برمنگھم یونیورسٹی میں ایڈوانس فیز اری اینٹینا سسٹمز میں استعمال کے لیے ایک نئی قسم کی اعلیٰ کارکردگی کا \’فیز شفٹر\’ تیار کیا گیا ہے۔ برمنگھم کے اسکول آف انجینئرنگ سے ڈاکٹر یی وانگ کی قیادت میں محققین نے مائع گیلیم الائے کا استعمال کرتے ہوئے ایک نئی قسم کی اعلیٰ کارکردگی کا \’فیز شفٹر\’ بنایا، جو مائیکرو ویو اور ملی میٹر ویو ریڈیو سگنلز کے فیز اینگل میں فرق کرتا ہے۔
فیز شفٹر ایڈوانسڈ فیزڈ اری انٹینا (PAA) کے لیے ایک کلیدی قابل بنانے والی ٹیکنالوجی ہے جو موبائل بیس اسٹیشن، سیٹلائٹ اور ریڈار سسٹم میں بڑے پیمانے پر استعمال ہوتی ہے۔ یہ PAA سسٹمز کنٹرول شدہ فیز انکریمنٹ فراہم کرنے کے لیے متعدد فیز شفٹرز کا استعمال کرتے ہیں جو ریڈی ایشن بیم کو چلاتے ہیں (تصویر دیکھیں)۔ تاہم موجودہ فیز شفٹر عام طور پر سیمی کنڈکٹرز استعمال کرتے ہیں اور…
برمنگھم یونیورسٹی میں ایڈوانس فیز اری اینٹینا سسٹمز میں استعمال کے لیے ایک نئی قسم کی اعلیٰ کارکردگی کا \’فیز شفٹر\’ تیار کیا گیا ہے۔ برمنگھم کے اسکول آف انجینئرنگ سے ڈاکٹر یی وانگ کی قیادت میں محققین نے مائع گیلیم الائے کا استعمال کرتے ہوئے ایک نئی قسم کی اعلیٰ کارکردگی کا \’فیز شفٹر\’ بنایا، جو مائیکرو ویو اور ملی میٹر ویو ریڈیو سگنلز کے فیز اینگل میں فرق کرتا ہے۔
فیز شفٹر ایڈوانسڈ فیزڈ اری انٹینا (PAA) کے لیے ایک کلیدی قابل بنانے والی ٹیکنالوجی ہے جو موبائل بیس اسٹیشن، سیٹلائٹ اور ریڈار سسٹم میں بڑے پیمانے پر استعمال ہوتی ہے۔ یہ PAA سسٹمز کنٹرول شدہ فیز انکریمنٹ فراہم کرنے کے لیے متعدد فیز شفٹرز کا استعمال کرتے ہیں جو ریڈی ایشن بیم کو چلاتے ہیں (تصویر دیکھیں)۔ تاہم موجودہ فیز شفٹر عام طور پر سیمی کنڈکٹرز استعمال کرتے ہیں اور…
Before surgery, a metal frame was attached to Harry Forestell’s head to keep it still during an MRI scan. During surgery, the frame was bolted to the surgical table. (Submitted by Harry Forestell)
This First Person article is written by Harry Forestell, host of CBC News New Brunswick at Six, who draws upon his experiences with Parkinson\’s disease.
My latest party trick is a real attention grabber.
It\’s a vivid illustration of the before and after effects of my recent treatment for Parkinson\’s disease. Proof of just how much a little poking around in the brain can achieve.
The treatment is called deep brain stimulation (DBS). It involves implanting thin electrodes into the brain where they emit tiny electrical pulses. Those pulses, applied continuously to just the right section of grey matter, stimulate centres in the brain that control signals sent to your muscles. In the basal ganglia, the engine house of the brain, signals are sent to the body ordering everything from speaking, to swallowing, to walking and touching. When those signals don\’t get through, or when the instructions get scrambled, the body\’s reaction can be cruel. Hands tremble uncontrollably, legs shake, walking becomes increasingly difficult, even swallowing is a challenge.
These are all early symptoms of Parkinson\’s disease and the list is by no means exhaustive.
Parkinson\’s is considered a chronic but not fatal disease. As neurologists will often explain, you will die with Parkinson\’s, not from Parkinson\’s. While true, it doesn\’t really capture the creeping, insidious progress of the disease as it deprives victims of the ability to control their own bodies.
Medical stories like this have always been a source of fascination for me. I worked for several years as a medicine and science reporter, covering stories that included the panic over mad cow disease in the U.K. I produced radio features on brain development and decay.
Little did I know that I eventually would be reporting on my own brain malady.
A shock of a diagnosis, and a relief
The day my diagnosis of Parkinson\’s disease was officially confirmed came as much of a relief as a shock.
It was 2015 and for the previous two years, my wife Jenny and I had been careering back and forth between hope and despair. My Fredericton neurologist, Dr. Eva Pniak, a patient and persevering soul, suspected Parkinson\’s, but suggested the problems I experienced walking and with my tremoring hands could also be explained by a modestly more benign condition called essential tremor.
These are just some of the drugs used to control Parkinson\’s disease. While levodopa is initially the most effective medication, it produces side effects that require other drugs that produce their own side effects. (Harry Forestell/CBC)
She referred me to a specialist in Toronto where the diagnosis was conclusive.
At 53, I had Parkinson\’s.
From leaping out of a tree to dancing the tango, very little happens in the body without first being ordered by the basal ganglia. Those orders are sent at the speed of light through nerve networks with the help of a neurotransmitter called dopamine. It is the as-yet unexplained decline in the brain\’s dopamine-producing cells that leads to movement disorders like Parkinson\’s.
It\’s a simple equation: no dopamine, no movement.
With Parkinson\’s, those dopamine cells start quietly dying off years before symptoms first appear. Scientists aren\’t certain why this happens, or why the process cannot be stopped or slowed.
Doctors can replace some of the lost dopamine with a medication called levodopa, but it causes a side effect known as dyskinesia — sudden uncontrolled muscle movements in the arms and upper body that create a writhing, torquing motion. As doctors increase doses of levodopa to stave off Parkinson\’s tremors, dyskinesia increases.
The payoff is in quality of life for patients
Neurologists have been experimenting with DBS to treat Parkinson\’s and other movement disorders for nearly 40 years. In 1997, the U.S.-based Food and Drug Administration approved DBS to treat Parkinson\’s disease.
