Musician Plays Violin as Surgeons Operate on His Brain

Here’s a wonderful, positive story about Roger Frisch, the Minnesota Orchestra Associate Concertmaster, who underwent brain surgery at the Mayo Clinic to correct tremors.  His story was featured  on national news with Diane Sawyer.  Find it here.

http://abcnews.go.com/WNT/video/fiddling-brain-10142847

Musician Plays Violin as Surgeons Operate on His Brain
Cutting Edge: Treating Tremors Through Deep Brain Stimulation

By LARA SALAHI, LANA ZAK and DARRIA LONG
Mar. 18, 2010

It seemed like a scene from a science fiction movie. But every note he
played told the surgeons whether the electronic pulses they were sending to
his brain worked to ease his body’s tremors.

In June 2009, doctors diagnosed Frisch with essential tremors, a condition
that occurs when sections of the brain that control movement start sending
abnormal signals.

Nearly 10 million Americans suffer from essential tremors, according to the International Essential Tremor Foundation.
<http://www.essentialtremor.org/>

The condition most often affects hand movements, and simple tasks such as
drinking a glass of water or eating become difficult. But for Frisch, a
concert master with the Minneapolis Orchestra, his right hand
shook uncontrollably only when he held his bow up to his violin.
<http://topics.abcnews.go.com/topic/Minneapolis>

Frisch hid his tremors for two years, he said. However, the shaking became
apparent when he held out long notes in concerts.

“I was playing these solos and could no longer draw a straight movement with
the bow,” said Frisch. “This was potentially the end of my career.”

Deep into the Folds of the Brain

While it is not known what causes essential tremors, many experts believe it
arises from abnormal signals in the brain. According to Dr. Michele
Tagliati, division chief of movement disorders at Mount Sinai School of
Medicine in New York, brain scans such as magnetic resonance imaging, or
MRIs, and CAT scans cannot detect these types of tremors.

“It’s a clinical diagnosis that we detect when we ask the patient to conduct
a certain movement that will bring about the tremor,” said Tagliati.

When other medical therapies did not work for Frisch, Dr. Kendall Lee,
director of the Mayo Clinic Neural Engineering Laboratory, turned to deep
brain stimulation — a surgical treatment that implants an electrode to send
electrical pulses to the specific parts of the brain signaling erroneously.

Lee and his team of surgeons found the area of Frisch’s brain sending
abnormal signals and implanted two electrodes. That allowed tiny electronic
pulses to be sent from a pacemaker-like device into the brain.

“We can place a recording device in the brain and hear the tremors,” said
Lee.

While it is not known exactly how DBS works, many doctors believe that it
stops the abnormal brain activity, which stops the tremors.

“Just touching the brain at the right location oftentimes improves the
tremors dramatically,

” said Lee.

Deep brain stimulation is a well-established treatment for essential
tremors, but most patients are treated with beta blockers and other
medications and don’t require surgery, according to Tagliati. “The
percentage of success when the device is properly implanted is incredibly
high. It’s a dramatic improvement that lasts for years,” said Tagliati.

Since the brain does not contain pain receptors, patients can be awake
during surgery and do not feel pain. The device is normally implanted while
patients are under local anesthesia, but Frisch also underwent the surgery
while playing his violin to let the surgeons pinpoint the exact spot to
target in his brain with the pulses.

“As I was lying on the operating table, they put the violin under my chin
and as soon as they put the second lead in, I played,” said Frisch.

While deep brain stimulation is only approved in the U.S. for treatment of
Parkinson’s disease and other movement disorders, the procedure also shows
promise in diseases like obsessive-compulsive disorder, epilepsy and
depression.

The procedure, however, is not without risk. According to the American
Academy of Neurology, complications are seen in 18 percent of procedures,
primarily related to equipment failure or lead migration.

In a recent study of patients with epilepsy, deep brain stimulation reduced their seizures by 40 percent in three months and the reduction in seizures lasted for about one year.
<http://abcnews.go.com/Health/MindMoodNews/deep-brain-stimulation-people-epileptic-seizures/story?id=10134321>

For patients who kept their stimulator on longer, their seizures were
reduced by 56 percent at two years and 68 percent at three years, according
to the study.

An expert Food and Drug Administration Advisory panel ruled on Friday, March
12, to recommend approval of the deep brain stimulation device for epilepsy
that cannot be treated with medications. The FDA could not give information
regarding the timeline for an official decision, an FDA spokesperson told
ABC News.

Tremors Play Second Fiddle

Frisch’s surgery was not even over when his tremors eased and he gained back
control of his hands.

“It was truly remarkable, enough that the entire room broke out in
applause,” said Frisch.

Although stimulation has reduced the number of tremors, he probably will
experience tremors for the rest of his life, according to Lee. But that
prognosis has not stopped Frisch, who said his tremors will not rob him of
the chance to perform again.

“I fell in love with the violin before I started playing,” said Frisch.
“Since I was a little boy, playing in the orchestra was all I wanted to do
for the rest of my life.”