Surgery helps short-circuit Tourette's syndrome

An implant that flips the off-switch on misfiring brain cells could
eventually help treat everything from addictions to depression, PAUL
TAYLOR writes

PAUL TAYLOR

From Tuesday's Globe and Mail


POSTED AT 7:49 AM Tuesday, October 12

Jeff Matovic used to eat with a plastic spoon to prevent himself
from accidentally gouging out one of his eyes.The 31-year-old has
Tourette's syndrome, a neurological disorder characterized by
involuntary muscle movements. Mr. Matovic, who developed symptoms at
age 3, could not sit, walk or even sleep without his body exploding
in an endless series of jerking motions and verbal outbursts. He has
broken glasses in his bare hands and dented walls with his head
because of sudden muscle contractions.
Things got so bad, Mr. Matovic sought out doctors who would implant
electrodes in his brain to quiet his restless body, after hearing
about another patient who had the treatment. The operation took
place six months ago at the University Hospitals of Cleveland, and
his body has been calm ever since.

"It's just amazing. It is truly phenomenal," Mr. Matovic said in a
telephone interview from his home in a Cleveland suburb. Before the
operation, he could barely talk on a phone because of an
irrepressible urge to clear his throat, grunt and hiss -- not to
mention the difficulty of holding the receiver.

Mr. Matovic underwent a treatment known as deep-brain stimulation,
increasingly used to treat a wide range of brain disorders. Much
like a heart pacemaker, the treatment provides a stream of
electrical current to counteract a part of the brain that is
misbehaving.

During surgery, electrodes are inserted into specific spots in the
brain. They are then connected through wires under the skin (beneath
the scalp, neck and upper chest) to a replaceable battery unit
implanted beneath the collarbone.

Only a handful of people (none in Canada) has received the treatment
for Tourette's. But deep-brain stimulation has been used for more
than a decade to treat other movement disorders, such as Parkinson's
disease, tremors and dystonia, which distorts posture. About 30,000
people around the world now have such brain implants.

As neurosurgeons refine their skills, medical experts speculate that
deep-brain stimulation could be used to treat everything from drug
addictions to depression. Studies are under way at various medical
institutions to expand its use. The technique is proving effective
partly because the brain itself operates like an electrical circuit.
When even just a few brain cells are misfiring, they can cause
widespread problems resulting in either a physical or mental
disorder.

A little electrical current, applied in the right place, seems to
restore harmony to the discordant symphony of the disordered brain,
said Dr. Robert Maciunas, the neurosurgeon who operated on Mr.
Matovic.

Years ago, Dr. Maciunas noted, surgeons performed lobotomies in
which connections between dysfunctional parts of the brain were
permanently severed.

"Remember, this was an era when there was no medication for these
horrible psychiatric disorders. So somebody who could demonstrate a
significant benefit in some of these hopeless patients was a
godsend," he said. The problem with lobotomies was that they were
overused -- and irreversible, he added. Surgeons also attempted to
destroy small areas of the brain, which appeared to be the source of
specific disorders. It finally occurred to them that they could
achieve the results though electric probes, and the current could be
fine-tuned to fit the ailment.

Most of the initial deep-brain stimulation operations were performed
on people with Parkinson's disease (which results from the death of
brain cells that produce the neurotransmitter dopamine, which is
involved in body movements). Parkinson's sufferers have difficulty
moving with ease. They develop a stony stare, a shuffling walk and,
at times, their body trembles like leaves in the wind.

"The treatment turns back the clock five to 10 years on the illness,
to a point when the patient had less severe symptoms," said Dr.
Andres Lozano, a neurosurgeon at Toronto Western Hospital, who has
performed the operation on almost 200 Parkinson's patients. But he
cautioned that it is not a cure: It merely controls symptoms for a
time. Parkinson's is a degenerative neurological disorder in which
brain cells continue to die. Eventually, patients develop dementia
and their bodies shut down.

It is uncertain how long deep-brain stimulation can control the
symptoms of Tourette's. But there's a good chance it could be long-
lasting. Unlike Parkinson's disease, Tourette's does not involve the
progressive death of increasing numbers of brain cells.

"If it [Tourette's] is a disorder of brain function only, and if we
improve that function, then the disease should not continue
progressing," said Dr. Lozano.

Mr. Matovic, however, wasn't made any promises when he went under
the knife. As one of the first Tourette's patients to receive deep-
brain stimulation, his doctors were unsure of his outcome.

Yet Mr. Matovic was willing to take a risk because the usual
treatment of drugs and various therapies had failed. What's more, he
was fed up with strangers laughing at his incessant muscle tics. And
even though he has a college education, he had to take menial
jobs. "I'm so grateful they did the operation," Mr. Matovic said,
adding that he is 99-per-cent symptom-free. He now has an office
job, is planning to write a book and his wife is expecting a
baby. "We are certainly very excited about it."

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Paul Marshall
Editor