Director of the Movement Disorders Program at Inova, he knew he had found a medical team that could help him.

Improving Side Effects and Symptoms with Medication Adjustment

Dr. Rogers spent more than an hour with Bachir reviewing his medications and recommending exercises he could do to improve his symptoms.

“The medicines I had been taking were too much for me and I was having dyskinesia — movement of the whole body,” recalls Bachir.

Dr. Rogers adjusted his medications, and while Bachir noticed an improvement in both symptoms and side effects, the symptoms returned throughout the day each time the medication wore off. To provide consistent symptomatic relief that could not be achieved by drug therapy alone, Dr. Rogers recommended a procedure called deep brain stimulation (DBS).

“Mr. Flih was getting benefit from the medication, but it wouldn’t last long enough so he would have to take it multiple times a day,” says Dr. Rogers. “Once we saw he was heading down that road, I recommended DBS.”

Surgical Treatment for Parkinson’s

Deep brain stimulation (DBS) has been shown to be an effective treatment for alleviating the symptoms of movement disorders, allowing a significant reduction in medications. During the procedure, a specially trained neurosurgeon implants an electrode in the area of the brain that controls movement. After the initial procedure, a pacemaker-like device is implanted in the upper chest under the skin. This device delivers electrical stimulation by way of the electrode to block abnormal impulses in the brain.

“There is so much hope in the world of Parkinson’s disease,” says Drew Falconer, MD, a neurologist and Co-Director of the Inova Movement Disorders Program.

“We have the ability to do things now that even 10 years ago were not possible. We can make what was a scary, debilitating condition into a livable and manageable one in a matter of a few months.”

Calming Nerves: Neurosurgery with Direct MRI Visualization

At first, Bachir had concerns about his ability to tolerate the procedure while awake. To make sure he could benefit from DBS, Mahesh Shenai, MD, MBA, a neurosurgeon and Director of Functional and Restorative Neurosurgery at IFMC, and his team went above and beyond to adapt the procedure to Bachir’s needs.

“Normally we do this surgery awake so that we get direct feedback on how the stimulation affects the tremors. But in a certain subset of people we can’t do the surgery awake due to anxiety, claustrophobia and a variety of related issues,” says Dr. Shenai.

The clinical team strategized to transform the MRI suite into an operating room so that surgery could be done with Bachir asleep, but under direct MRI visualization. The state-of-the-art facility has been an effective addition to an already successful program. In patients with Parkinson’s disease, on average, DBS reduces symptoms on one side by 50–60 percent, and for patients with essential tremor, it reduces symptoms by about 80–90  percent.

“Those are pretty dramatic numbers that allow someone to go from being completely nonfunctional to functional,” says Dr. Shenai.

“He Got His Life Back”

For Bachir, the procedure was everything he had hoped for.

“I have no movements whatsoever on the right side,” he says. “I am very happy.”

Of course, Carrie is thrilled to see her husband acting like his old self, throwing a football with his sons, joking around and playing with the family dog.

“He got his life back,” says Carrie. “Through the whole process, the whole program was amazing from start to finish. For every single aspect they went above and beyond. As daunting as this is, it’s worth it.”

Parkinson’s Treatment: Before and After

Follow Bachir Flih’s journey in this YouTube video, which shows interviews with Bachir before and after deep brain stimulation (DBS) treatment:

Expert treatment for Parkinson’s and other movement disorders in Northern Virginia

See videos, get to know Inova’s Movement Disorders physicians, and learn about treatment options at www.inova.org/movement-disorders-program. If you have questions about DBS or other treatment options, call the Inova Movement Disorders Program at 703.845.1500.