Margaret Fleming
In the summer of 2006, Alon Mogilner, MD, a neurosurgeon at North Shore University Hospital (NSUH), took a woman in her eighties into the operating room to implant electrodes in her brain. Margaret Fleming, at 82, spent her life as a commercial artist. Her husband John was an art director and the two of them raised a daughter and filled enough canvases to cover the walls of their home in Garden City, NY. After her husband died, Mrs. Fleming kept at her art and made a good living until she was well into her seventies. Eventually, though, her drawing hand began to tremble. Within a year, she stopped sketching and could barely scratch out her name.
“For an artist, that’s the worst thing that can happen,” said Mrs. Fleming, who swallowed a long list of vitamins and tried acupuncture. Nothing worked. She and her daughter Diane heard about deep brain stimulation when they were in the audience for the radio program of Ronald Hoffman, MD, an alternative medicine specialist who had a large following from his books and radio show. When Mrs. Fleming and her daughter were in the audience, Dr. Hoffmann’s guest speakers were Dr. Mogilner and a colleague at NSUH, neurologist Michael Pourfar, MD.
They called the doctors the next day. Drs. Pourfar and Mogilner were concerned about Mrs. Fleming’s age. She may have been the oldest person to sign on for the surgery and they wondered whether the risks would be worth the benefit. Most people who came through their office spent a long time on L-dopa, but Mrs. Fleming had never taken any medicine for what they believed was essential tremor. She wanted to skip the pills and have the brain surgery as soon as possible.
They asked her to write a list of groceries. She could have been back in first grade, the way she took great care to scribble the letters. The pen was shaking under her grip and the letters came out slowly and sloppy; words spilling across the page. They made her take hours of cognitive tests to make sure her mind and memory were intact. She passed the tests easily.
Mrs. Fleming signed on for deep brain stimulation (DBS). The technique calls for drilling a hole on one or both sides of the skull and then threading a lead with four tiny electrodes deep into the brain tissue. Dr. Pourfar used computer mapping of Mrs. Fleming’s brain scans to trace a path to the final destination of the DBS electrodes. The leads were placed one side. Her tremors stopped once the stimulator was turned on and the settings adjusted.
During a second operation, the lead is connected to a battery pack placed in the chest wall. Then, the DBS team turns on the stimulators and adjusts the settings so that the tremor disappears.
“Watch my finger and tell me when you feel tingling,” Dr. Mogilner asked the artist during the surgery to implant the electrodes. Her blue eyes were clear despite the four screws in her skull that attached to an immovable metal head frame. She was quiet, even when her hand stopped trembling. A nurse handed her a pen and paper. “Write your name,” Dr. Pourfar asked. Without a thought, the artist wrote in beautiful script, straight and steady -- Margaret Fleming.
The next day, they implanted the battery under general anesthesia, and the following morning her daughter brought some of her mother's colored pens to the hospital. She drew a rose in bloom.
To celebrate her mother’s courage to fight for her passion to paint, Diane Fleming organized a show of her mother’s decades of work on exhibit in May at the East Meadow Library. Mrs. Fleming continues to draw and paint. Her daughter is also an artist who had some of her pieces hanging alongside her mother.
“I am so proud of her,” said Diane. “She is an inspiration to everyone.”
Deep brain stimulation got its first federal approval in the summer of 1997 for the treatment of Essential Tremor. The technique grew out of surgery for movement disorders that involved cutting or freezing or burning tissue in abnormally active brain regions.
In November 1986, Alim-Louis Benabid, MD, operated on a man with essential tremor. The neurosurgeon from Grenoble, France, and his colleagues in neurosurgery used electrodes to map their destination in the brain. They would thread the electrode down into the thalamus (to treat tremors) and start stimulating, climbing to 100 hertz. Suddenly, his tremor stopped. “I was not prepared,” Dr. Benabid recalled. “Initially, I thought I obtained a contraction because I was in the wrong place, in the internal capsule. I apologized to the patient.”
“It’s no problem,” said the patient. “It was nice.”
Dr. Benabid repeated the stimulation at 100 hertz. The man moved his fingers, wiggling with the utmost control and surprise. The stimulation suppressed his tremor. Dr. Benabid continued with his original surgery to lesion, or destroy, an area of the thalamus called the ventral intermedius nucleus. He repeated the electrical stimulation on the next five patients. “I observed this phenomenon,” Benabid explained. “At low frequency, the tremor would worsen. At high frequency, it would completely disappear.”
Dr. Benabid is considered the father of deep brain stimulation. Thanks to his discovery, more than 40,000 patients worldwide have undergone deep brain stimulation. For many, like Mrs. Fleming, it worked.
For more information on deep brain stimulation for movement disorders (Parkinson's, dystonia and essential tremor) contact Maria Gillego at 516-570-4468.
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