Deep-brain stimulation changes life of former educator with disabling essential tremor

There are limits to a person’s endurance. For Mark Honeyman of Rochester Hills, MI, his limit was nearly 50 years. That’s how long Mark suffered from the symptoms of essential tremor, a nervous system disorder that can disrupt daily life by causing involuntary shaking of the head, hands, or other parts of the body.

For Mark, the frustration and embarrassment started young. He remembers making a presentation to his classmates at age 12, and his teacher laughing at his shaking hands. At age 32, when he was finally diagnosed with essential tremor, he wept with relief. “I tortured myself thinking I was a weakling, and the tremor was a character flaw,” says Mark.

Working as a high school and middle school teacher for 35 years, Mark developed ways to hide his progressive shaking. Medications had limited effectiveness and intolerable side effects. His shaking hands made it nearly impossible to write comments on his students’ work. Yet students related well to Mark because he spoke openly about his condition and created lasting bonds. Over time, Mark’s tremor worsened. Eventually, he lost more muscle control, making him unable to sing and play piano, including at the weddings of his former students.

Decision making

By age 60, Mark had been doing research for two decades about deep brain stimulation (DBS) to treat essential tremor. He understood that during DBS surgery, the patient typically remains awake to answer the surgeon’s questions as he pinpoints specific areas of brain function. As with any surgery, there are risks and concerns. “I love life, and I have a wife who I adore,” says Mark. “The risk was daunting, but when the impairment outweighed the risk, I was ready.”

Yet there was another hurdle. Mark suffers from severe claustrophobia and the thought of remaining awake and confined in a head-stabilizing device during surgery made him deeply uncomfortable. For that reason, a neurologist referred Mark to Jason Schwalb, M.D., surgical director of the Movement Disorders Center at Henry Ford Hospital.

Dr. Schwalb is one of a select group of surgeons in the world who performs DBS while the patient is asleep. He and other surgeons at Henry Ford Hospital were the second in the United States to publish results of using a proprietary software to perform DBS while the patient was completely asleep in an MRI scanner.

Safety and precision

Doing DBS in an MRI scanner is much more predictable than doing it in awake patients. It reduces the drama. We’ve been doing it for seven years,” says Dr. Schwalb. “We can take images in mid-surgery to make sure the leads are in the right position and then make sure there was no movement of the electrodes after disassembling all the equipment.”

For safety within the MRI environment, special instruments are used that are not magnetic. Building on previous experience with patients with Parkinson Disease, asleep DBS is being done now for patients with essential tremor who typically don’t do well with awake surgery, says Dr. Schwalb.

At Mark’s initial appointment, dark humor helped to establish his rapport with Dr. Schwalb. “He playfully asked me, ‘What took you so long to get here? I could have relieved your suffering long ago,’” laughs Mark. “Yet, he answered all my questions with grace and compassion.”

Preparations for surgery included MRI brain scans, cognitive functioning tests, speech evaluations and a pre-op visit with Dr. Schwalb. Also, Mark asked his friends and family for prayers and healing energy. He created “positive affirmations” – uplifting phrases and statements – for Dr. Schwalb to read aloud before, during and at the end of the surgery.

During the five-hour procedure, wired electrodes were implanted into Mark’s brain. Following a 30-hour hospital stay, he returned home. Two weeks later, outpatient surgery was done to place extension cords behind his right ear and connect his system to a battery pack within Mark’s chest.

“After both surgeries, I was back in the saddle within two days,” says Mark, who credits Dr. Schwalb and his team for the fast recovery.

“As if my body was still for the first time in 50 years”

Although a video of Mark shows astounding physical changes, Dr. Schwalb says, “there was nothing unique about the degree of Mark’s improvement. One-year satisfaction rates after this procedure tend to be at least 95 percent. Patients with essential tremor do really well with surgery.”

Henry Ford has the infrastructure, experience team and a high volume of cases to do these surgeries well, Dr. Schwalb adds. “We are fortunate to have an intraoperative MRI suite to make the procedure go more smoothly,” he says. “You want to go someplace where the procedure is routine. We’re the busiest center in the state and have been for many years.”

A few weeks after surgery, Mark met with his neurologist to program the unit that controlled the electrodes in his brain. “The second my neurologist swiped his finger on his iPad, my arms stopped flapping and thrashing in mid-air. I was completely at ease in two seconds. It was as if my body was still for the first time in 50 years,” says Mark, whose relatives also suffer from severe tremors.

Celebrate life

These days, every day feels like a celebration for Mark and his wife, Mary. “There are a hundred little miracles each day. I can eat in public, cut a straight line, and I filled out my voting ballot for the first time in 20 years!” says Mark, who loves to travel and hike with his wife. “She is my rock,” he adds. The couple are looking forward to a long-dreamed-of trip to New Zealand.

With his tremor under control, Mark can help more young people. The retired teacher developed a non-profit organization to help students determine their direction beyond graduation. Finally, he plans to walk a former student down the aisle and sing at her wedding reception. Says Mark, “Having this surgery gave me a new lease on life.”


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