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Tuesday, December 27, 2005

A Winning Hand

Medical College of Georgia
A decade and a half-ago, Tim Simpson was on top of the professional golf world. The Atlanta-based Simpson was a champion golfer with four PGA Tour victories who had twice finished in the top 10 on the money list and who had led the PGA tour in top 10 finishes in 1983 and 1990.

But in 1991, that life ended...

While on a hunting trip, Mr. Simpson contracted Lyme disease, but that was only the beginning. The previously strong and healthy Simpson found himself at the mercy of lingering illness, muscle joint stiffness and, worst of all, a tremor that developed in his left hand. To some, it would be considered just a flutter, but for a man who made his living from precise putts and perfect drives, a man who was considered one of the greatest ball strikers in PGA Tour history, the flutter effectively derailed his career.

“I struggled, trying to continue and fight back, taking medications that helped the tremor but left me groggy. The fact that I had no control over my essential tremor and its negative effect on my game nearly drove me crazy. But when I couldn’t hit a routine chip shot, at that point, I decided to retire from competition,” says Mr. Simpson. Ironically, the tremor usually occurred only while he was playing golf or was stressed or tired.

Still, Mr. Simpson never lost faith that someday, someone would be able to help him return to the game he loved. “A day didn’t go by that I didn’t miss it,” says Mr. Simpson. “My goal has always been to try to come back when I was 50 to play in the Champions Tour. One day, somehow, that was my goal.”

That day came when he met Dr. Kapil Sethi, a neurologist who was recommended to him by a friend. A golfer himself, Dr. Sethi understood Mr. Simpson’s urgent need to return to the game. And as director of the MCG Movement Disorders Program, Dr. Sethi understood the tremor that was preventing Mr. Simpson from playing golf.

“When we examined Mr. Simpson, we thought we could help him through a relatively new procedure called deep brain stimulation,” said Dr. Sethi.

DBS is a surgical treatment used to help control tremor, rigidity, slowness of movement and equilibrium problems associated with movement disorders. During surgery, electrodes are implanted into hyperactive areas of the brain that cause tremor. Wires from the electrodes are then tunneled under the skin of the neck down into a surgically fashioned pocket directly under the collarbone. The wiring is attached to a pulse generator, which is programmed to send targeted stimulation to the brain to help control symptoms.

Dr. Sethi referred Mr. Simpson to Dr. Joseph Smith, a neurosurgeon with the MCG Neuroscience Center, who examined Mr. Simpson and discussed the risks, goals and limitations of surgery. But not before the patient did his own homework on Dr. Smith. “I was told repeatedly by other neurosurgeons that he was the best of the best at DBS surgery,” Mr. Simpson says.

Ultimately, he decided to undergo the procedure. “It was a dream come true,” he says. “They gave me back the greatest gift of all, the gift of hope. Hope that I could be normal again and let my talent shine.”

Tim Simpson holds golf club during deep brain stimulation.With his wife, Leigh Anne, by his side, Mr. Simpson arrived at MCG Health System for his surgery last March. He was met by physician assistant Patrick Jenkins and Dr. Smith. After Dr. Smith reviewed Simpson’s MRI on the computer planning work station to determine exactly where the electrode should be placed, Mr. Simpson was wheeled to the operating room.

Inside the OR, a hush fell as the team began to place a 14-millimeter bur hole in the patient’s skull. Upstairs in the day surgery waiting area, Mr. Simpson’s wife and parents waited, tense but optimistic the surgery would go well.

About an hour into the procedure, Dr. Smith began the careful work of placing recording-stimulating microelectrodes into Mr. Simpson’s brain to verify the proper location of the target area as seen on the MRI scan. To ensure correct placement of these electrodes and the final DBS electrode, patients remain semi-conscious during surgery. This allows the neurosurgeon to bring out the tremor on command, and then check how the tremor is controlled when the stimulation is turned on. Mr. Simpson groggily said hello to Dr. Smith and Mr. Jenkins and asked how things were going.

“Tim, let’s see if we can get that tremor going,” said Dr. Smith. Mr. Simpson had brought one of his own golf clubs, which was now placed in his hand. He held it up. Nothing. The team waited. “During surgery, we try to use triggers selected by the patient to help bring out the tremor,” explains Dr. Smith. “That could include a coffee cup or pen. In Tim’s case, his tremor was mostly caused when holding a golf club, so that’s what we tried first.”

Next they tried a Styrofoam coffee cup. Still nothing. Next, Dr. Smith placed a cane in Mr. Simpson’s hand. Almost immediately, his hand and arm visibly shivered, then vibrated back and forth in a steady tremor. “There it is,” said Dr. Smith. “Let’s turn the stimulator on.”

Stimulation was applied in varying degrees of intensity until, all at once, the tremor stopped. Mr. Simpson recalls feeling electricity transiently go down his arm and his hand suddenly go still.

“Dr. Smith, as well as Patrick, had told me that during DBS surgery, the moment when the stimulator is turned on tends to be emotional for many patients when they realize that they aren’t shaking anymore,” says Mr. Simpson. “What I remember was the tremendous excitement in the operating room when the stimulator was turned on and my tremor stopped dead. My hand was solid as a rock. This was something I hadn’t experienced in years, and it was amazing.”

“Every time we are able to use this treatment to change someone’s quality of life for the better, it is an exciting moment,” says Dr. Smith. “In this case, seeing Tim’s tremor suddenly stop was even more satisfying, knowing that we were providing a chance for him to return to the life and career he loved.”

Tim SimpsonMr. Simpson remained in the 3 West Neuroscience Unit at MCG Medical Center for several days, then went home to Lake Oconee. Unable to resist the draw of the greens, he was back out working on his short game at his home course, the Harbor Club, in just three days.

“It was unbelievable to be able to go back out there, and not experience any tremor at all,” says Mr. Simpson. “I saw it in the hospital and at home, but I had to see it out on the course. When I was practicing out there is when it hit me. The second ball that I pitched from 15 yards went right in the hole, and that is when I started crying. I knew that my prayers had been finally answered.

“Dr. Smith, Dr. Sethi and Patrick have my sincere thanks for their amazing work as well as for their friendships.”

While Mr. Simpson continues to return to the MCG Movement Disorders Clinic for regular checkups and further programming on his device to enhance tremor control, he is 100 percent back to his golf career, busy traveling and competing in tournaments, his eye still on his goal of playing on the Champion’s Tour in 2006.

“Everywhere I go, there are articles written about my surgery and how I am coming back strong. I told Dr. Smith and Dr. Sethi before my surgery that if they could stop me from shaking, I would make them more famous than they already are,” jokes Mr. Simpson. “I plan on fulfilling my end of the bargain. It has been a while since I have won on the PGA Tour, but I assure you, I still know how to win.”

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