Effective April 1, 2019, Dr. Christopher Honey, UBC neurosurgeon, will be increasing his operating time to accommodate 72 Deep Brain Stimulation (DBS) surgeries annually, instead of the current 36. Parkinson Society BC appreciates the work done by the Vancouver Coastal Health Authority and the Ministry of Health to make this happen. We are hopeful that this increase in operating room time will allow some patients, who have been waiting for up to three years, to access this life changing surgery.
Although this is good news, the waitlist remains lengthy, and continues to grow, with over a 100 patients approved for the surgery. We request that the Ministry of Health continue to look at options for further reducing the waitlist to a more acceptable six months, which is similar to that of other provinces such as Alberta and Ontario.
In addition to issues with waitlist time, surgery access is a concern as it is only available in Vancouver. This places financial burden on patients who reside outside the Lower Mainland, as they are responsible for covering the cost of repeated trips for assessment, surgery, and weekly post-surgery follow-ups (often 8-10 trips). Patients would benefit most from recruiting additional qualified neurosurgeons and the development of more surgical sites.
We are encouraged by the additional days for DBS added to the upcoming budget (2019-2020) and ask that the Ministry of Health and Regional Health Authorities continue to work on reducing the waitlist to align with provinces that have more reasonable waitlist times of up to six months. The full press release on this announcement can be accessed at: https://news.gov.bc.ca/releases/2019HLTH0029-000159
On waiting for Deep Brain Stimulation...
“I was diagnosed with Parkinson’s disease when I was 49 years old at the height of my teaching career. Life with my family was going well, and I had two wonderful children. I was absolutely blind-sided by the diagnosis, and I don’t even remember driving home. My symptoms progressed rapidly and were not typical, so I had to step away from a job I loved. At this stage in the progression of the disease, I am looking for relief from the incredible suffering I have to ensure every evening. My hope is that this surgery will allow me to capture as many good years as I can and make the most of what I have left. I have two beautiful grandchildren that I can’t even talk to because Parkinson’s has taken my voice. The extensive waitlist is putting additional and unnecessary stress on our medical system by forcing people like me to make multiple trips to the emergency room. Furthermore, all signs are pointing towards the incidence of Parkinson’s disease growing exponentially. Something needs to be done now, so people like me can remain in the workforce, as tax paying citizens, and not be forced to live a life confined to our homes on disability.”Maureen Hafstein
“I have been close friends with Maureen since before her Parkinson’s diagnosis, observing her journey with the disease for over a decade. I witnessed her dyskinesia, tremors and torturous withdrawals. When she is in the process of withdrawals from her medication, she writhes like a fish on a hook, then sits on the edge of a table and rocks, then moves around the table shaking – stopping periodically to put pressure on one foot or the other to break the pattern. The muscles in her legs shake convulsively as she moves up the stairs to her bedroom, Once there, she lies on her back moving back and forth, trying to hold both of her feet to arrest the motion. During this process she sweats as though running a marathon and says only three words: kleenex, water and help. When it is over, she is completely exhausted. I ask her to rate her withdrawals on a scale of 1-10. She replies that they’ve been a 5. Her symptoms have become so bad that she has looked into dying with dignity arrangements. The wait seems interminable and unsustainable. My friend Maureen, and others on the waitlist, need urgent care. Please do not fail them.” Patricia Wilson, friend of Maureen Hafstein
“Before Parkinson’s came along I was a fairly active person. My favorite pastime was traveling with my son and daughter on hockey excursions; I enjoyed being employed as a heavy duty mechanic in the mining industry; and I was (and remain) happily married to a wonderful woman, Shelly. I was 52 years old, and life was great. When I was diagnosed with Parkinson’s my initial reaction was total disbelief. Fast forward several years after my diagnosis, and my life was drastically different than it had previously been. I was consuming large amounts of medications daily, as my condition had deteriorated considerably. Dyskinesia, which is uncontrollable movement, greatly affected my quality of life on a day-to-day basis. While the wait for Deep Brain Stimulation (DBS) was frustrating, I finally had my surgery in June of 2012. I was initially told the procedure would only control my tremors, but I discovered nearly everything Parkinson’s had taken from me (speech, etc) returned to my pre-Parkinson’s state. It gave me back my life.” Terry Hume
“The wait for Deep Brain Stimulation surgery was torture. I spent many hours studying the risks and benefits of the surgery. Waiting to see the solution in recovering one’s quality of life, and not having reasonable access, was enough to depress a saint.”Garry Toop
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Why the DBS Program Remains an Issue
- Across Canada, there is at least one functional neurosurgeon for every two million people -- except in BC, where it is one for every five million people.
In comparison, Saskatchewan with a much smaller population of 1,098,352 people has virtually no wait list with three qualified neurosurgeons; and Alberta, again with a smaller population than BC, has a waitlist of six months with two qualified neurosurgeons.
Parkinson’s disease is a progressive neurological disorder that can be treated surgically only within a certain time period. A lost year of benefit may be devastating for a patient, condemning them to a life of disability with flailing limbs, debilitating tremors, and/or the inability to move, work or lead a normal life.
Dr. Christopher Honey, MD, DPhil, FRCSC is currently the only stereotactic functional neurosurgeon in BC performing these very complex surgeries. Although the waitlist to see Dr. Honey is still 3 years for initial consult, the doubling of surgeries from 36 to 72 per year, as per the Ministry of Health announcement in February 2019, will reduce the wait time for surgery following assessment.
