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Dr. Francisco Ponce – Deep Brain Stimulation

 In Podcast

Dr. Francisco Ponce is a Neurosurgeon and Residency Program Director at Barrow Neurological Institute (BNI). He studied at Harvard University and The University of Chicago Pritzker School of Medicine. He then did his neurosurgery training at Barrow Neurological Institute, where he now helps train future neurosurgeons as the program director. 

In addition to being an excellent physician, Dr. Ponce is also a loving husband, father, and friend. His area of practice is in the fascinating field of stereotactic and functional neurosurgery.

Here’s a glimpse of what you’ll learn: 

  • Dr. Francisco Ponce’s journey to becoming a neurosurgeon
  • What is deep brain stimulation?
  • How Dr. Ponce helps patients restore and regain functionality
  • Dr. Ponce shares a success story and discusses some of the diseases he’s been working on treating
  • Who are other doctors that are working on deep brain stimulation?
  • Dr. Ponce talks about his passion for long-distance running
  • The people Dr. Ponce acknowledges for his achievements
  • How to get in touch with Dr. Francisco Ponce

In this episode…

Over the years, advancements in the medical field have helped make treatment easier, faster, and more accurate. One of these advancements is called deep brain stimulation. It involves implanting electrodes within the brain to treat certain health conditions.

Dr. Francisco Ponce has been using this procedure to treat his patients and has seen its benefits. He uses it to treat diseases like Alzheimer’s and Parkinson’s. And, the procedure has been shown to help with hearing issues involving severe tinnitus.

Dr. Francisco Ponce, the Residency Program Director at Barrow Neurological Institute, is Dr. Mark Syms’ guest in this episode of ListenUp! Together, they discuss a procedure referred to as deep brain stimulation. Dr. Ponce explains how the procedure works and the benefits of this kind of treatment. Plus, Dr. Ponce shares some inspiring patient stories. 

Resources Mentioned in this episode

Sponsor for this episode…

This episode is brought to you by the Arizona Hearing Center.

The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans. 

As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients. 

So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!  

To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.

Episode Transcript

Intro  0:04  

Welcome to the Listen Up! Podcast where we explore hearing loss, communication, connections and health.

Dr. Mark Syms  0:16  

Hey, it’s Dr. Mark Syms here. I’m the host of the Listen Up! Podcast where I feature top leaders in health care. This episode is brought to you by Arizona Hearing Center. I help patients treat their hearing loss so that they can connect better with their family and friends and remain independent. The reason I’m so passionate about helping patients is because I lost my brother Robbie twice, first from his hearing loss from radiation for his brain tumor, and then again when he passed away. I only care for ears. I’m the E of ENT and performed over 10,000 ear surgeries over the past 20 years. I’m the Founder of Arizona Hearing Center. I’m the author of Listen Up, a book about hearing loss. Go to listenuphearing.com and if you want to ask me or contact me, go to azhear.com and contact me with any questions. 

So today I’m really excited because we’re connecting with Dr. Francisco Ponce. He’s a colleague of mine at the Barrow Neurological Institute, otherwise known as the BNI. I’ve been there for 20 years practicing ears and he’s a neurosurgical colleague at this world renowned BNI. He went to college at Harvard Medical School and at University of Chicago and then he did his neurosurgery training back here at Barrow. He’s helping train future neurosurgeons as the program director, and he runs the residency. He’s also an excellent physician, husband, father and friend. His area of practice is the fascinating field of stereotactic and functional neurosurgery. We’re going to explore his expertise and passion on Listen Up! Dr. Ponce, welcome.

Dr. Francisco Ponce  1:39  

Thanks, Mark. Sure.

Dr. Mark Syms  1:41  

So you know, tell me your pathway to neurosurgery and the specialization, most fascinating how people end up where they end up. So you know, that you probably weren’t born saying, I’m going to be a functional neurosurgeon. So how’d you get there?

Dr. Francisco Ponce  1:53  

Yeah, I am. I think like a lot of a lot of people. It’s kind of the environment I grew up in. My father was a physicist, he worked at a Polish Research Center at Xerox where the mouse and the Ethernet and the laser printer, the digital user interface, were first invented and never commercialized. Right in one of those jobs that he never felt like he had to work a day in his life. Notice, like every day was played. And, and I thought, that’s what I wanted to do. I did physics as an undergrad. And I remember my father basically saying, this job I have doesn’t exist, like, you can’t plan for this just and, and my mother was a nurse. And she had spine surgery when I was in high school. And I remember that’s kind of at that point, before High School, because from then on my brothers and I divvied up laundry, garbage and dishes, and what’s your recovery kept doing that? So we can, even today my own, those are the responsibilities that cover. So I kind of went in with this passion for physics, and sort of this practicality, right for medicine. And a lot of you my experience with research as an undergrad was frustration. I remember when I was a researcher, one set of it’s not frustrating, it’s not research. And I think the the idea with with neurosurgery was kind of that interface, that potential for interface between sort of the physics, the biophysics, the biological physics, and the immediacy, that gratification of going to work each day, and helping somebody within a finite amount of time, and finishing that day with that behind you.

Dr. Mark Syms  3:27  

So it’s cool, it kind of wraps up both of your passions into one thing and you get to help people. That’s a pretty cool combination. It sounds like you.

Dr. Francisco Ponce  3:36  

Yeah, we all kind of create these narratives, right off of our trajectories, now everything gets tied together.

