Robert Wood Johnson University Hospital

Young Patient Finds Relief With Deep Brain Stimulation Surgery

Turning 35 is a landmark birthday for many, but for Jose Valentin, there was extra cause for celebration when his big day rolled around in May.

Jose Valentin
Parkinson's patient Jose Valentin poses with artwork from his portfolio at his home in Middlesex.

Just two months earlier, Mr. Valentin underwent deep brain stimulation surgery (DBS) at Robert Wood Johnson University Hospital (RWJUH) to provide relief for his hereditary Parkinson's disease that has affected the right side of his body since he was just 28 years old.

"I wanted to live my life as normal as possible," Mr. Valentin said, explaining that the side effects from his medications had troubled him for years. "My friends were playing Guitar Hero. The simplest things I couldn't do." That included his inherent knack for art - sketching, painting and drawing with charcoal - which he'd done since childhood and throughout high school.

"Jose became discouraged with the lack of immediate and robust response to his medications and the side effects," said Mr. Valentin's neurologist, Jeffrey Greenberg, MD, of Princeton and Rutgers Neurology, P.A. in Somerset.

Then last year, Dr. Greenberg met a pioneering neurosurgeon: Shabbar F. Danish, MD, Assistant Professor and Director, Functional Neurosurgery and DBS Program at UMDNJ-Robert Wood Johnson Medical School (RWJMS) and RWJUH. "I became intrigued by this DBS surgery and his program," Dr. Greenberg said. "I'd seen some good responses with other patients, so I mentioned it to Jose to start percolating the idea." After giving it some thought, Mr. Valentin decided to move forward.

Shabbar F. Danish, M.D., Director, Stereotactic and Functional Neurosurgery and Assistant Professor at UMDNJ-Robert Wood Johnson Medical School (RWJMS) and Robert Wood Johnson University Hospital (RWJUH)
Shabbar F. Danish, MD, Assistant Professor and Director, Functional Neurosurgery and DBS Program at UMDNJ-Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital

"Once people undergo DBS, they become much less patient with their medications because it's a life-altering surgery," explained Dr. Danish. "Most patients present at an older age for surgical evaluation at a time when their symptoms have already affected both sides of their body, so we implant both sides of the brain. But in Jose's case, we were able to just do a single implant and give him complete relief."

In 2008, Dr. Danish and Rocco DiPaola, MD, Clinical Assistant Professor of Neurology and Co-Director of the Surgical Movement Disorder Program at RWJMS and RWJUH, opened the only multidisciplinary DBS clinic in New Jersey. The process begins at the clinic with a comprehensive team of doctors evaluating a patient's candidacy for the DBS surgical treatment.

That group of physicians includes a neurologist; a neurophysiologist; a rehabilitation physician; a speech therapist; a psychiatrist; and a recently added urologist who specializes in voiding disorders secondary to movement disorders.

"The patient makes one appointment and sees the doctors, spending a half-day with us so they don't have to run back and forth making different appointments," said Dr. Danish, who has performed more than 200 DBS surgeries. DBS was approved for Parkinson's disease in the United States in 2003.

This "one-stop-shop" approach also allows the physicians to stay in communication and agreement about a patient's ongoing care, which is a growing problem for patients whose care depends on multiple specialties.

The next step involves two DBS surgeries a couple of weeks apart for appropriate patients, followed by programming and long-term maintenance of the implanted device.

The surgery requires implanting precisely placed stimulating leads into specific deep brain targets, which connect to small extension cables that are placed underneath the skin and plugged into a device called the Internal Pulse Generator (IPG). The IPG is implanted in the second surgery and lies under the skin, typically in the chest.

It works somewhat like a pacemaker, sending small, brief pulses to the deep brain targets. After the surgeries, the patient undergoes several months of programming of the device until the optimal level of treatment is attained for relief of symptoms, explains Eric Hargreaves, PhD, Clinical Coordinator of the DBS Program and Co-Director of the DBS Research Program at RWJMS and RWJUH. Both Dr. Hargreaves and Dr. Greenberg provide ongoing evaluation and programming for Mr. Valentin.

"We had a feeling that we were going to get a good response for Jose because of the intraoperative results obtained during the DBS surgery itself," Dr. Hargreaves explains. "In the case of Jose, as soon as the stimulation was turned on, the tremor that had been present during most of the surgery suddenly subsided. That's very compelling to see and we knew we had hit what Dr. Danish likes to call the 'sweet spot.'"

Indeed, life has become much sweeter for Mr. Valentin. "I'm so happy," he says. "I have so much to look forward to."