- Currently, all patients must travel to Vancouver for the procedure. The budget is held by Vancouver Coastal Health Authority (VCHA) and yet the majority of patients reside outside Vancouver in other health authorities.
What should be a provincial program is being funded through the VCHA, resulting in considerable costs for patients as they must travel to Vancouver multiple times for pre and post-surgery follow-up appointments. Alternative, telehealth care for follow-up should also be put in place for patients outside Vancouver.
- Increasing access to Deep Brain Stimulation for people with advanced Parkinson’s disease will reduce the suffering endured by those with this neurodegenerative disease and provide them with the ability to live independently for 10 or more years.
Helping people stay independent also has a strong economic rationale. Many people with advanced, disruptive symptoms of Parkinson’s disease will end up in hospital beds or long-term care in the near future. The cost of this care is roughly $80,000 to $100,000 per person per year, or $1 million per person over ten years. Thus, it makes moral and economic sense to provide DBS to those who need it, as soon as possible.
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Frequently Asked Questions (FAQs)
In summary, there are a number of medical conditions where symptoms in the body occur because of an abnormal activity of the brain. Deep Brain Stimulation (or DBS) is a way of “turning off” a small area of the brain. It involves placing a small platinum electrode or wire into the abnormal area of the brain. Instead of destroying the area (like we used to do), we use high frequency electrical stimulation to “turn it off”.
The electrode is connected by a subcutaneous wire to a pacemaker which sits under the skin, usually in the chest. When electrical pulses are produced by the pacemaker and sent to the tip of the electrode, the brain cells in the region of the electrode are “turned off”. The pacemaker can then be adjusted to maximize the benefits (turning off the malfunctioning area) and minimize the side effects (turning off adjacent important areas). That is the greatest strength of DBS – it can be adjusted to maximally benefit an individual patient and if there are unwanted side effects, it can be turned down.
Patients with Parkinson’s disease have areas of their brain that are overactive and a DBS electrode can be placed in those areas to correct the brain activity. This may be a confusing concept for some because everyone has been told that Parkinson’s disease is due to a loss of the dopamine brain cell. Loss of this cell can result in overactivity (or underactivity) depending on whether the dopamine cell was working as a stimulating or inhibiting cell.
At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications. If you are doing well on your medications, you cannot have the surgery.
Neurosurgeons and specialists will be looking for three motor symptoms that do not respond to optimal medications in order to determine if an individual is a good candidate for DBS:
- Motor fluctuations
Who is a poor candidate for Deep Brain Stimulation?
- Those with a diagnosis of an atypical parkinsonian syndrome (eg, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, corticobasal degeneration, or vascular parkinsonism). These people are often referred for DBS because of poor response to medical therapies but, unfortunately, typically do not respond well to the surgery.
- People with Parkinson’s disease whose primary goals are to improve speech, respiratory and pharyngeal control, postural instability (history of falling), and freezing. Several long-term studies have shown that these dopaminergic-resistant symptoms continue to progress despite changes in stimulation parameters and improvement of other motor symptoms, such as tremor, rigidity, and bradykinesia.
- People with more than mild cognitive dysfunction, active psychiatric disease, dementia or significant cognitive impairment. This is mostly due to reports of cognition in Parkinson disease worsening irreversibly after deep brain stimulation surgery in patients with pre-existing cognitive impairment. Most centres use detailed neuropsychological testing to screen for dementia.
The benefits of DBS are directly related to the surgical target. Targeting the thalamus will reduce tremor by approximately 80-100%. Targeting the pallidum will reduce dyskinesia by approximately 80-100%. Targeting the subthalamic nucleus will reduce motor fluctuations. The details are best reviewed with your neurosurgeon and, of course, vary from patient to patient.
DBS does not improve the non-motor symptoms of Parkinson’s disease. Non-motor symptoms include but are not limited to dementia, depression, loss of smell, constipation, bladder dysfunction, imbalance (this is complicated and can be improved in some), impulse control disorders (also very complicated and can potential be improved), and REM sleep disorders.
While the electrodes in the brain will stay forever, the pacemaker will eventually run out of power and need to be changed in approximately 3 years (range 2-7 years). The effects or benefits of the DBS will continue forever, but new symptoms may develop that are not controlled by the DBS. For example, if a patient develops dementia years after the DBS surgery, the device will not be able to help this. The patient’s quality of life will then deteriorate because of the new dementia, not because the DBS stopped working.
There are two waiting lists. The first (W1) is the time from when your neurologist puts in a referral for surgery until the time of your neurosurgical appointment. W1 is approximately 2-3 years. The second (W2) is the time from deciding you want surgery to the day of surgery. W2 is approaching 2 year.
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- Promised Parkinson’s surgery sparks hope for Salmon Arm woman, BC Local News, April 2, 2019 [read]
- Action plan to provide faster care for people with Parkinson's, Ministry of Health, BC Government, February 5, 2019 [read]
- People with Parkinson’s disease set to receive better deep brain stimulation access, Global BC, February 5, 2019 [read] [watch]
- Province announces more access to deep brain stimulation treatment for Parkinson's, CBC News, February 5, 2019 [read]
- 'It's inhumane': B.C. Parkinson's patients frustrated with long waits for life-changing surgery, CBC, Oct 29, 2018 [read]
- Larry Gifford: Behind the Parkinson patient viral video, Global BC, October 15, 2018 [read]
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