Lisa McIntyre: Flying High
Like many patients who benefit from the teamwork of movement
disorders specialist Mya Schiess, M.D., and neurosurgeon Albert Fenoy, M.D.,
Lisa McIntyre arrived in their offices by a circuitous route, after nearly a
decade of medical treatment that led to only temporary relief.
McIntyre, now 52, started noticing “little things” when she was 40. “First it was the
tremor in my wrist. I had just stopped taking an antidepressant and knew that stopping
can sometimes cause a slight tremor,” she says. “It continued but I wasn’t too
worried about it. Later I started getting headaches and stiffness in my neck
and shoulders.”
An appointment with her family physician led to referral to a neurologist. In
2006, after nearly a year of tests to rule out other disorders, the neurologist
diagnosed her with Parkinson’s disease and prescribed pain medication. “But the
medications made me feel drugged and interfered with my work,” says McIntyre, a
flight attendant for United Airlines who, at that time, was flying four or five
days a week between Houston, New York and Los Angeles.
Three
neurologists later, she made an appointment with Dr. Schiess at the Memorial
Hermann Mischer Neuroscience Institute at the Texas Medical Center. Professor
and vice chair of the department of Neurology at UTHealth Medical School, Dr.
Schiess is director of UT MOVE, a program focused on clinical care, education and basic science research on the
neurological conditions of motor systems disruption, including movement
disorders, cerebral palsy, spasticity, neurodegenerative diseases and
dementias.
“It was clear from our first
meeting that Lisa is a trooper,” Dr. Schiess says. “You’re immediately struck
by her independence and her positive, healthy attitude. Physically, she was
slow and stiff on only one side, which is not the classic presentation of
Parkinson’s disease, and she was also very young onset. Our initial treatment
was the usual medical management, which provided symptomatic relief.”
At about the eight-year mark of
treatment, McIntyre’s medications no longer kept her in a smooth state of
functioning. “It just wasn’t working,” she says. “I was really sick, couldn’t
fly and nothing worked. Dr. Schiess said it’s time for deep brain stimulation.
At that point I didn’t have a life so I said let’s go for it.”
Based on their excellent
outcomes over time, both Dr. Schiess and Dr. Fenoy support early deep brainstimulation (DBS) surgery in appropriate patients. “We had talked with Lisa
about deep brain stimulation all along but she was so high functioning on
medication that she wanted to wait,” Dr. Schiess says. “But as the disease progresses,
the response to medication therapy always diminishes. We talked about DBS
again, she met with Dr. Fenoy to discuss the surgery, and we did the usual
pre-surgical workup.”
Predictor of a Good Response
One predictor of a good response
to DBS is the effectiveness of dopamine therapy in reducing the motor symptoms
of Parkinson’s disease. The Unified Parkinson’s Disease Rating Scale (UPDRS),
introduced in 1987 and since updated, provides an objective measure to monitor
the impact of Parkinson’s disease and the degree of disability it causes.
“In making the decision about whether DBS was appropriate for Lisa, we took
her off her medication for 12 hours and used the Unified Parkinson’s scale to
assess her without medication,” says Dr. Fenoy, an assistant professor in the
Vivian L. Smith Department of Neurosurgery at UTHealth Medical School who
practices at Mischer Neuroscience Associates in two locations – at Memorial Hermann Northeast Hospital and Memorial Hermann-Texas Medical Center. “Then we
allowed her to take her medication and reevaluated her using the same scale.
What we’re looking for is a 33 percent reduction in motor symptoms while on the
therapy, which is a good indicator of how well a patient will respond to deep
brain stimulation.”
"I was really sick, couldn’t
fly and nothing worked. Dr. Schiess said it’s time for deep brain stimulation.
At that point I didn’t have a life so I said let’s go for it."
— Lisa McIntyre
McIntyre responded appropriately, and on August 21, 2012, Dr. Fenoy and
Dr. Schiess accompanied her to the OR, where she remained awake during the
surgery. “Through two burr holes in the skull, we descended microelectrodes
into the subthalamic nucleus of the brain to verify neuronal activity and
confirm that we had reached the target area,” Dr. Fenoy says. “Then we placed
the actual DBS leads and test stimulated to see what kind of response she had
and whether there were any side effects.”
The surgery went well, and two weeks later, with McIntyre under general
anesthesia, they placed extensions from the electrodes to the neurostimulator
and implanted it in her abdomen. Two weeks after the implantation surgery, Dr.
Schiess programmed the neurostimulator. Five weeks later, McIntyre celebrated
her 50th birthday in Hawaii with her mother, husband and friends.
“Deep brain stimulation is recognized in North America as a therapy
that should be used as early as you’re secure with the diagnosis of idiopathic
Parkinson’s disease,” Dr. Fenoy says. “We don’t wait for motor fluctuations to
occur before offering surgery, because the intervention is as good if not
better than medical management. A recent article reported that DBS improves
symptom control, decreases morbidity, improves quality of life and increases
the lifespan of an individual with Parkinson’s disease by protecting from
immobilization, swallowing disorders, aspiration pneumonia and falls. DBS has a
powerful effect on the life of a person with Parkinson’s disease. Dr. Schiess
and I have shown that our team approach is effective in both the short and
longer term.”
McIntyre, who is now flying two days a week and
considering a career change, would like to thank her husband T. J. McIntyre for
“always being there for me” and Dr. Schiess and Dr. Fenoy, who transformed her
life. “I got very lucky. The two of them make an awesome team. They’re
brilliant. They know what they’re doing, they listen to their patients, and
they’re good communicators. You get embraced by their whole approach and the obvious
fact that they really care.”