Deep Brain Stimulation Tamed the Tremor in Annita Ray Hirsch's Hands and Voice, Allowing Her to Sign Holiday Cards for the First Time in Years
Annita Ray Hirsch used to sing, from Vegas to Vietnam.
In 1960, she joined a former big band leader to perform at the Sahara Hotel & Casino in Las Vegas. Annita Ray, as she was known then, was a "bookend," along with singer Diane Hall, in the group Ray Anthony and His Bookends.
After a couple of years, the two women began touring on their own, performing throughout the United States and in many parts of the world, even spending two months in Vietnam in 1967.
The singer retired in 1970 and later went "full-bore" into commercial real estate. But her voice – the voice that once entertained thousands – started to quiver.
"I would be in high-powered meetings, and people thought I was nervous. But I knew what I was talking about and was completely confident," said Hirsch, who married attorney Ephraim Hirsch in 1976 and retired from real estate in 2007.
It never occurred to her that the unsteadiness in her voice was caused by an essential tremor, the most common movement disorder – a classification that includes Parkinson's disease, dystonias, Huntington's disease, spasticity and other neurological conditions. Although essential tremor often causes shaking of the hands, head and voice, its effects can be more widespread.
"My voice was bad, my hands and head started shaking, and I lost my balance. I got the whole package," she said. "It got so bad I couldn't function. I couldn't brush my teeth. I couldn't write."
And then the holidays came. And with the holidays came the annual joy of writing notes, sending cards and reconnecting with friends. But the tremor in her hand made the words undecipherable, and she barely recognized her own signature.
"I had to do something because my lifestyle was impaired," said Hirsch, who already had tried medications that worked at first, but only for a while. Botulinum toxin – known by the brand names Botox, Dysport and Xeomin – injected into the back of her neck and into her vocal cords helped for a while, but effectiveness waned.
Although DBS had been suggested before, Hirsch, who now is a volunteer at Cedars-Sinai, had resisted – for three years. But she decided to discuss it with Michele Tagliati, MD, director of the Movement Disorders Program, and Adam Mamelak, MD, director of the Functional Neurosurgery Program. Those visits changed her mind.
"Dr. Mamelak and Dr. Tagliati are wonderful. They're not only wonderful, but they're kind. They care, and that's important," Hirsch said.
In two operations in 2012, Mamelak implanted electrical leads deep inside Hirsch's brain and placed pulse generators under the skin in her chest. Tagliati programmed the devices with a remote, hand-held controller.
As the tremor began to abate, the fluid lines of Hirsch's signature started to reappear. Despite a couple of setbacks, including a device-repair operation in April 2014, she recently told a friend she'd make the same decision again "in a New York minute."
"It has been such a miracle for me. There is no question that I would do it again," she said. "Essential tremor is not curable, but it is controllable through DBS. I'm just sorry I didn't do it sooner."