Leaps in Technology

by Zach Benoit

Growing up, Diane Kylander noticed that her mother’s hands would shake but didn’t think much of it.

Now 72, the Billings performer and writer for decades figured it was just something that happened later in life, until it began happening to her, too.

“I always thought it was just age,” Kylander said. “I knew nothing about the essential tremor, and I thought she was just old. But I started noticing it myself while acting about 15 years ago.”

Diana Kylander

Diana Kylander

An essential tremor is a neurological disorder that causes a rhythmic shaking, most often in the hands, that tends to increase inintensity during attempts at basic tasks like holding something up or writing.

Years after her own shaking began and when it took a toll on her work, Kylander learned more about the
condition and decided to treat it with a new, high-tech and noninvasive brain surgery at Billings Clinic.

“It’s not like you stand up and say, ‘Oh my God, it’s a miracle,’ after,” she said. “It’s very subtle. But to someone like me, it makes a huge difference.”

Called the Gamma Knife, the treatment is a radio-surgery technique – and related technology – that treats some benign and metastatic tumors, abnormalities, neurological conditions and other issues in the brain and head.

It uses intense, focused shots of about 200 tiny concentrated beams of radiation to treat a small
targeted area while leaving surrounding tissue undamaged, unlike other more invasive procedures.

Billings Clinic purchased the $4.7 million tool in 2014 after years of planning, bringing in an
alternative to standard, more invasive brain surgeries for some patients.

It’s the only Gamma Knife in a five-state region that includes Idaho, Montana, Wyoming and the
Dakotas, and with it the clinic can to expand patients’ options, said Dr. John Schallenkamp, chair of the hospital’s radiation oncology department.

“This allows us the capability to really think about what treatments we can provide,” he said. “You have to have the experts, you have to have the people that are willing to commit, and you have to have the technology.”

Billings Clinic doctors has used the Gamma Knife to treat more than 100 patients. Kylander was
the very first.

She underwent the procedure in March, receiving a single shot from the Gamma Knife after living with her tremor for 15 years.

When Kylander first noticed the tremor, she said she didn’t know exactly what it was but noticed a slight shake in her hand while holding things.

Over time, the tremor worsened. She often worked as a substitute teacher at Senior High and had
trouble writing on the chalkboard.

A playwright, writer, performer and stand-up comedian, she noticed that her hand and arm would shake while holding a microphone. Most concerning of all, she could barely write, a process she’s always
done using a pen and yellow legal pad.

“It got to the point where I just couldn’t do it,” Kylander said.

Compounding things was Kylander’s depression, for which she took antidepressants.

“Something like a tremor just escalates the frustration you feel,” she said.

She began to research her condition and eventually met with her doctor and then officials from Billings
Clinic’s neurosurgery department.

Dr. Mark Piedra

Dr. Mark Piedra

Dr. Mark Piedra, a neurosurgeon, said that Kylander initially had a number of treatment options. Those included medication; a process called deep brain stimulation that involves a surgery to put electrodes into the brain to stimulate the thalamus, which among other things relays sensory and motor signals; or an older, more invasive surgery that involves burning part of the surface of the thalamus.

None of those options seemed right for Kylander.

“It’s very invasive,” she said of the surgeries. “I didn’t want to go that route.”

That’s when she was introduced to Piedra, who told her about Gamma Knife.

He went over the possible side effects and complications — including weakness, vision problems and loss of sensation — and they decided to move forward.

“It’s to alleviate patients’ fear and balance the risk against the results,” Piedra said.

Doctors from several departments planned the treatment using MRIs and CT scans. When the time came, Kylander lay on the machine with a sort of cage or mask over her face to help keep her head in place and line up the radiation shot.

Everything went pretty quickly, with the single shot to the right side of Kylander’s brain focusing on
an area about 4 millimeters around.

“The amazing thing is we checked in at about 6:30 that morning and by 11:30, I was at Perkins eating
lunch,” Kylander said. “The only discomfort, during and after, was that cage on my head.”

Piedra said that the Gamma Knife isn’t an option for every condition and that it can only be used for
procedures on the head and possibly the upper neck.

He also said results might not be seen right away, since the procedure doesn’t physically remove anything.

“It takes time,” he said. “You do not have an immediate awareness or see immediate improvement. But it’s another option for people who can’t handle the other procedures or don’t want to (go through them).”

That was the case for Kylander — and almost 100 other patients, mostly being treated for tumors — who will go in for an evaluation next spring to check her progress and see if she needs another round
with the Gamma Knife.

So far, though, she’s thrilled with the results as they settle in over time.

“See that?” she said, sticking out her hand flat in front of her and holding it steady. “I couldn’t do that before.”

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