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Device halts Parkinson's tremor Phillis Emerson's most precious gift this past Christmas was a simple holiday greeting card. Her mother Evelyn Bolt, had signed it—something the family had not seen in a long time.  “We were so excited because she had signed it herself,” Emerson said. Four years ago a constant shaking of both hands sent Bolt to see the family doctor. Tests were conducted and a diagnosis of Parkinson's disease was made. “It was so hard,” said Karen Gate, Bolt's daughter who lives close to her parents in North Charleston. “You're talking about someone who raised eight children. This was Mom, the person who could do anything. She kept everything going, cooked, baked, sewed our clothes and upholstered furniture.” As expected, the neuromuscular disease progressively took its toll on Bolt's day-to-day activities. The tremor affected her hands and jaw. Eating, drinking and other skills became impossible. She suffered from poor balance and difficulty walking. The medicine prescribed by her neurologist did very little to ease the tremor and caused undesirable side effects. In 1998, national awareness of Parkinson's disease heightened when Michael J. Fox publicly admitted his own diagnosis. Then the Bolts saw a television series on a new surgical treatment for the disorder. In the treatment, called deep brain stimulation, surgeons implanted a device that delivered an electrical pulse to the brain and halted a patient's tremor. The Bolts contacted their doctor who referred them to Richard K. Osenbach, M.D., of MUSC Neurosurgery Services. “In the past, the only surgical option for treatment of tremor from Parkinson's disease and other causes was a thalamotomy,” Osenbach said. “A dime-sized area of the brain thought to be responsible for the tremor is identified, and a small hole is made in that area. This destroys the nerve cells thought to be responsible for the tremor. Eventually it was discovered that the stimulation procedure used to identify that part of the brain also caused the tremor to stop. The new procedure was developed, based on stimulation instead of making a hole in the brain. The stimulation can be adjusted and reversed, which is a tremendous benefit to the new approach.” “Mrs. Bolt was a good candidate for the deep brain stimulator,” Osenbach said. “Her tremors were present during activity and rest, and interfered with her daily life. Her medications were not helping, and she did not have significant additional symptoms that can be associated with Parkinson's disease.” The surgery was described to Bolt and her family. The recommendation was made to implant the left side of the brain, which controls the right side of her body. That was important because Bolt is right-handed. “We all agreed that it had to be her decision,” said Clyde Bolt, her husband of nearly 60 years. “It wasn't our decision to make, so we agreed to support whatever she wanted to do.” Her surgery was performed in December 1998, the first time ever in South Carolina. Two weeks later, the device was “turned on” in the neurosurgery clinic at MUSC's Rutledge Tower. In an emotional moment, while bolt held her two shaking hands out in front of her, the device was activated. Her right hand calmed immediately, making it obvious that the new procedure had worked. “I felt a tingle when they turned it on and then the shaking stopped,” Bolt said. “Other than that the worst part was that they had to shave my head. I told Dr. Osenbach that he might be a good brain surgeon, but he's no beautician!” Osenbach is encouraged by Bolt's success. “This procedure provides a tremendous amount of satisfaction because the impact is immediate and dramatic,” he said. “It's gratifying to help people be able to do things that most of us take for granted like holding a cup, eating or writing.” Bolt has not decided if she will do the second surgery, aimed at ceasing the tremor on the left side. The benefits of the first procedure are clear. Beyond the cessation of her right tremor, her walk and balance have improved. Osenbach believes that regaining function on one side is enough for many patients. “They have enough improvement to do things for themselves, and often don't see the need to go through the open surgery again,” he said. Bolt has the ability to turn the device on and off at home. She leaves it on most of the time and has had very little trouble with her recovery. If she chooses, the second surgery could take place within six months of her first. Osenbach is optimistic about future surgeries and looks forward to following such cases long-term. Editor's note: The article is reprinted from Checkup newsletter, produced by  MUSC Creative Services.