Why not more? The simple reason is that it is a treatment involving intricate brain surgery by highly specialized surgical teams and requiring considerable aftercare.
WATCH | How deep brain stimulation can help overcome debilitating effects of Parkinson\’s:
See the almost instantaneous effects of deep brain stimulation for Parkinson’s disease treatment
Harry Forestell shows how DBS therapy can work in daily life — and demonstrates what happens when he turns it off.
\”The surgical expertise is extremely important,\” he said.
\”You have to have a surgeon that knows how to do the procedure and knows how to put the electrodes in the right spot. But then after the surgery, you need an expertise in doing all of the programming and adjusting the stimulators and also adjusting the medication doses which typically change after the operation,\” he said.
\”So it\’s a very complicated procedure that requires a team and it\’s the neurologist and the nurses after the surgery that are doing a great deal of the work in optimizing the responses.\”
It is a procedure, Lang points out, that requires support from provincial governments. The payoff is a treatment that can offer major improvements in quality of life for Parkinson\’s patients.
\”The Ontario government has appreciated the importance,\” said Lang, adding he feels lucky to have a team of expert neurosurgeons, neurologists, nurses and others to support patients.
\”The government recognized the importance of this technique and have provided what\’s called volume-based funding to allow us to operate on a much larger number than most centres.\”
My own experience is a vivid illustration of the relief DBS can bring to some Parkinson\’s patients.
Holes in my head
I entered Toronto Western Hospital on Sept. 30, 2022 with an idea of what was going to happen, but no real appreciation of what it would feel or sound like.
A metal structure was bolted to Forestell\’s skull prior to surgery at Toronto Western Hospital in September. (Harry Forestell/CBC)
I knew at some point before the end of the day someone was going to drill a hole in my head. At least one hole. Maybe two.
I was forewarned by reliable parties that the sound of that drilling would be akin to an airplane taking off. More like Concorde taking off inside my head!
Before surgery I had a metal structure bolted to my skull, not unlike the square lightshade at the top of a lamppost.
This was meant to hold my head steady during the MRI scan and throughout the more delicate procedure of skewering my brain without damaging the useful bits.
In the surgical suite there was a bustle of activity as half a dozen surgeons and nursing staff prepared for the procedure. My head head frame was bolted to the surgical table, and plastic sheets were draped over me to create an antiseptic site for the skull opening.
The drilling of two nickel-sized holes in my skull was every bit as loud as I had been warned. But no pain, just a feeling of pressure.
\”Somewhere in the middle of all this is me, wide awake,” says Forestell. The clear plastic barrier divides the room into sterile and non-sterile zones. (Submitted by Harry Forestell)
In the back of the suite, a cluster of medical IT specialists sat in front of computer screens ready to track and to provide feedback and directions as to where the probes needed to go in my brain.
I know all of this because I was awake — wide awake — for the duration of the six-hour long surgery. I have spent plenty of time around hospitals, both as a patient and as the c
hild of a hospital worker. I\’ve covered many medical stories as a reporter. So rather than fear, the prospect of this procedure filled me with curiosity. How would it feel? What would it change? Would it work?
A strange experience indeed
The surgical suite hummed with the normal hubbub of a workplace. The surgeons and I kept up an amiable conversation as I asked questions about what was happening. In the background, a steady staccato, like the noise of a Geiger counter, attested to the continuing activity in my brain.
Clicks coming through a loudspeaker amplified the activity of each busy cell.
It was a strange experience to have someone rooting through your brain.
A closer look at how the surgeons implant the sensors on Forestell’s brain that will eventually provide the electrical impulses to help override some of the physical symptoms of Parkinson\’s. (Submitted by Harry Forestell)
There was no feeling to it as the brain has no pain sensors. But as the probes slid into place, there were tell-tale signs that gave away what was happening — most commonly a tingling feeling in an arm or leg — as the surgeons carefully threaded the electrodes through my brain to reach the basal ganglia.
Along the way they asked me whether I could recite the days of the week, the months of the year backwards skipping every second month, and the progression of prime numbers to the fifth integer.
Once the probes were in place, it was time to install the wiring and other hardware. For this part of the surgery, anesthetic was required and I was put soundly to sleep. Both probes are attached to wires that are threaded through the skull and under the skin behind the ear, down the neck, over the clavicle and finally are plugged into a battery-operated pulse generator — similar to a pacemaker — that sits just under the skin of the chest. While the surgery involves all the usual risks of infection, hemorrhage, stroke and heart attack, side effects are rare.
A shocking conclusion
So, does it work?
Well, you can see the party trick I\’ve been boasting about in the video above. You be the judge.
Here is how it works.
Once the electrodes have been implanted in the brain, their ability to deliver the required electrical stimulation is controlled by a pulse transmitter and an adapted cellphone.
Forestell one week post-operation. Aside from what he describes as a terrible haircut, the only sign of surgical intervention is the ‘railway track’ of staples closing the wound. The procedure took less than 48 hours from hospital check-in to discharge. (Harry Forestell/CBC)
The cellphone carries an app that controls the frequency of the electrical stimulation of the basal ganglia. The stimulator is set to discharge regular electrical pulses day and night that miraculously override or disrupt the scrambled neural instructions that are a Parkinson\’s hallmark.
Suddenly I am able to walk normally. There are no tremors. The annoying signs of dyskinesia — those involuntary movements I described above — seem to disappear.
WATCH | In September 2022, before undergoing DBS, Harry Forestell described to his audiences what he was undertaking:
Harry Forestell opens up about the next stage in his treatment for Parkinson\’s
The host of CBC New Brunswick News at 6 speaks with Rachel Cave about how deep brain stimulation is expected to help him deal with his Parkinson\’s disease diagnosis.
Regaining control of motor functions is nothing short of a miracle, but it will not work for every Parkinson\’s patient. Those with other conditions are not suited for DBS. It alleviates motor symptoms most successfully among those who respond well to levodopa. Where it is successful in those cases, it means a decrease in that drug and its side effects.
I have been able to cut my medication in half and I recently
returned to work after four months away. I sleep soundly and, while I still tire easily, my mood has brightened.
Parkinson\’s disease will continue to dog my life. DBS may allow me another 10 or 15 years without disabling tremors, though they will probably return at some point as they continue to grow in intensity. There are other insidious effects of Parkinson\’s that are not affected by DBS.
