http://www.boston.com/dailyglobe2/038/metro/Brain_waves_of_the_future_now+.shtml

Brain waves of the future, now

Implants do the job neural signals can't

By Raja Mishra, Globe Staff, 2/7/2002

BURLINGTON - Allan Womac has thousands of thoughts, feelings, and impulses coursing through his brain, but yesterday morning, as he sat on a Lahey Clinic operating table, surgeons peered into two narrow surgical head incisions and saw a vast electronic appliance.

Womac, 27, has dystonia, a neurological disorder that makes his limbs, neck, and head twitch uncontrollably. Typically, he would be treated with drugs. Or part of his brain would be removed. But yesterday he was outfitted instead with what resembles a brain pacemaker - two battery-powered electrodes, one on each side of his brain, that will transmit tiny shocks for years to come, to block the frenetic brain signals that cause his disorder. With local anesthesia, Womac was awake for the entire six-hour procedure, blinking and nodding as surgeons bore into his brain.

In recent years, the procedure has produced encouraging results for Parkinson's disease patients, reducing tremors in many. But specialists believe this targeted, implanted shock therapy could one day treat depression, eating disorders, paralysis, epilepsy - almost any affliction involving neurological dysfunction.

The operation yesterday was the first use in Massachusetts of the treatment, called deep brain stimulation, or DBS, in a dystonia patient. Expanding the use of DBS to Womac and others like him takes neurologists a step closer to their dream of repairing the brain with electricity just as engineers fix computers.

''We're on the tip of the iceberg. The potential is incredible,'' said Dr. Erwin Montgomery, co-director of the Cleveland Clinic's Center for Functional and Restorative Neuroscience, a DBS pioneer. ''The brain has more in common with a computer than a stew of chemicals after all.''

Womac lives in Kirkland, Wash., in his own condominium. He does volunteer data entry work for local law enforcement agencies. But life is not easy.

''Pouring milk, picking up a glass, holding a fork and spoon - it's all very hard,'' he said in an interview on the eve of his surgery.

Womac's words are slurred - the tremors have reached his tongue. They began in his left arm following a junior high gym class accident. A few years after the first tremors, his left foot started twitching uncontrollably. In the last five years, he has lost control of his torso, neck, and speech.

Despite the problem, Womac managed to graduate from college, with the help of a note-taking aide. But his slurred speech and twitching made holding a job difficult.

''I've gone through all these stages - why me, and all that - but I've learned to live with it,'' he said.

Womac could not find any DBS specialists in Washington, so he searched the country, landing in the office of the Lahey Clinic's resident DBS specialist, neurosurgeon Dr. Jeff Arle. Arle's calm demeanor charmed Womac and his parents.

Arle's team used CAT scans and MRI pictures to create a detailed map of Womac's brain. The key to the surgery would be to place the electrodes in a tiny part of the globus pallidus, a large, central brain mass that contributes to movement, thinking, and emotion. Missing the location by even millimeters could have proved catastrophic.

Navigating the brain is no easy task. Arle flew in Jay L. Shils, a neurophysiology specialist from Beth Israel Hospital in New York City who once worked as an engineer for defense contractor General Dynamics. Shils is one of only a handful of US experts in positioning DBS electrodes, and that limits how many procedures can be done.

Arle's team placed Womac's head in a cage, clamped to the table. Two narrow incisions were made near the top of his head. Then holes were drilled. A device allowed doctors to position a needle-like threading device, using coordinates from the computer brain map, above the incisions. And in went the threaders.

''Allan, you OK?'' asked Arle.

''Yeah,'' he replied, peeking out from beneath bloodied surgical cloths.

The threaders, which would guide the electrodes in, were in approximately the right spot, but they had to be exact. Arle slipped a hair-thin microelectrode into the hollow of the threader. Then he started moving Womac's arms. If the threaders were in the right spot, the microelectrode would respond, through a computer, by producing a high-pitched static that Shils is expert at recognizing.

By day's end, both electrodes were in the right place. In two weeks, two tiny batteries will be inserted in Womac's chest, connected to the electrodes by wires running under his skin, much like a cardiac pacemaker. For the next six years, they will send tiny electrical impulses, which will be adjusted over time.

''I'm hoping we'll see something,'' said Arle. ''Less fidgeting with the arms and legs, better speech articulation.''

About a hundred dystonia patients have undergone this procedure around the world. Some dystonic children have gone from wheelchair dependency to walking and playing. The US Food and Drug Administration has not approved the treatment for the 300,000 Americans with dystonia, but it has approved it for Parkinson's disease, for which DBS can eliminate half of a patient's tremors. Because this procedure was not approved by Womac's insurer, the surgery cost Womac's parents $85,000.

Neurologists seek to expand DBS to more common brain disorders. Clinical trials are underway around the country for treatment of epilepsy, obsessive-compulsive disorder, depression, and paralysis.

Womac was resting comfortably last night at Lahey Clinic. Arle said the procedure was among the most stressful - and rewarding - surgeries he has performed.

''We've given him a good chance,'' he said. ''A good chance at a better life.''

This story ran on page B1 of the Boston Globe on 2/7/2002. © Copyright 2002 Globe Newspaper Company.

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