VCU news

By Leha Byrd

Eight years ago William Pappadake’s life and his lifestyle were interrupted.

Things he had done effortlessly, like golf, write, and carry his plate during an evening out at dinner, became a debilitating struggle because of a 2008 diagnosis of essential tremor. The disease, a nerve disorder that surfaces in different parts and different sides of the body, caused Pappadake’s hands to tremble uncontrollably. A practicing psychologist, Pappadake was losing his independence in a way that was frightening and progressive.

After his prescribed medication failed to control the tremor, Pappadake’s neurologist suggested he have deep brain stimulation surgery to more aggressively reduce his tremors. His surgery was performed in March by VCU Health neurosurgeon Kathryn Holloway, M.D., who was recently ranked the one of the most active deep brain stimulation surgeons in the nation by Medtronic, a Minnesota-based medical technology company.

Pappadake is grateful to have been one of Holloway’s patients. Since his surgery, he can read his own handwriting and doesn’t have to eat all his food with a spoon. He is also less dependent on his wife Jan, who would tactfully divert attention away from his trembling hands when the pair mingled socially.   

“This is the best treatment I’ve received at any facility, ever, and I’ve had a number of [unrelated] surgeries,” he said. “I used to play the guitar, and now I’m able to do that again. I can carry my own food and go places and not feel as if people are watching me.”

To date, Holloway has performed nearly 1,000 general deep brain stimulation surgeries, and more than 500 lead implant surgeries. These surgeries are used to treat movement disorders, which affect millions of Americans. Movement disorders such as essential tremor, Parkinson’s disease and dystonia interfere with a person’s ability to carry out normal activities, Holloway said. In the case of essential tremor, the patient’s hand shakes uncontrollably whenever he or she tries to use it. In Parkinson’s disease, patients not only have tremor but also have a short shuffling walk that can peter out mid stride — leaving them stuck and off balance. Patients with dystonia experience twisting motions and can have their bodies set in odd postures that can be both painful and debilitating.

Deep brain stimulation can help with all of these symptoms. A small wire must be placed in exactly the right location within the brain. This surgery to implant the lead is a highly specialized form of neurosurgery that requires a dedicated multidisciplinary care team in and out of the operating room. Nothing beats experience and breadth of knowledge in getting good results from these exacting surgeries, Holloway said.

Holloway said she’s delighted at the opportunity to restore and improve patients’ abilities. She performs her surgeries at the Virginia Commonwealth University Medical Center and the McGuire VA Medical Center.

“It is an honor and a pleasure to have patients come to me to help them with these very disabling disorders,” said Holloway. “I will continue to do research that advances the lead implant surgery procedure, and I am thrilled to work within a health system that offers this benefit to patients.”

Holloway has developed innovative methods for performing lead implant surgery, including a surgical technique that utilizes a sophisticated navigation system that is like having GPS for the brain. The team is also engaged in a continuous quality improvement program that is always looking at ways to improve the patient experience and outcome. Neurosurgeons from as far away as New Zealand have come to observe Holloway in the operating room.

Pappadake is scheduled to have a second deep brain stimulation surgery in August. His March surgery, which involved a right lead implant, was to reduce tremors in his left hand, his writing hand. The next one is to reduce tremors in his right hand and will be performed on the left side of his brain.

As she has since her husband’s diagnosis, Jan Pappadake continues to support his progress and his upcoming surgery. They have been married 37 years.

“You have to understand that my tremor in effect was my wife’s as well,” William Pappadake said. “She is 100 percent for [surgery]. She says she’s got me back.”

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