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 50^th 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.”