But for the time being, it is as though the disease is caged.
On a leash.
I can hear it barking, but for now at least, it can\’t bite me.
Do you have a compelling personal story that can bring understanding or help others? Here\’s more info on how to pitch to us.
Before surgery, a metal frame was attached to Harry Forestell’s head to keep it still during an MRI scan. During surgery, the frame was bolted to the surgical table. (Submitted by Harry Forestell)
This First Person article is written by Harry Forestell, host of CBC News New Brunswick at Six, who draws upon his experiences with Parkinson\’s disease.
My latest party trick is a real attention grabber.
It\’s a vivid illustration of the before and after effects of my recent treatment for Parkinson\’s disease. Proof of just how much a little poking around in the brain can achieve.
The treatment is called deep brain stimulation (DBS). It involves implanting thin electrodes into the brain where they emit tiny electrical pulses. Those pulses, applied continuously to just the right section of grey matter, stimulate centres in the brain that control signals sent to your muscles. In the basal ganglia, the engine house of the brain, signals are sent to the body ordering everything from speaking, to swallowing, to walking and touching. When those signals don\’t get through, or when the instructions get scrambled, the body\’s reaction can be cruel. Hands tremble uncontrollably, legs shake, walking becomes increasingly difficult, even swallowing is a challenge.
These are all early symptoms of Parkinson\’s disease and the list is by no means exhaustive.
Parkinson\’s is considered a chronic but not fatal disease. As neurologists will often explain, you will die with Parkinson\’s, not from Parkinson\’s. While true, it doesn\’t really capture the creeping, insidious progress of the disease as it deprives victims of the ability to control their own bodies.
Medical stories like this have always been a source of fascination for me. I worked for several years as a medicine and science reporter, covering stories that included the panic over mad cow disease in the U.K. I produced radio features on brain development and decay.
Little did I know that I eventually would be reporting on my own brain malady.
A shock of a diagnosis, and a relief
The day my diagnosis of Parkinson\’s disease was officially confirmed came as much of a relief as a shock.
It was 2015 and for the previous two years, my wife Jenny and I had been careering back and forth between hope and despair. My Fredericton neurologist, Dr. Eva Pniak, a patient and persevering soul, suspected Parkinson\’s, but suggested the problems I experienced walking and with my tremoring hands could also be explained by a modestly more benign condition called essential tremor.
These are just some of the drugs used to control Parkinson\’s disease. While levodopa is initially the most effective medication, it produces side effects that require other drugs that produce their own side effects. (Harry Forestell/CBC)
She referred me to a specialist in Toronto where the diagnosis was conclusive.
At 53, I had Parkinson\’s.
From leaping out of a tree to dancing the tango, very little happens in the body without first being ordered by the basal ganglia. Those orders are sent at the speed of light through nerve networks with the help of a neurotransmitter called dopamine. It is the as-yet unexplained decline in the brain\’s dopamine-producing cells that leads to movement disorders like Parkinson\’s.
It\’s a simple equation: no dopamine, no movement.
With Parkinson\’s, those dopamine cells start quietly dying off years before symptoms first appear. Scientists aren\’t certain why this happens, or why the process cannot be stopped or slowed.
Doctors can replace some of the lost dopamine with a medication called levodopa, but it causes a side effect known as dyskinesia — sudden uncontrolled muscle movements in the arms and upper body that create a writhing, torquing motion. As doctors increase doses of levodopa to stave off Parkinson\’s tremors, dyskinesia increases.
The payoff is in quality of life for patients
Neurologists have been experimenting with DBS to treat Parkinson\’s and other movement disorders for nearly 40 years. In 1997, the U.S.-based Food and Drug Administration approved DBS to treat Parkinson\’s disease.
Why not more? The simple reason is that it is a treatment involving intricate brain surgery by highly specialized surgical teams and requiring considerable aftercare.
WATCH | How deep brain stimulation can help overcome debilitating effects of Parkinson\’s:
See the almost instantaneous effects of deep brain stimulation for Parkinson’s disease treatment
Harry Forestell shows how DBS therapy can work in daily life — and demonstrates what happens when he turns it off.
\”The surgical expertise is extremely important,\” he said.
\”You have to have a surgeon that knows how to do the procedure and knows how to put the electrodes in the right spot. But then after the surgery, you need an expertise in doing all of the programming and adjusting the stimulators and also adjusting the medication doses which typically change after the operation,\” he said.
\”So it\’s a very complicated procedure that requires a team and it\’s the neurologist and the nurses after the surgery that are doing a great deal of the work in optimizing the responses.\”
It is a procedure, Lang points out, that requires support from provincial governments. The payoff is a treatment that can offer major improvements in quality of life for Parkinson\’s patients.
\”The Ontario government has appreciated the importance,\” said Lang, adding he feels lucky to have a team of expert neurosurgeons, neurologists, nurses and others to support patients.
\”The government recognized the importance of this technique and have provided what\’s called volume-based funding to allow us to operate on a much larger number than most centres.\”
My own experience is a vivid illustration of the relief DBS can bring to some Parkinson\’s patients.
Holes in my head
I entered Toronto Western Hospital on Sept. 30, 2022 with an idea of what was going to happen, but no real appreciation of what it would feel or sound like.
A metal structure was bolted to Forestell\’s skull prior to surgery at Toronto Western Hospital in September. (Harry Forestell/CBC)
I knew at some point before the end of the day someone was going to drill a hole in my head. At least one hole. Maybe two.
I was forewarned by reliable parties that the sound of that drilling would be akin to an airplane taking off. More like Concorde taking off inside my head!
Before surgery I had a metal structure bolted to my skull, not unlike the square lightshade at the top of a lamppost.
This was meant to hold my head steady during the MRI scan and throughout the more delicate procedure of skewering my brain without damaging the useful bits.
In the surgical suite there was a bustle of activity as half a dozen surgeons and nursing staff prepared for the procedure. My head head frame was bolted to the surgical table, and plastic sheets were draped over me to create an antiseptic site for the skull opening.
The drilling of two nickel-sized holes in my skull was every bit as loud as I had been warned. But no pain, just a feeling of pressure.
