Patients who are being treated for Parkinson's disease and for whom medication has stopped working should not lose heart as a new brain operation can improve their quality of life in an unprecedented manner.
Among those performing this new brain surgery is Ludvic Zrinzo, a young Maltese doctor working as a specialist registrar and research fellow at the National Hospital for Neurosurgery in Queen Square, London.
Mr Zrinzo graduated from the University of Malta in 1995. His father, Laurence, established the first neurosurgical unit on the Maltese islands with the help of his mother, Sylvia, a neuroradiologist. When his uncle and aunt, Antoine and Salvina, returned to Malta as a neurosurgeon-neuroradiologist team, the course seemed a natural one for him to follow.
"Perhaps it is something in our genes," he says jokingly but adds that one of the things that had influenced him most was seeing his father sporting a stubble on his return from a 30-hour stint at St Luke's Hospital where he had operated on three gunshot victims of the Egypt Air hijack in 1985.
"I was pretty impressed with the event and more so when he received letters of thanks from various quarters. Little did I know that removing bullets from the brain was nothing in comparison to negotiating hospital politics and bureaucracy!" he said.
For the past five years, Mr Zrinzo has been interested in a technique known as deep brain stimulation. "In plain language, it is like a pacemaker for the brain. The operation is highly specialised and cannot be done locally but I was invited to speak to medical students and medical practitioners in Malta as it is important that they are aware that this procedure is available," he explained.
Together with his mentor in London, an internationally renowned functional neurosurgeon, Mr Zrinzo has been involved in the treatment of over 40 patients using this new method. They now benefit from a much better quality of life and video clips of patients, before and after surgery, are striking.
One patient had such a bad tremor he could not control the affected hand from shaking, even when holding it down with his "normal" hand. But after the operation, his tremor abolished and he could return to playing the piano!
Perhaps even more impressive is the story of a 16-year-old girl, her twisted body, imprisoned by the involuntary movements of dystonia since the age of six, being liberated from the cruel disease to return to a normal life of schooling, A-level exams and boyfriends.
But Mr Zrinzo cautions that the operation can have complications. "None of the patients we have operated on in London have had severe complications that could not be rectified by adjusting the type of stimulation delivered to the brain but I want to emphasise that this is not a miracle cure.
"Patients should rely on medication first and only when that stops working is the intervention recommended. However, at this point, the sooner it is carried out the better. Early surgery avoids complications that arise from operating on patients with extremely advanced disease," he said.
Patents suffering from Parkinson's disease, tremor, dystonia and related conditions as well as some psychiatric disorders, cerebral palsies and chronic pain can be treated with the new method.
"The operation takes about seven hours and for most of the time the patient is conscious as we want to see how the patient reacts when the electrode is being implanted in the brain. But most patients describe the operation as not more painful than going to the dentist," he said.
Patients are only anaesthetised when the "pacemaker" is installed under the collarbone.
"The operation is not life saving but greatly improves quality of life. It offers hope for those for whom medication no longer works. I would like people to be aware that the operation is available. I am sure many patients who could benefit are not referred only because many doctors have not yet heard about it," he said.