PERSEVERING With Parkinson’s Kootenai Health helps a trumpeter fine-tune his treatment and play on Even with Parkinson’s disease, Robert Cunningham continues to play the trumpet for two to four hours a day. By Kim Anderson Approximately 1 in every 100 people over the age of 60 develops some form of Parkinson’s disease. Parkinson’s is a movement disorder that affects people in three different ways: tremors, rigidity, and bradykinesia; a slowness of movement or hesitations and halts. While the cause of Parkinson’s disease is unknown and it cannot be cured, treatment makes life better and longer for those who are affected. Movement disorders—such as Parkinson’s disease, Huntington’s disease, ataxia, dystonia and Tourette syndrome—affect the nervous system and cause increased movements or reduced or slowed movements. In many cases, the movements they cause are involuntary and can range from annoying to life-altering. In 2020, Kootenai Health made a commitment to develop a robust neurosciences program. Today, that program includes neurologists specializing in nonsurgical care as well as neurosurgeons specializing in surgical treatment of the brain, spinal cord and nervous system. When both specialties work together and also bring in help from other medical professionals—such as physical, occupational and speech therapists—patients have the best possible outcomes. For patients like Robert Cunningham, this combination of care has made the past few years significantly better. Early stages Nearly 30 years ago, Robert and Deborah Cunningham left the hustle and heat of Austin, Texas, for the serene beauty of Sandpoint, Idaho. Robert worked as a project manager for the Idaho Transportation Department and kept busy playing trumpet, regularly practicing for hours each day. Several years ago, while having a consultation about shoulder surgery, the surgeon recommended that Robert see a neurologist. Deborah did some online research and found board-certified neurologist William Britt, M.D., at Kootenai Clinic Neurology. Dr. Britt confirmed the surgeon’s suspicion: Robert was in the early stages of Parkinson’s disease. Over the next six years, Robert and Dr. Britt managed his Parkinson’s with medication. As with most patients, medications helped for a while, but as the disease progressed, medications no longer gave the same results. “I would be in meetings at work, and my hands would be moving so much it was embarrassing,” Robert said. “I had to sit on my hands to keep them from moving.” When medication alone was no longer managing Robert’s symptoms, it was time for a different course of treatment. Deep brain stimulation, or DBS, is a surgical procedure that can significantly help people with conditions such as Parkinson’s disease and other essential tremor disorders. During surgery, a small device is implanted in the brain. It delivers electrical pulses to block or override signals in the brain that cause tremors. Approved by the FDA in 2001, DBS can be a life-changing procedure for people who are no longer seeing the same results from medications. Better results In 2019, neurosurgeon William Ganz, M.D., implanted Robert’s DBS device. “The DBS program at Kootenai Health was started in 2012,” said Dr. Ganz. “Placing the electrode is an intensive process. We use a combination of CT and MRI scans to map a path to the brain’s subthalamic nucleus that avoids blood vessels. Once we reach the subthalamic nucleus, we use electrophysiology to locate the densest area of tremor cells. This is where we place the electrode that will provide the high-frequency impulses that override the tremor cells. The electrode is secured at the skull and connected to an 12
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