Innovative Treatment Gives Parkinson's Patient Her Life Back

Ana Velasco’s problems began 11 years ago when the then-41-year-old Doral Park resident and mother of two noticed a twitch in her eyes, and later an “out of control” shaking in one of her fingers. This was soon followed by tremors in her hand, her arm, her leg, her foot and eventually her head. On the advice of her husband and friends, she finally went to see a neurologist. He told her, “Ana, you have Parkinson’s disease.”

(Watch now: See how experts at Baptist Health Miami Neuroscience Institute used an innovative procedure called deep brain stimulation to eliminate the symptoms Parkinson’s disease was causing in 52-year-old Ana Velasco of Doral Park. Video by Plum Productions.)

It was rough at first, Ms. Velasco admits. “When you get a diagnosis like that, your life just crumbles. You think the worst and worry that you’re going to die any moment,” says the Venezuela native who, prior to her diagnosis, had always loved riding her bike and running and was even a marathon runner. As long as it got her outdoors, she was happy.

After her diagnosis, it took Ms. Velasco a few weeks to come to terms with the fact that she had Parkinson’s disease. “Then I said to myself, ‘Okay, let’s go. I’m not letting this stop me. What do I do now?’” As far as she was concerned, this was just another test in her life. She knew she would just have to be stronger and push her body even harder. “So that’s what I did. I started training harder. I was training four hours a day and I was in perfect shape.”

Over the next decade, however, Ms. Velasco’s condition persisted and, even with medication, her tremors were affecting every aspect of her life, every minute of her day.

“I had no quality of life. I had no social life because I didn’t want to see people or be seen in my condition,” she says. “I couldn’t eat, I couldn’t type, I couldn’t work, I couldn’t run and I couldn’t bike. Even buttoning my blouse or brushing my hair was a challenge, with the shaking and the more or less constant pain that I was feeling. It was bad.”

Parkinson’s disease expert joins Miami Neuroscience Institute

Coincidentally, Ms. Velasco’s boss at work was diagnosed with Parkinson’s disease a little over a year ago and had been receiving treatment from specialists at Baptist Health Miami Neuroscience Institute. He had heard that a new Parkinson’s disease specialist was joining the Institute as chair of its neurology program. “He told me, ‘He’s Venezuelan like you, Ana, and he’s supposedly a very good doctor. Why don’t you go see him?’ So, I said I would.”

Diego Torres-Russotto, M.D., chair of neurology at Baptist Health Miami Neuroscience Institute

Ms. Velasco was able to get an appointment with the new neurology chair, Diego Torres-Russotto, M.D., who specializes in neurology and movement disorders, including Parkinson’s disease, dystonia, tremors, spasticity, gait disturbance, tics and other neurological conditions.

“I really liked him. He knows what he’s talking about, he’s very well prepared and I like the way he approaches things,” says Ms. Velasco, who made clear when she first met with the physician that she had only one objective. “I told him I need my quality of life back. I didn’t want anything else. I mean, I’m not exactly young but I’m not that old, either. I want to be able to get back on my bike again and back to running again.”

Dr. Torres-Russotto says that Ms. Velasco is “somewhat unique” in that she is younger than the average patient with Parkinson’s disease. “Oftentimes, we’ll see people in their sixties or seventies and so it was unusual to see somebody her age,” he says. “Although her disease had a huge impact on her quality of life, she has a very positive attitude. She’s extremely strong willed and she has a lot of energy and focus on her own wellbeing.”

Treating Parkinson’s disease with deep brain stimulation

After being unable to achieve significant benefits with adjustments to her medications, the doctor and his patient discussed advanced therapies for her Parkinson’s disease.

One possibility was Duopa™ pump therapy, a form of carbidopa-levodopa delivered directly into the intestine in gel form rather than a pill. According to the Parkinson’s Foundation, this improves absorption of the drug and reduces the “off” times for patients who experience changes in movement abilities as their levodopa dose wanes.

Other treatment options for Ms. Velasco included high intensity focused ultrasound (HIFU) and deep brain stimulation (DBS), procedures that have proven highly effective in alleviating symptoms for certain Parkinson’s patients. She opted for DBS, which held the promise of immediate relief after she had struggled with her symptoms for more than a decade.

“I considered her a great candidate for DBS because she had a known diagnosis for a number of years that was responding to medication but she had a lot of fluctuations where maybe the dose was too high or then it was too low,” Dr. Torres-Russotto says. Once she was cleared for DBS by Miami Neuroscience Institute’s case review panel, Dr. Torres-Russotto introduced his patient to his colleague, neurosurgeon Justin Sporrer, M.D., the Institute’s director of functional neurosurgery.

