Playing an instrument on an operating table. A feat which challenges but which is nevertheless very real. Denise Bacon, 65, played the clarinet during brain surgery. Dr Marc Lévêque, neurosurgeon, pain specialist and author of the book “Pain Surgery”, deciphers this astonishing case for True Medical.
Precision awake surgery
11 years ago, Denise Bacon, an English woman living in Crowborough, East Sussex, received a grim diagnosis: suffering from Parkinson’s disease, she would soon no longer be able to walk, dance or play her clarinet. Lucid about her condition but determined, the sixty-year-old nevertheless decides not to let the disease dictate her life. She plans an operation to benefit from deep brain stimulation – to try to improve her mobility.
Denise Bacon was given local anesthesia to numb her scalp and skull. She then remained perfectly conscious because during this type of operation, different tests are done to assess tremor, stiffness, movement, fine motor skills, ability to speak as well as other effects… The patient’s collaboration is essential.
A concert in the middle of the operating room
The former speech therapist quickly felt the effects of the brain stimulation. The immediate improvement in the mobility of his fingers even allows him to play the clarinet on the operating table.
“I remember my right hand moving much more easily after the stimulation, which improved my ability to play the clarinet, which I was delighted with. I am already seeing an improvement in my ability to walk and can’t wait to get back to the pool and dance floor to see if my abilities have improved,” said the Englishwoman.
A performance, which delighted the doctors on site.
“We were delighted to see an immediate improvement in his hand movements, and therefore his ability to play, once the brain stimulation was applied”they reveal in an official press release.
But how exactly does this deep brain stimulation work? Dr. Marc Lévêque, neurosurgeon and pain specialist, answers our questions.
A technique invented by a French neurosurgeon
Although deep brain stimulation does not cure Parkinson’s disease, it still offers notable effects. It helps reduce certain motor symptoms by targeting specific areas of the brain.
“This surgical technique consists of implanting, in very specific regions of the brain, electrodes connected to a generator placed under the skin, a bit like a pacemaker,” explains the doctor. “These electrodes deliver a continuous electrical current, which makes it possible to modulate the activity of the brain circuits involved in movement disorders. It is also the occasion for a coincidence because it is the French neurosurgeon Louis-Alim Benabid who is at the origin, in 1986, of this technique.
In Parkinson’s disease, deep brain stimulation significantly improves motor symptoms, continues the neurosurgeon: tremors, rigidity, slowness of movements, fluctuations linked to drug treatments, etc.
“Patients often regain an autonomy that they had lost. It is a therapy that can really transform daily life, even if it does not cure the disease,” he says.
Potentially multiple indications
This technique is mainly aimed at patients suffering from advanced Parkinson’s disease – below a certain age, usually 70 years – when drug treatments become insufficient or cause disabling side effects. “The selection is rigorous: it is necessary to ensure that the patient does not present medical contraindications, that the neurological and cognitive profile is compatible, and that expectations are realistic,” specifies Dr. Marc Lévêque.
“As I explain in “The Surgery of the Soul”, (Ed. JC Lattès) this deep brain stimulation technique can also be used in the treatment of certain psychiatric illnesses such as depression or OCD with, however, different anatomical targets”, he continues.
Action on the symptoms, not the disease
Deep brain stimulation does not stop the progression of the disease and does not act on all symptoms (such as balance problems, speech problems or certain cognitive difficulties).
“Like any surgery, it also carries risks: hemorrhage, infection, complications linked to the equipment. Finally, the settings must be adapted regularly and medical monitoring remains essential. This neuromodulation device also benefits from the technological boom that we are currently experiencing, particularly through our smartphones”, concludes the doctor.