\”Somewhere in the middle of all this is me, wide awake,” says Forestell. The clear plastic barrier divides the room into sterile and non-sterile zones. (Submitted by Harry Forestell)
In the back of the suite, a cluster of medical IT specialists sat in front of computer screens ready to track and to provide feedback and directions as to where the probes needed to go in my brain.
I know all of this because I was awake — wide awake — for the duration of the six-hour long surgery. I have spent plenty of time around hospitals, both as a patient and as the c
hild of a hospital worker. I\’ve covered many medical stories as a reporter. So rather than fear, the prospect of this procedure filled me with curiosity. How would it feel? What would it change? Would it work?
A strange experience indeed
The surgical suite hummed with the normal hubbub of a workplace. The surgeons and I kept up an amiable conversation as I asked questions about what was happening. In the background, a steady staccato, like the noise of a Geiger counter, attested to the continuing activity in my brain.
Clicks coming through a loudspeaker amplified the activity of each busy cell.
It was a strange experience to have someone rooting through your brain.
A closer look at how the surgeons implant the sensors on Forestell’s brain that will eventually provide the electrical impulses to help override some of the physical symptoms of Parkinson\’s. (Submitted by Harry Forestell)
There was no feeling to it as the brain has no pain sensors. But as the probes slid into place, there were tell-tale signs that gave away what was happening — most commonly a tingling feeling in an arm or leg — as the surgeons carefully threaded the electrodes through my brain to reach the basal ganglia.
Along the way they asked me whether I could recite the days of the week, the months of the year backwards skipping every second month, and the progression of prime numbers to the fifth integer.
Once the probes were in place, it was time to install the wiring and other hardware. For this part of the surgery, anesthetic was required and I was put soundly to sleep. Both probes are attached to wires that are threaded through the skull and under the skin behind the ear, down the neck, over the clavicle and finally are plugged into a battery-operated pulse generator — similar to a pacemaker — that sits just under the skin of the chest. While the surgery involves all the usual risks of infection, hemorrhage, stroke and heart attack, side effects are rare.
A shocking conclusion
So, does it work?
Well, you can see the party trick I\’ve been boasting about in the video above. You be the judge.
Here is how it works.
Once the electrodes have been implanted in the brain, their ability to deliver the required electrical stimulation is controlled by a pulse transmitter and an adapted cellphone.
Forestell one week post-operation. Aside from what he describes as a terrible haircut, the only sign of surgical intervention is the ‘railway track’ of staples closing the wound. The procedure took less than 48 hours from hospital check-in to discharge. (Harry Forestell/CBC)
The cellphone carries an app that controls the frequency of the electrical stimulation of the basal ganglia. The stimulator is set to discharge regular electrical pulses day and night that miraculously override or disrupt the scrambled neural instructions that are a Parkinson\’s hallmark.
Suddenly I am able to walk normally. There are no tremors. The annoying signs of dyskinesia — those involuntary movements I described above — seem to disappear.
WATCH | In September 2022, before undergoing DBS, Harry Forestell described to his audiences what he was undertaking:
Harry Forestell opens up about the next stage in his treatment for Parkinson\’s
The host of CBC New Brunswick News at 6 speaks with Rachel Cave about how deep brain stimulation is expected to help him deal with his Parkinson\’s disease diagnosis.
Regaining control of motor functions is nothing short of a miracle, but it will not work for every Parkinson\’s patient. Those with other conditions are not suited for DBS. It alleviates motor symptoms most successfully among those who respond well to levodopa. Where it is successful in those cases, it means a decrease in that drug and its side effects.
I have been able to cut my medication in half and I recently
returned to work after four months away. I sleep soundly and, while I still tire easily, my mood has brightened.
Parkinson\’s disease will continue to dog my life. DBS may allow me another 10 or 15 years without disabling tremors, though they will probably return at some point as they continue to grow in intensity. There are other insidious effects of Parkinson\’s that are not affected by DBS.
But for the time being, it is as though the disease is caged.
On a leash.
I can hear it barking, but for now at least, it can\’t bite me.
Do you have a compelling personal story that can bring understanding or help others? Here\’s more info on how to pitch to us.
Before surgery, a metal frame was attached to Harry Forestell’s head to keep it still during an MRI scan. During surgery, the frame was bolted to the surgical table. (Submitted by Harry Forestell)
This First Person article is written by Harry Forestell, host of CBC News New Brunswick at Six, who draws upon his experiences with Parkinson\’s disease.
My latest party trick is a real attention grabber.
It\’s a vivid illustration of the before and after effects of my recent treatment for Parkinson\’s disease. Proof of just how much a little poking around in the brain can achieve.
The treatment is called deep brain stimulation (DBS). It involves implanting thin electrodes into the brain where they emit tiny electrical pulses. Those pulses, applied continuously to just the right section of grey matter, stimulate centres in the brain that control signals sent to your muscles. In the basal ganglia, the engine house of the brain, signals are sent to the body ordering everything from speaking, to swallowing, to walking and touching. When those signals don\’t get through, or when the instructions get scrambled, the body\’s reaction can be cruel. Hands tremble uncontrollably, legs shake, walking becomes increasingly difficult, even swallowing is a challenge.
These are all early symptoms of Parkinson\’s disease and the list is by no means exhaustive.
Parkinson\’s is considered a chronic but not fatal disease. As neurologists will often explain, you will die with Parkinson\’s, not from Parkinson\’s. While true, it doesn\’t really capture the creeping, insidious progress of the disease as it deprives victims of the ability to control their own bodies.
Medical stories like this have always been a source of fascination for me. I worked for several years as a medicine and science reporter, covering stories that included the panic over mad cow disease in the U.K. I produced radio features on brain development and decay.
Little did I know that I eventually would be reporting on my own brain malady.
A shock of a diagnosis, and a relief
The day my diagnosis of Parkinson\’s disease was officially confirmed came as much of a relief as a shock.
It was 2015 and for the previous two years, my wife Jenny and I had been careering back and forth between hope and despair. My Fredericton neurologist, Dr. Eva Pniak, a patient and persevering soul, suspected Parkinson\’s, but suggested the problems I experienced walking and with my tremoring hands could also be explained by a modestly more benign condition called essential tremor.
These are just some of the drugs used to control Parkinson\’s disease. While levodopa is initially the most effective medication, it produces side effects that require other drugs that produce their own side effects. (Harry Forestell/CBC)
She referred me to a specialist in Toronto where the diagnosis was conclusive.
