New therapy may offer hope for those living with Parkinson's

    Three years ago, Arnie Nash was felled, quickly and decisively, by Parkinson's -- a disease characterized by trembling, slowness of movement and impaired balance and coordination.

    He was driving around town handing out flyers about the opening of his wife's new knit shop in San Marcos.

    "All of a sudden I couldn't drive," recalled Nash, 66, a retired medical social worker who lives in Vista with his wife of 20 years, Sandy. "I was having what they call 'the pulls' ---- I could feel part of my body being pulled in a different direction."

    Soon the symptoms were so pronounced, Nash said, he needed nearly constant help and assistance.

    "The hardest time in my life was when my wife and I talked about sending me to the nursing home," Nash said. "Would she visit me once a week? Or maybe more?"

    It was a decision the Nashes never had to make. They remain together ---- at home ---- thanks to a new therapy that uses brain stimulation to suppress the symptoms associated with movement.

    "It has made all the difference to me," Nash said of the therapy. "It was the difference between going into a rest home and staying here with my wife."

    Many who suffer from the complex neurological disorder describe themselves as prisoners in their own bodies, each day increasingly unable to perform daily activities and routines. Parkinson's disease is chronic, progressive and, at present, there is no cure.

    "The first doctor I went to thought I had arthritis," said Nash, who became frustrated with the wide array of medications prescribed for his symptoms. "We were always trying out new pills."

    Until now, the most common treatment is the drug levodopa (also called L-dopa). It has been the standard treatment for Parkinson's since it was introduced more than 30 years ago.

    First described by the British physician, James Parkinson, in 1817 as "the shaking palsy," little was uncovered about the disease until the early 1960s when researchers identified a fundamental brain defect that is the hallmark of the disease ---- the loss of brain cells that produce a chemical called dopamine. Dopamine is a chemical messenger responsible for transmitting signals involved in muscle control.

    Unfortunately, the effectiveness of levodopa decreases after four to five years, and after five to 10 years, the drug begins to create unmanageable side effects that are often worse than the disease itself. For many patients, the most common side effects are nausea, vomiting and restlessness. With long-term use, patients also may experience sudden, unpredictable changes in movement.

    While doctors insist that no two patients react the same way to a given drug and it may take time and patience to get the dose just right, Nash just didn't like the way some of them made him feel.

    "Then finally someone asked me if I had heard about surgery ---- they called it deep vein stimulation. 'What surgery, I said?' "

    Activa Therapy was developed by Medtronic Inc. Also referred to as deep brain stimulation, the therapy was approved for use to treat Parkinson's disease in 2002.

    Nash underwent the new surgical procedure about three months ago. He credits the treatment for giving him a new lease on life.

    The new therapy uses brain stimulation to suppress the symptoms associated with movement. A neurostimulator, not unlike a pacemaker for the heart, is implanted near the patient's collarbone. The neurostimulator is connected by way of a thin wire that is passed under the skin of the patient's shoulder, neck and head to another coiled wire, the tip of which contains four electrodes that may be programmed to stimulate centers in the brain and counter the brain signals that cause motor symptoms.

    For Nash, the surgeons implanted one on each side of the brain, as well as the newly FDA-approved electrode apparatus that can be controlled by him through the use of a remote control device. This device enables him to adjust the stimulation based on his needs. It also can be completely disabled if the treatment is no longer required.

    After the procedure, during which he was conscious much of the time, Nash couldn't believe the difference in his symptoms.

    "Right after the surgery, the family all went out to dinner at Benehana's for my birthday," he said. "It's an awfully big restaurant and I walked the whole way without a cane."

    "The most dramatic results of the treatment are the effects on trembling," said Dr. Anchi Wang, a neurologist at the North County Neurology Center in Oceanside who treats patients with Parkinson's as well as other movement disorders.

    "Those who have tremors as the predominant symptom have the best response to the surgery," she said. "Those with gait and balance problems don't respond as well, though those symptoms can improve some, too.

    "In the short term, the surgery reduces the trembling, but in the long term, it will help us reduce the patient's medication, which is also important."

    Nash is currently working at home developing healthy crock pot recipes for a class he is going to teach on nutrition for North County's Solutions for Change. He also plans to volunteer his time at a local hospice.

    "All those years working as a social worker, I never appreciated the old man with the walker," Nash said."I guess you never can know what it is like ---- on the other side of the walker ---- until you have been there yourself."