Joan: deep brain stimulation gave him back his mobility after ten years with Parkinson's

Ten years with Parkinson's and a diagnosis that took its time

Joan is 67 and comes from Formentera. When the symptoms started, the medical journey was anything but direct: he first went through psychiatry, with two short admissions, until someone pointed him towards the right specialist.

"What you need is neurology. They ran tests and diagnosed Parkinson's."

That was about ten years ago, although the first symptoms had appeared earlier. For almost a decade he lived with better days and worse days, with good spells and bad spells within the same day. Then, over the last year, everything accelerated.

"I had lost a lot of ground and the medication was not doing much for me any more."

A Parkinson's that was more rigid than tremulous

The pre-surgical examination showed a clear picture. Joan's Parkinson's was not predominantly tremulous but slow and rigid: pain in the joints and feet, difficulty walking, a masked face and obvious bradykinesia in every movement.

The simplest gestures had become impossible. Turning over in bed, putting on his shoes or standing up from a chair were daily obstacles. In the consulting room, with his arms stretched forward and all the momentum he could muster, he could not get up.

"Can you? Impossible. I cannot even lean forward like that."

The gait examination confirmed the same thing: slow steps, no arm swing, laboured turns and greatly reduced facial expression. And all of this with his medication already taken, because, as he explained himself, levodopa no longer worked the way it used to. Joan had motor fluctuations, with ON periods and very deep OFF periods that made medical management extremely difficult.

The decision: surgery for Parkinson's

Joan had never considered surgery. The confidence of the medical team and the prospect of getting back to the state he had been in ten years earlier were decisive.

"The doctor was very confident and I was a little nervous. I had never thought about having Parkinson's surgery."

The procedure: four hours and two electrodes in the subthalamus

Dr. Roldán talked him through the surgery step by step before he went into theatre. Deep brain stimulation is performed with the patient asleep: a four-point stereotactic frame is fitted, a control scan is taken and, based on that planning, two small incisions are made to insert the two intracerebral electrodes.

"Two tiny holes, one electrode and then the other. I run them under the skin and they stay hidden."

Once the electrodes are confirmed to be exactly where they were planned, the leads run beneath the skin down to a battery placed under the collarbone. When the current is verified to be flowing correctly, the operation is over. Around four hours in total.

The first 24 hours: walking down the corridor

The day after surgery Joan was already getting up, putting his feet on the floor and walking down the corridor towards the nurses' station, looking well and free of discomfort. Before the operation he could not even rise from a chair.

"I can feel it and they can see it. Things I could not do before, like turning over in bed, standing up or putting my shoes on, I can do now."

Programming the stimulator: tuning the current, reducing the medication

After surgery comes the second half of the treatment: programming. The implanted stimulator is connected to a control console with which the team, together with Dr. Gabriel Salazar, adjusts the stimulation parameters of each electrode while the medication is gradually reduced.

For now stimulation is kept low, with modest amplitudes and conventional frequencies, targeting the posterior part of the subthalamus. A second programme is ready and there is still plenty of room for adjustment. The technology also allows anatomical tailoring of the electrode to each patient's own subthalamus using artificial intelligence.

And there is a key detail for patients coming from outside Barcelona: adjustments do not mean travelling every time.

"They will be on the islands and we, from Barcelona, can modify certain parameters whenever there is a problem."

The outcome: no slowness, no rigidity, no tremor

With the stimulator running, the same examination performed before surgery is unrecognisable. Opening and closing the hand quickly, moving the feet, assessing rigidity, dysmetria or arm swing while walking: all within normal limits, with no freezing on turning.

"There is no slowness here, no rigidity, no tremor. At this moment there are no signs of Parkinson's disease."

The team stresses that this result will keep improving. The oedema around one of the electrodes, which resolves very slowly, will allow even better stimulation: a considerably better result is expected at one month, and the definitive one at three months.

Back to the boat, the tractor and the car

For Joan, the improvement is measured in concrete things. He has a small boat he had been unable to use for years and is already planning to go fishing again. Lately he had almost stopped driving and he expects to get that back. And he wants to work the land again with the tractor and the hoe once he is home.

"I am very well now. I would never have thought this could happen to me."

Joan also highlights the care he received throughout the process, from Dr. Roldán and Dr. Salazar to the nursing staff.

"Everyone treated me very well. The nurses, well, everybody."

When to consider deep brain stimulation

Joan's case illustrates the typical DBS candidate: years of Parkinson's disease in which medication no longer controls symptoms in a stable way, with motor fluctuations and deep OFF periods that dominate daily life. In these patients, deep brain stimulation of the subthalamic nucleus restores mobility, independence and quality of life, and the treatment can be fine-tuned over time without further surgery.