Justin Sporrer, M.D., director of functional neurosurgery at Baptist Health Miami Neuroscience Institute

Dr. Sporrer, who specializes in general neurosurgery, functional neurosurgery and treating movement disorders with deep brain stimulation (DBS) and high-intensity focused ultrasound (HIFU), says he’s grateful to work with a resource such as Dr. Torres-Russotto – especially with something as complex as Parkinson’s disease.

“It’s really important for patients with Parkinson’s disease to see a specialist who is up to date with all the technology, the latest medications and the latest management, and who has easy access to all of the available treatments, including neurosurgery,” Dr. Sporrer says. “Dr. Torres-Russotto is one of the country’s leading authorities on movement disorders and tremors.”

How deep brain stimulation works

Using the analogy of the brain as motor, Dr. Sporrer describes DBS as a way to “jump-start” dopamine production in the brain.

“With Parkinson’s disease, you’re losing the cells that make dopamine, which I think of as the fuel that runs that motor,” he explains. “What happens to that motor when it runs out of fuel? It starts to move slower, it sputters and then it stops altogether. DBS stimulates that circuit with electricity so that the patient doesn’t need as much dopamine in the first place.”

Computer-aided view of electrodes implanted in Ms. Velasco's brain to relieve symptoms of Parkinson's disease

DBS is a “fairly straightforward operation,” according to Dr. Sporrer, who has performed hundreds of the procedures over the years. “We don’t even need to shave the hair but we do place a temporary ring on the patient’s head to keep it steady during the operation, which entails making a very small hole in the skull so that we can introduce this electrode deep into the brain.”

While the patient is awake, Dr. Sporrer hooks up the electrode to a temporary battery so they can see exactly what the results are going to be. “It’s like taking a test drive before we actually make a permanent decision,” he says.

The second phase of the operation, he says, is to implant a small battery – in this case, an internal pulse generator – under the skin just below the collarbone, and then connect it under the skin to the electrode in the brain. “Once we do that, the patient has a full system that can actually stimulate this abnormal circuit,” says Dr. Sporrer.

Virtually all of his DBS patients have benefitted from the procedure, according to Dr. Sporrer, who says that one year after surgery, roughly 95 percent of patients report that they are very happy with the results.” Count Ms. Velasco as one of them.

“Since I went to Miami Neuroscience Institute and met Dr. Torres-Russotto and Dr. Sporrer, I’m a human being again,” she says. “The surgery was a smooth ride and I feel much, much better. As a matter of fact, I just fixed my bike because I’m planning to ride again soon.”

Fine-tuning the patient’s device for optimal results

Once a patient has the DBS surgery, they need to come in regularly for the first few weeks to have their device properly programmed. “It’s not like flipping a switch. It’s a fine-tuning process that requires a series of precise adjustments over several weeks,” says Dr. Torres-Russotto. “We have to slowly increase the stimulation so that at the same time we can carefully diminish the medications the patient is taking.”

Ms. Velasco underwent DBS on the first side of the brain and has had that side fully programmed. Now that she’s had her second side done, Dr. Torres-Russotto’s team is starting to do the programming on that side. “She’s doing well and feels that her tremor control has improved dramatically,” he says. “She has had a significant reduction of the stiffness and the slowness that was limiting her lifestyle.”

Ms. Velasco credits the two physicians with giving her her life back. “Dr. Torres and Dr. Sporrer are special human beings,” she says. “I have not stopped recommending them a hundred percent. I will always be thankful to both of them. They’re my two angels.”

The patient’s attitude makes a real difference

Dr. Torres-Russotto credits his patient’s strength, courage and her determination to fight her disease. He says Ms. Velasco works so hard at improving her quality of life and keeps a very positive attitude, which makes a real difference.

Ms. Velasco with her mother and her husband, Jesús

“The number one therapeutic driver of success in every patient with Parkinson’s disease is exercise and physical activity,” says Dr. Torres-Russotto. “The more physical activity the patients do, the more active they are, the more different types of activities they do, the better their quality of life will be. Mrs. Velasco is a great example of that.”

Says Dr. Sporrer, “What we do as doctors is try to improve the quality of the patient’s life, for however many years that may be. I view my role as returning somebody to the activities they enjoyed prior to their diagnosis and surgery. It’s super important that we try to get somebody out of the mindset of ‘I have an illness’ and back to not even thinking about it.”

Ms. Velasco says that Parkinson’s disease runs in her family and now that she has it, she wants to help others with the disease. “My grandmother had it. My uncle has it. My older brother who passed away had the beginning stages of it. I want to do what I can to help people with Parkinson’s understand that they have various options and a reason for hope.”