Henry Ford West Bloomfield neurosurgeon Dr. Jason Schwalb, right, is pictured performing a procedure. A new deep brain stimulation device to help manage Parkinson’s disease symptoms gained FDA approval in January.

Henry Ford West Bloomfield neurosurgeon Dr. Jason Schwalb, right, is pictured performing a procedure. A new deep brain stimulation device to help manage Parkinson’s disease symptoms gained FDA approval in January.

Photo provided by Jeff Adkins

Henry Ford West Bloomfield Hospital first in U.S. to use new tech for Parkinson’s, seizure patients

By: Mark Vest | West Bloomfield Beacon | Published March 21, 2021


WEST BLOOMFIELD — Last month, Henry Ford West Bloomfield Hospital became the first in the United States to surgically implant a “next-generation” deep brain stimulation system to help manage Parkinson’s disease symptoms.

Parkinson’s is a progressive neurological condition that affects nearly 1 million people in the U.S. and 10 million worldwide. It is the second most common neurodegenerative condition after Alzheimer’s disease.

According to a release, neurosurgeon Jason Schwalb surgically implanted the Vercise Genus deep brain stimulation, or DBS, system, which stimulates a targeted region of the brain through implanted leads that are placed in the brain.

The leads are powered by a device called an implantable pulse generator, which sits under the skin in the chest.

Over the past 25 years, more than 160,000 DBS systems have been surgically implanted in patients worldwide to treat movement disorders such as Parkinson’s. However, Henry Ford Health System was the first in the U.S. to offer the new Vercise system, which gained FDA approval in January.

According to a press release, Vercise is small and thin, and it allows patients to safely undergo MRI scans when certain conditions are met. When it is turned on, the implanted pulse generator sends a predetermined program of mild electrical impulses to stimulate the brain.

Unlike traditional DBS systems that are built from pacemaker technology, the Vercise system “is developed from a foundation of cochlear implant technology and the precise stimulation of auditory nerves it uses to replicate hearing.”

It is equipped with Bluetooth connectivity to provide enhanced communication during programming, and “the system’s proprietary Cartesia 3D provides physicians and patients the precise control of stimulation they need to optimize therapy and the ability to deliver the prescribed amount of therapy to target different regions of the brain, which can help address changes in symptoms during the progression of the condition.”

Schwalb said he has been implanting DBS systems since 1998. He expanded on what a DBS system does.

“It’s basically very focused delivery of electricity, so if there’s a circuit in the brain that isn’t working normally and causing symptoms or causing a disease, we can precisely place electrodes in the brain to help modulate that electrical activity,” Schwalb said. “For most of the things we’re putting electrodes in, you have to be very accurate. You have to have the electrode within three millimeters of your intended target for it to work. That may be a little bit more forgiving with these new systems, like the Vercise system.”

As for how the patient who had the Vercise system implanted last month is doing, Schwalb said, “We should have a better idea, (in) terms of how effective or user-friendly it is, once we’re two or three months out.”

Schwalb said DBS tends to be done in two stages, with the first being the placement of electrodes in the brain. That can take approximately four or five hours.

“A lot of places do that awake,” he said. “We do some awake surgery, but most of our surgeries we do in the MRI scanner with the patient asleep. That way, we can have the patient be comfortable but also make sure the electrode ends up in the right place. We can get an MRI before we close the scalp.”

Patients generally go home the day after that surgery is performed and return a couple of weeks later, which is when, Schwalb said, “We run extension cords underneath the skin and put (in) the battery.”

He said that takes about 45 minutes, with the patient going home the same day.

Dr. Bisena Bulica is a movement disorder neurologist at Henry Ford. She expanded on that stage of the procedure.

“Dr. Schwalb put in, it’s called an impulse generator,” Bulica said. “That’s another word for a battery. That battery has Bluetooth technology, and unlike regular, pre-existing DBS batteries and DBS systems that are usually, they’re similar to pacemaker-like devices, this one uses new technology that’s more similar to a cochlear implant that people use for their hearing, which delivers more precise stimulation, so it’s an improvement on the existing (technology) that we have.”

Bulica said the battery is implanted into the chest.

It isn’t just Parkinson’s that DBS is used for, and Schwalb provided some examples of the benefits that can come from it.

“(It) depends what diseases you’re treating,” he said. “If you’re treating tremor, tremor goes away. If you’re treating epilepsy, the frequency and severity of seizures gets better. If you’re treating Parkinson’s disease, it can help with tremor rigidity, slowness of movement and kind of inconsistent drug dosing. If you’re putting it in for obsessive compulsive disorder, it can help (the) person’s obsessions.”

It can be important for those with Parkinson’s to have proper expectations when considering whether or not to go the route of DBS.

“We don’t think it changes the course of the disease, but we don’t know,” Schwalb said. “I think there has been a fair amount of theory about whether it slows progression (with) Parkinson’s disease, but we don’t know whether that’s the fact or not.”

Bulica shared her perspective of an advantage DBS offers.

“The disease will still progress, but the deep brain stimulation can really offer patients better symptom control during their daytime waking hours when they’re trying to function and do things,” she said. “Deep brain stimulation is considered to be very beneficial in patients who are willing to undergo the procedures. … Anyone with Parkinson’s disease would be a candidate for deep brain stimulation once they start to feel that they are no longer happy with how they’re doing with medications alone.”

The first line of treatment for those with Parkinson’s is medication.

Schwalb said DBS is not ideal for everyone. He said it’s usually for patients who have had the disease for around 4 1/2 years, and when medications aren’t controlling the symptoms enough or there are side effects as a result.

“It’s really only for the motor symptoms, the symptoms that are affecting the person’s movement,” Schwalb said. “A lot of patients with Parkinson’s have problems with constipation or sense of smell, with their voice, or with their thinking. It doesn’t help with those things, but it helps for the movements.”

Schwalb said that, generally, well-placed electrodes cause “pretty minimal side effects.”

However, an electrode that is not in the right place can lead to problems with speech and double vision.

Schwalb discussed other potential side effects of DBS.

“It’s hardware,” he said. “Hardware can break down and get infected. Fortunately, those sorts of complications are rare. And then a complication that everyone’s scared of is bleeding in the brain, causing a stroke. Fortunately, that’s very rare, probably less than 1% that you have enough bleeding that would cause a stroke.”

As far as cost, Schwalb said, “It varies so much between hospitals and insurance plans.”

“The devices to be implanted run in the $20,000 to $30,000 range,” he said. “Unlike some of the other surgeries I do, this is not something that I end up on the phone a lot with insurance companies trying to get approved. … How much a patient would pay out-of-pocket depends on their co-pay plan with their insurer.”

Bulica shared her thoughts about Henry Ford being the first hospital in the country to implant the Vercise Genus DBS system.

“It’s very exciting, and I think it provides more tailored therapy for the patient,” she said.