Michael Richardson

Michael RichardsonHow deep brain stimulation put one man back in the game

Like a lot of boys, Michael Richardson played little league baseball. "I wasn't very good at it," he says. But that was shortly before he developed symptoms of dystonia, a movement disorder.

Dystonia causes muscles to contract involuntarily leading to repetitive or twisted movements. Dystonia can also prove painful, but the degree of pain varies depending on the severity of the disease and the person affected.

For Richardson, diagnosed at 13, the dystonia manifested itself in his gait. Instead of walking with his heal striking the ground before his toes, his toes struck the ground first and his heal would follow. It wasn't long before Richardson needed crutches and then a wheel chair to get around.

He and his family moved to Mexico when he was in his early teens. It was there Richardson saw a pediatric neurologist who treated him with botulinum toxin, or Botox. Botox blocks the release of a chemical causing muscle contractions. After a few treatments, Richardson no longer needed a wheelchair or crutches, although he says he still walked with a noticeable limp.

But after Richardson returned to the United States to attend college, the symptoms returned despite Botox treatments and later a baclofen pump. The pump delivers the drug baclofen directly to the spine, which lessens side effects.

Winters were especially hard on Richardson. Cold can worsen muscle contractions associated with dystonia. And so can stress, much of which was connected to his job. So, with every passing winter, the dystonia worsened, says Richardson, despite the recuperative warmth summer would bring.

Richardson's physician one day suggested he consider deep brain stimulation, or DBS. DBS involves implanting electrodes into a specific area in the brain and are then connecting them to a neurostimulator implanted in the chest. Electrical pulses created by the stimulator travel first to the electrodes and then to the brain to reduce muscle contractions.

Richardson gave the idea of DBS some thought and eventually agreed to give it a try. In February 2007, he found himself in the operating room surrounded by Emory physicians and surgeons, including neurosurgeon Dr. Robert Gross and neurologist Dr. Mahlon DeLong. The surgical team implanted the leads with Gross performing the surgery and DeLong mapping the brain to determine exactly where the leads should be placed. Three weeks later, they implanted the neurostimulator and programmed it to generate precise electrical impulses.

"It was interesting, I saw some improvement even before they turned on the leads," says Richardson. "I didn't know this then, but just putting in the leads can improve dystonia even before the stimulator is implanted."

Every three months, Richardson visits Emory so his neurostimulator can be fine-tuned. Its electrical impulses are adjusted for frequency, intensity, and duration, all of which affect how well DBS will work. 

And for Richardson it's done just that. In fact, the DBS has worked so well that Emory medical students get to learn from Richardson's experience with dystonia. "After Dr. DeLong gives a lecture on neurological disorders, I go too, and students can ask me questions about my experience." says Richardson. "It's kind of fun."

While attending DeLong's lectures, Richardson said he has learned about how DBS affects other movement disorders, such a Parkinson's disease. "What's really interesting about DBS for Parkinson's patients is the immediate effect DBS has on their tremors," says Richardson. "If they turn off their neurostimulator, they start to shake almost immediately. I could go a week with mine off and not know it until quite a bit later."

The DBS has allowed Richardson to return to playing baseball. "I play in a church league, and we range in age from 18 to 76," he says with a smile. "I'm still not very good. You know, I think our team should get a couple of bonus points since our pitcher is 76 and our catcher, that's me, has had brain surgery. We played three games a week last spring, and it was a lot of fun. And I can do pretty much anything I want to now."

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