At 53, I had Parkinson\’s.
From leaping out of a tree to dancing the tango, very little happens in the body without first being ordered by the basal ganglia. Those orders are sent at the speed of light through nerve networks with the help of a neurotransmitter called dopamine. It is the as-yet unexplained decline in the brain\’s dopamine-producing cells that leads to movement disorders like Parkinson\’s.
It\’s a simple equation: no dopamine, no movement.
With Parkinson\’s, those dopamine cells start quietly dying off years before symptoms first appear. Scientists aren\’t certain why this happens, or why the process cannot be stopped or slowed.
Doctors can replace some of the lost dopamine with a medication called levodopa, but it causes a side effect known as dyskinesia — sudden uncontrolled muscle movements in the arms and upper body that create a writhing, torquing motion. As doctors increase doses of levodopa to stave off Parkinson\’s tremors, dyskinesia increases.
The payoff is in quality of life for patients
Neurologists have been experimenting with DBS to treat Parkinson\’s and other movement disorders for nearly 40 years. In 1997, the U.S.-based Food and Drug Administration approved DBS to treat Parkinson\’s disease.
Why not more? The simple reason is that it is a treatment involving intricate brain surgery by highly specialized surgical teams and requiring considerable aftercare.
WATCH | How deep brain stimulation can help overcome debilitating effects of Parkinson\’s:
See the almost instantaneous effects of deep brain stimulation for Parkinson’s disease treatment
Harry Forestell shows how DBS therapy can work in daily life — and demonstrates what happens when he turns it off.
\”The surgical expertise is extremely important,\” he said.
\”You have to have a surgeon that knows how to do the procedure and knows how to put the electrodes in the right spot. But then after the surgery, you need an expertise in doing all of the programming and adjusting the stimulators and also adjusting the medication doses which typically change after the operation,\” he said.
\”So it\’s a very complicated procedure that requires a team and it\’s the neurologist and the nurses after the surgery that are doing a great deal of the work in optimizing the responses.\”
It is a procedure, Lang points out, that requires support from provincial governments. The payoff is a treatment that can offer major improvements in quality of life for Parkinson\’s patients.
\”The Ontario government has appreciated the importance,\” said Lang, adding he feels lucky to have a team of expert neurosurgeons, neurologists, nurses and others to support patients.
\”The government recognized the importance of this technique and have provided what\’s called volume-based funding to allow us to operate on a much larger number than most centres.\”
My own experience is a vivid illustration of the relief DBS can bring to some Parkinson\’s patients.
Holes in my head
I entered Toronto Western Hospital on Sept. 30, 2022 with an idea of what was going to happen, but no real appreciation of what it would feel or sound like.
A metal structure was bolted to Forestell\’s skull prior to surgery at Toronto Western Hospital in September. (Harry Forestell/CBC)
I knew at some point before the end of the day someone was going to drill a hole in my head. At least one hole. Maybe two.
I was forewarned by reliable parties that the sound of that drilling would be akin to an airplane taking off. More like Concorde taking off inside my head!
Before surgery I had a metal structure bolted to my skull, not unlike the square lightshade at the top of a lamppost.
This was meant to hold my head steady during the MRI scan and throughout the more delicate procedure of skewering my brain without damaging the useful bits.
In the surgical suite there was a bustle of activity as half a dozen surgeons and nursing staff prepared for the procedure. My head head frame was bolted to the surgical table, and plastic sheets were draped over me to create an antiseptic site for the skull opening.
The drilling of two nickel-sized holes in my skull was every bit as loud as I had been warned. But no pain, just a feeling of pressure.
\”Somewhere in the middle of all this is me, wide awake,” says Forestell. The clear plastic barrier divides the room into sterile and non-sterile zones. (Submitted by Harry Forestell)
In the back of the suite, a cluster of medical IT specialists sat in front of computer screens ready to track and to provide feedback and directions as to where the probes needed to go in my brain.
I know all of this because I was awake — wide awake — for the duration of the six-hour long surgery. I have spent plenty of time around hospitals, both as a patient and as the c
hild of a hospital worker. I\’ve covered many medical stories as a reporter. So rather than fear, the prospect of this procedure filled me with curiosity. How would it feel? What would it change? Would it work?
A strange experience indeed
The surgical suite hummed with the normal hubbub of a workplace. The surgeons and I kept up an amiable conversation as I asked questions about what was happening. In the background, a steady staccato, like the noise of a Geiger counter, attested to the continuing activity in my brain.
Clicks coming through a loudspeaker amplified the activity of each busy cell.
It was a strange experience to have someone rooting through your brain.
A closer look at how the surgeons implant the sensors on Forestell’s brain that will eventually provide the electrical impulses to help override some of the physical symptoms of Parkinson\’s. (Submitted by Harry Forestell)
There was no feeling to it as the brain has no pain sensors. But as the probes slid into place, there were tell-tale signs that gave away what was happening — most commonly a tingling feeling in an arm or leg — as the surgeons carefully threaded the electrodes through my brain to reach the basal ganglia.
Along the way they asked me whether I could recite the days of the week, the months of the year backwards skipping every second month, and the progression of prime numbers to the fifth integer.
Once the probes were in place, it was time to install the wiring and other hardware. For this part of the surgery, anesthetic was required and I was put soundly to sleep. Both probes are attached to wires that are threaded through the skull and under the skin behind the ear, down the neck, over the clavicle and finally are plugged into a battery-operated pulse generator — similar to a pacemaker — that sits just under the skin of the chest. While the surgery involves all the usual risks of infection, hemorrhage, stroke and heart attack, side effects are rare.
A shocking conclusion
So, does it work?
Well, you can see the party trick I\’ve been boasting about in the video above. You be the judge.
Here is how it works.
Once the electrodes have been implanted in the brain, their ability to deliver the required electrical stimulation is controlled by a pulse transmitter and an adapted cellphone.
Forestell one week post-operation. Aside from what he describes as a terrible haircut, the only sign of surgical intervention is the ‘railway track’ of staples closing the wound. The procedure took less than 48 hours from hospital check-in to discharge. (Harry Forestell/CBC)
The cellphone carries an app that controls the frequency of the electrical stimulation of the basal ganglia. The stimulator is set to discharge regular electrical pulses day and night that miraculously override or disrupt the scrambled neural instructions that are a Parkinson\’s hallmark.
