Stilling tremors

Hours after a surgeon drilled two holes in the top of 82-year-old James Culwell's skull, Culwell was eating soup with a steady hand and dreaming of snagging a bass at Flaming Gorge.

Electrodes placed earlier that day inside his brain had not only stilled his trembling hands, but opened his heart again to the simple pleasures he had missed.

Friends who had provided care and taxi service for years "couldn't believe it" when Culwell left Salt Lake Regional Hospital in February, mostly free of the "essential tremor" of the hands and feet that had stolen much of his self-sufficiency. "They still can't," he said recently in a bit of cowboy twang.

Experienced by as many as 10 million Americans, essential tremor disorder is believed to be much more common than Parkinson's disease, which most people associate with involuntary limb movement.

Advanced treatment for both disorders, known as deep brain stimulation (DBS), introduces electrodes into regions of the brain — the globus pallidus or subthalmic nucleus — that receive signals to create the tremors, confusing the transmission of those signals much like static interferes with broadcast signals in the public airwaves.

Culwell now drives again, works around the house and is readying his boat for fishing season — all activities he was unable to do as the tremors became steadily more uncontrollable.

While the treatment has been in use in the United States for several years, new technology allows patients to recharge the battery pack implanted in their chests that run the device, rather than having to undergo replacement surgery.

Last month, an advisory panel of experts recommended that the Food and Drug Administration approve the therapy to help treat epilepsy.

Dr. Elena James, a neurologist at Salt Lake Regional, said the treatment has been used since 1987 in essential tremor (ET) patients, when medication and other interventions have failed. About 1.5 million Americans have been diagnosed with essential tremor — the nation's most common involuntary movement disorder.

Lance Bremser, a nurse in James' clinic, said the International Essential Tremor Foundation estimates some 20 million Americans have the disorder, but it has gone undiagnosed.

Though the FDA is considering deep brain stimulation as a treatment for epilepsy, James said there is no connection between ET and epilepsy, which is characterized by periodic seizures rather than continual involuntary movement.