Suddenly I am able to walk normally. There are no tremors. The annoying signs of dyskinesia — those involuntary movements I described above — seem to disappear.
WATCH | In September 2022, before undergoing DBS, Harry Forestell described to his audiences what he was undertaking:
Harry Forestell opens up about the next stage in his treatment for Parkinson\’s
The host of CBC New Brunswick News at 6 speaks with Rachel Cave about how deep brain stimulation is expected to help him deal with his Parkinson\’s disease diagnosis.
Regaining control of motor functions is nothing short of a miracle, but it will not work for every Parkinson\’s patient. Those with other conditions are not suited for DBS. It alleviates motor symptoms most successfully among those who respond well to levodopa. Where it is successful in those cases, it means a decrease in that drug and its side effects.
I have been able to cut my medication in half and I recently
returned to work after four months away. I sleep soundly and, while I still tire easily, my mood has brightened.
Parkinson\’s disease will continue to dog my life. DBS may allow me another 10 or 15 years without disabling tremors, though they will probably return at some point as they continue to grow in intensity. There are other insidious effects of Parkinson\’s that are not affected by DBS.
But for the time being, it is as though the disease is caged.
On a leash.
I can hear it barking, but for now at least, it can\’t bite me.
Do you have a compelling personal story that can bring understanding or help others? Here\’s more info on how to pitch to us.
Before surgery, a metal frame was attached to Harry Forestell’s head to keep it still during an MRI scan. During surgery, the frame was bolted to the surgical table. (Submitted by Harry Forestell)
This First Person article is written by Harry Forestell, host of CBC News New Brunswick at Six, who draws upon his experiences with Parkinson\’s disease.
My latest party trick is a real attention grabber.
It\’s a vivid illustration of the before and after effects of my recent treatment for Parkinson\’s disease. Proof of just how much a little poking around in the brain can achieve.
The treatment is called deep brain stimulation (DBS). It involves implanting thin electrodes into the brain where they emit tiny electrical pulses. Those pulses, applied continuously to just the right section of grey matter, stimulate centres in the brain that control signals sent to your muscles. In the basal ganglia, the engine house of the brain, signals are sent to the body ordering everything from speaking, to swallowing, to walking and touching. When those signals don\’t get through, or when the instructions get scrambled, the body\’s reaction can be cruel. Hands tremble uncontrollably, legs shake, walking becomes increasingly difficult, even swallowing is a challenge.
These are all early symptoms of Parkinson\’s disease and the list is by no means exhaustive.
Parkinson\’s is considered a chronic but not fatal disease. As neurologists will often explain, you will die with Parkinson\’s, not from Parkinson\’s. While true, it doesn\’t really capture the creeping, insidious progress of the disease as it deprives victims of the ability to control their own bodies.
Medical stories like this have always been a source of fascination for me. I worked for several years as a medicine and science reporter, covering stories that included the panic over mad cow disease in the U.K. I produced radio features on brain development and decay.
Little did I know that I eventually would be reporting on my own brain malady.
A shock of a diagnosis, and a relief
The day my diagnosis of Parkinson\’s disease was officially confirmed came as much of a relief as a shock.
It was 2015 and for the previous two years, my wife Jenny and I had been careering back and forth between hope and despair. My Fredericton neurologist, Dr. Eva Pniak, a patient and persevering soul, suspected Parkinson\’s, but suggested the problems I experienced walking and with my tremoring hands could also be explained by a modestly more benign condition called essential tremor.
These are just some of the drugs used to control Parkinson\’s disease. While levodopa is initially the most effective medication, it produces side effects that require other drugs that produce their own side effects. (Harry Forestell/CBC)
She referred me to a specialist in Toronto where the diagnosis was conclusive.
At 53, I had Parkinson\’s.
From leaping out of a tree to dancing the tango, very little happens in the body without first being ordered by the basal ganglia. Those orders are sent at the speed of light through nerve networks with the help of a neurotransmitter called dopamine. It is the as-yet unexplained decline in the brain\’s dopamine-producing cells that leads to movement disorders like Parkinson\’s.
It\’s a simple equation: no dopamine, no movement.
With Parkinson\’s, those dopamine cells start quietly dying off years before symptoms first appear. Scientists aren\’t certain why this happens, or why the process cannot be stopped or slowed.
Doctors can replace some of the lost dopamine with a medication called levodopa, but it causes a side effect known as dyskinesia — sudden uncontrolled muscle movements in the arms and upper body that create a writhing, torquing motion. As doctors increase doses of levodopa to stave off Parkinson\’s tremors, dyskinesia increases.
The payoff is in quality of life for patients
Neurologists have been experimenting with DBS to treat Parkinson\’s and other movement disorders for nearly 40 years. In 1997, the U.S.-based Food and Drug Administration approved DBS to treat Parkinson\’s disease.
Why not more? The simple reason is that it is a treatment involving intricate brain surgery by highly specialized surgical teams and requiring considerable aftercare.
WATCH | How deep brain stimulation can help overcome debilitating effects of Parkinson\’s:
See the almost instantaneous effects of deep brain stimulation for Parkinson’s disease treatment
Harry Forestell shows how DBS therapy can work in daily life — and demonstrates what happens when he turns it off.
\”The surgical expertise is extremely important,\” he said.
\”You have to have a surgeon that knows how to do the procedure and knows how to put the electrodes in the right spot. But then after the surgery, you need an expertise in doing all of the programming and adjusting the stimulators and also adjusting the medication doses which typically change after the operation,\” he said.
\”So it\’s a very complicated procedure that requires a team and it\’s the neurologist and the nurses after the surgery that are doing a great deal of the work in optimizing the responses.\”
It is a procedure, Lang points out, that requires support from provincial governments. The payoff is a treatment that can offer major improvements in quality of life for Parkinson\’s patients.
\”The Ontario government has appreciated the importance,\” said Lang, adding he feels lucky to have a team of expert neurosurgeons, neurologists, nurses and others to support patients.
\”The government recognized the importance of this technique and have provided what\’s called volume-based funding to allow us to operate on a much larger number than most centres.\”
My own experience is a vivid illustration of the relief DBS can bring to some Parkinson\’s patients.
Holes in my head
I entered Toronto Western Hospital on Sept. 30, 2022 with an idea of what was going to happen, but no real appreciation of what it would feel or sound like.
A metal structure was bolted to Forestell\’s skull prior to surgery at Toronto Western Hospital in September. (Harry Forestell/CBC)
I knew at some point before the end of the day someone was going to drill a hole in my head. At least one hole. Maybe two.
I was forewarned by reliable parties that the sound of that drilling would be akin to an airplane taking off. More like Concorde taking off inside my head!
Before surgery I had a metal structure bolted to my skull, not unlike the square lightshade at the top of a lamppost.
This was meant to hold my head steady during the MRI scan and throughout the more delicate procedure of skewering my brain without damaging the useful bits.
In the surgical suite there was a bustle of activity as half a dozen surgeons and nursing staff prepared for the procedure. My head head frame was bolted to the surgical table, and plastic sheets were draped over me to create an antiseptic site for the skull opening.
The drilling of two nickel-sized holes in my skull was every bit as loud as I had been warned. But no pain, just a feeling of pressure.
\”Somewhere in the middle of all this is me, wide awake,” says Forestell. The clear plastic barrier divides the room into sterile and non-sterile zones. (Submitted by Harry Forestell)
In the back of the suite, a cluster of medical IT specialists sat in front of computer screens ready to track and to provide feedback and directions as to where the probes needed to go in my brain.
I know all of this because I was awake — wide awake — for the duration of the six-hour long surgery. I have spent plenty of time around hospitals, both as a patient and as the c
hild of a hospital worker. I\’ve covered many medical stories as a reporter. So rather than fear, the prospect of this procedure filled me with curiosity. How would it feel? What would it change? Would it work?
A strange experience indeed
The surgical suite hummed with the normal hubbub of a workplace. The surgeons and I kept up an amiable conversation as I asked questions about what was happening. In the background, a steady staccato, like the noise of a Geiger counter, attested to the continuing activity in my brain.
Clicks coming through a loudspeaker amplified the activity of each busy cell.
It was a strange experience to have someone rooting through your brain.
A closer look at how the surgeons implant the sensors on Forestell’s brain that will eventually provide the electrical impulses to help override some of the physical symptoms of Parkinson\’s. (Submitted by Harry Forestell)
There was no feeling to it as the brain has no pain sensors. But as the probes slid into place, there were tell-tale signs that gave away what was happening — most commonly a tingling feeling in an arm or leg — as the surgeons carefully threaded the electrodes through my brain to reach the basal ganglia.
Along the way they asked me whether I could recite the days of the week, the months of the year backwards skipping every second month, and the progression of prime numbers to the fifth integer.
Once the probes were in place, it was time to install the wiring and other hardware. For this part of the surgery, anesthetic was required and I was put soundly to sleep. Both probes are attached to wires that are threaded through the skull and under the skin behind the ear, down the neck, over the clavicle and finally are plugged into a battery-operated pulse generator — similar to a pacemaker — that sits just under the skin of the chest. While the surgery involves all the usual risks of infection, hemorrhage, stroke and heart attack, side effects are rare.
A shocking conclusion
So, does it work?
Well, you can see the party trick I\’ve been boasting about in the video above. You be the judge.
Here is how it works.
Once the electrodes have been implanted in the brain, their ability to deliver the required electrical stimulation is controlled by a pulse transmitter and an adapted cellphone.
Forestell one week post-operation. Aside from what he describes as a terrible haircut, the only sign of surgical intervention is the ‘railway track’ of staples closing the wound. The procedure took less than 48 hours from hospital check-in to discharge. (Harry Forestell/CBC)
The cellphone carries an app that controls the frequency of the electrical stimulation of the basal ganglia. The stimulator is set to discharge regular electrical pulses day and night that miraculously override or disrupt the scrambled neural instructions that are a Parkinson\’s hallmark.
Suddenly I am able to walk normally. There are no tremors. The annoying signs of dyskinesia — those involuntary movements I described above — seem to disappear.
WATCH | In September 2022, before undergoing DBS, Harry Forestell described to his audiences what he was undertaking:
Harry Forestell opens up about the next stage in his treatment for Parkinson\’s
The host of CBC New Brunswick News at 6 speaks with Rachel Cave about how deep brain stimulation is expected to help him deal with his Parkinson\’s disease diagnosis.
Regaining control of motor functions is nothing short of a miracle, but it will not work for every Parkinson\’s patient. Those with other conditions are not suited for DBS. It alleviates motor symptoms most successfully among those who respond well to levodopa. Where it is successful in those cases, it means a decrease in that drug and its side effects.
I have been able to cut my medication in half and I recently
returned to work after four months away. I sleep soundly and, while I still tire easily, my mood has brightened.
Parkinson\’s disease will continue to dog my life. DBS may allow me another 10 or 15 years without disabling tremors, though they will probably return at some point as they continue to grow in intensity. There are other insidious effects of Parkinson\’s that are not affected by DBS.
But for the time being, it is as though the disease is caged.
On a leash.
I can hear it barking, but for now at least, it can\’t bite me.
Do you have a compelling personal story that can bring understanding or help others? Here\’s more info on how to pitch to us.
پاکستان مسلم لیگ نواز (پی ایم ایل این) کی زیرقیادت مخلوط حکومت نے ایم کیو ایم پی کو چھوڑ کر قومی اسمبلی کے آئندہ ضمنی انتخابات میں حصہ نہ لینے کا فیصلہ کیا ہے، کابینہ کے اہم وزراء اور حکمران جماعتوں کے کئی رہنماؤں نے اس بات کی تصدیق کی ہے۔ ایکسپریس ٹریبیون جمعرات کو.
بظاہر یہ اقدام پاکستان تحریک انصاف کے لیے انتخابی دوڑ کو کھلا چھوڑ دے گا کہ وہ اپنے کھوئے ہوئے حلقوں پر دوبارہ قبضہ جمائے اور قومی اسمبلی میں حزب اختلاف کا عہدہ دوبارہ حاصل کرے اور نگران سیٹ اپ کی تشکیل میں حصہ لے۔ تمام نشستوں پر واپسی
پاکستان ڈیموکریٹک موومنٹ (پی ڈی ایم) اور اس کی اتحادی جماعتیں کئی دور کی مشاورت کے بعد اس فیصلے پر پہنچی ہیں، جن میں وزیراعظم شہباز شریف کی اتحادی جماعتوں کے سربراہان سے ملاقاتیں اور جماعتوں کے درمیان مذاکرات شامل ہیں۔
مسلم لیگ ن کے دو وزراء نے تصدیق کر دی۔ ایکسپریس ٹریبیون واضح رہے کہ پاکستان مسلم لیگ (ن) اور اس کی اتحادی جماعتیں 16 مارچ کو ہونے والے ضمنی انتخابات میں حصہ نہیں لیں گی، جو کہ اسپیکر قومی اسمبلی کی جانب سے پاکستان تحریک انصاف (پی ٹی آئی) کے قانون سازوں کے استعفے منظور کیے جانے کے بعد خالی ہوئی تھی۔ . وزیر منصوبہ بندی احسن اقبال نے تصدیق کی کہ \’مسلم لیگ ن اور اتحادی حکومت آئندہ قومی اسمبلی کے ضمنی انتخابات میں حصہ نہیں لے گی۔\’
پیپلز پارٹی سولو فلائٹ نہیں لے گی۔ بلکہ یہ اتحادی حکومت اور اتحادیوں بشمول اے این پی کے ساتھ چلے گی۔‘‘ سابق وزیراعظم یوسف رضا گیلانی نے انکشاف کیا، پی پی پی اتحادی حکومت کے ساتھ کھڑی ہوگی۔ پی پی پی کے ایک اور رہنما کا کہنا تھا کہ ضمنی انتخاب لڑنا حکومت میں شامل اتحادیوں کا اجتماعی فیصلہ ہوگا۔
جے یو آئی (ف) کے ترجمان اسلم غوری نے بھی اس بات کی تصدیق کی ہے کہ جے یو آئی (ف) ضمنی انتخابات میں حصہ نہیں لے گی، ان کا کہنا تھا کہ یہ جانتے ہوئے کہ عام انتخابات بالکل قریب ہیں۔ ترجمان کا کہنا تھا کہ ضمنی انتخابات میں حصہ لینا وقت اور پیسہ ضائع کرنے کے مترادف ہے۔
دریں اثناء ایم کیو ایم پی ایم این اے کشور زہرہ نے کہا کہ پارٹی اب تک این اے کے ضمنی انتخابات میں حصہ لے رہی ہے تاہم حتمی فیصلہ جلد ہی رابطہ کمیٹی کے اجلاس کے بعد کیا جائے گا۔
ایم کیو ایم پی کے ایک اور رہنما نے انکشاف کیا کہ اتحادی جماعتوں کے کئی رہنماؤں نے ایم کیو ایم پی کو انتخابات میں حصہ نہ لینے پر راضی کرنے کے لیے رابطہ کیا ہے۔ تاہم، انہوں نے کہا، ربیتا کمیٹی چند دنوں میں حتمی فیصلہ کرے گی۔
ابتدائی طور پر جے یو آئی ف کے سربراہ مولانا فضل الرحمان نے اعلان کیا تھا کہ ان کی جماعت ضمنی انتخابات میں حصہ نہیں لے گی۔ جے یو آئی ایف کے ایک رہنما نے انکشاف کیا کہ مولانا نے ماضی قریب میں اسلام آباد اور لاہور میں وزیر اعظم شہباز اور پی پی پی کے شریک چیئرمین آصف علی زرداری سے ملاقات کی اور انہیں قائل کرنے کی کوشش کی کہ حکمران اتحاد کو این اے کا ضمنی انتخاب نہیں لڑنا چاہیے۔ مسلم لیگ ق کے ایک رہنما نے یہ بھی کہا کہ پارٹی کا این اے کے ضمنی انتخابات میں حصہ لینے کا کوئی ارادہ نہیں ہے۔
قومی اسمبلی کے ضمنی انتخاب میں حصہ نہ لینے کے فیصلے کے بعد بتایا گیا ہے کہ وزیر اعظم شہباز نے پیپلز پارٹی کے چیئرمین بلاول بھٹو زرداری کو بھی ضمنی انتخاب سے دور رہنے پر راضی کر لیا۔ یہ ملاقات پیپلز پارٹی کے پارلیمانی بورڈ کے اس نتیجے پر پہنچنے کے بعد ہوئی تھی کہ پیپلز پارٹی کو مخلوط حکومت کے فیصلے کے ساتھ چلنا چاہیے۔
حکومت کے فیصلے نے پی ٹی آئی اور آزاد امیدواروں کو چھوڑ دیا ہے جو اب بھی این اے کے ضمنی انتخابات میں حصہ لے رہے ہیں۔ حیرت کی بات یہ ہے کہ پی ٹی آئی اپنے ٹریک ریکارڈ پر عمل کرتے ہوئے یہ پیغام دے رہی ہے کہ شاید وہ انتخابات کے بعد قومی اسمبلی میں واپس نہیں آئے گی۔ اس سے قبل پی ٹی آئی ضمنی انتخابات میں بھی کامیاب ہوئی تھی جب کہ اس نے اسمبلی میں واپس نہ آنے کا اعلان کیا تھا۔
اس طرح انتخابات صرف ایک آئینی تقاضے کو پورا کرنے کے لیے کرائے جائیں گے اور کروڑوں روپے ضائع ہو جائیں گے کیونکہ عام انتخابات اسمبلی کی آئینی مدت پوری ہونے کے بعد دوبارہ کرائے جائیں گے۔
آئین اس بات کو یقینی بنانے کے لیے کہ کسی بھی حلقے کو پارلیمنٹ میں نمائندگی سے محروم نہ کیا جائے، جلد از جلد خالی اسمبلی کی نشست کو پر کرنا لازمی قرار دیتا ہے، لیکن اس کے فریمرز نے سوچا بھی نہیں تھا کہ ایک دن سیاسی جماعتیں اور ان کے امیدوار اس ساری مشق کو بے کار کر دیں گے۔
سپیکر راجہ پرویز اشرف کی جانب سے پی ٹی آئی کے قانون سازوں کے استعفے منظور کرنے کے بعد خالی ہونے والی NA کی 33 نشستوں کے لیے آئندہ ضمنی انتخابات اس کی صرف ایک مثال ہے۔ اسپیکر کے فیصلے کے بعد الیکشن کمیشن آف پاکستان (ای سی پی) نے 16 مارچ کو 33 حلقوں پر ضمنی انتخابات کا اعلان کیا تھا۔
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