Dr. Mark Syms  3:42  

You know, it’s it’s good,

Dr. Francisco Ponce  3:44  

even with neurosurgery. You know, at one point it was clipping angels, etc, for me, right? And is actually talking to a friend from college years after who’s a physics professor at MIT, where I could not really kind of convey that next level. It was so cool about clipping an aneurysm. Right, highly trained monkey. And it was right around that time when kind of that switch occurred to what I currently do, which is neuromodulation stimulation. Yes,

Dr. Mark Syms  4:13  

sir. Tell me what that is. You know, it puts it you know, you’re stereotactic and functional neurosurgery. It’s a cool word. But what does that accomplish? Because I think I went for a personal reason I’m not sure they know what that all means.

Dr. Francisco Ponce  4:27  

Yes, deep brain stimulation, I think similar to cochlear implants. These are neural interfaces, right? We’re tapping into the brain circuitry to improve life. Right. And it’s, I think one thing with neurosurgery. You know, when people think about brain surgeons, they think about life saving surgery. But I do deep brain stimulation is life changing surgery, and if people can regain their independence, improve their quality of life, very similar to what you see your patients experiencing after a cochlear implant, and I and we use technology. It’s like a brain patient. maker, you know, it’s very similar to what matches a heart pacemaker. But instead of wires going and tapping into the nodes of the electrical circuitry of the heart, they’re actually going in the brain about four inches into the skull straight in, into the nodes that are part of the neural circuitry.

Dr. Mark Syms  5:15  

Now, that’s really cool. So, so actually, that’s so you know, when I think about cochlear implantation, it’s, you know, physiologically, or electrophysiologically. That’s what happened. But, you know, the way hearing loss affects people, it affects people’s overall wellness, right? Does that make sense? And so I suspect, you are in a lot of ways, like a wellness neurosurgeon, right? Because you’re, you’re restoring people’s wellness. So tell me about, you know, the diseases, how they impact people, and then how you’re able to reverse them or restore them to wellness, right, because people aren’t just interested in having the aneurysm go away, they actually want to be able to regain or restore functionality.

Dr. Francisco Ponce  5:50  

Yeah, a lot of these diseases are kind of insidious, right. It’s like a water hammer effect, you get the diagnosis of Parkinson’s, because you’re shaking, you know, right, or you’re slower, and you kind of slowly adapt to that new reality. And then something else builds upon that now you’re shuffling, you’re not able to eat your, you’re not able to work anymore, you go and have a disability. And then eventually, you know, you kind of figure out, you know, I don’t feel comfortable going to restaurants anymore, with friends, because I don’t know if my medicines are gonna be working or not. And then even relationships at home can evolve into sort of, you know, they say, disability can be the glue that keeps the family together, where the relationship at home becomes one of caregiver, patient caregiver. But that doesn’t happen like no, overnight, because it happened over the course of a year. And I think with things that the two primary conditions I treat with neuro stimulation, deep brain stimulation, or Parkinson’s disease, and essential tremor, right conditions or conditions that again, can be gradual, and things that people adapt to learn to live with, resigned themselves to. And in terms of wellness, the motor benefits that we give patients to these therapies are enormous. But if we wait too long, they become sort of socially-deconditioned such that those benefits they receive, they may be unwilling, or unable to apply them to improving their quality of life to the degree that they could, because that’s the condition that takes place.

Dr. Mark Syms  7:32  

Yeah, it’s fascinating I listened to a, you know, you’re hitting on the exact same impacts of hearing loss. You know, the two, the two analogies I use one is it’s death by 1000 paper cuts, right? So you know, it’s a slow editing, or the other thing I say is like, how did people get away, you know, 500 600 pounds, and it’s all one ounce at a time, right? It’s not like you go from, you know, weighing 170 pounds to those that are overweight, you slowly get there. And then one day you wake up and go, Oh, my gosh, I’m so I’m totally not functional. So it’s of the same nature, gradual erosion.

Dr. Francisco Ponce  8:07  

Yeah, that’s what it is. It’s an erosion. That’s a, and that’s where we can look at these windows and try to define based upon the safety of the operation, the efficacy, better clarify when the optimal time point for treatment is,

Dr. Mark Syms  8:22  

right, how far down the functional deterioration? Do they go, where you’ve got enough upside to do the procedure?

Dr. Francisco Ponce  8:29  

Yeah. What you know, it’s

Dr. Mark Syms  8:31  

being able to tell me like one of your best patient stories, like you know, we all have these times where, like, you know, a patient says something or there’s a profundity that comes up. So I’m always fascinated, like, you know, we all have those. And so what are yours? Like, tell me what you are yours.

Dr. Francisco Ponce  8:44  

So I had a patient come in from out of state. She’d not been able to play mascara for years, unable to bring a cup of coffee from out and, and we did, and she had a central tremor. And we placed the leads, and just by the micro trauma of inserting the leads, she woke up the next day, she came out of surgery that evening, the next morning, she’s drinking coffee, she wasn’t even turned on yet, right? There was already an electrical, separate battery and insurance. So even just with the operations, he was able to do things that she had never been able to do before, for years, and, and went home. So when I saw a few days later for the battery, she was raving about all these changes. And so we could do the battery. And the way and the reason this stands out is because a couple weeks after she went back home, I got a shift in you know, dry ice, you know, King Crab legs and salmon and it was just incredible. So we shared it with my office and we had a piece.

Dr. Mark Syms  9:48  

Yeah. I think the amazing thing is that that’s like such a wonderful gesture on that patient’s part, but probably doesn’t even come close to expressing the profundity of how her life was changed.

Dr. Francisco Ponce  9:59  

Yeah, no, it’s It’s one of those things that the way I see it is these are good chronic conditions. Right? Right. I, I’m a very small part of this, you know, focal point in this journey, but it’s, it’s a, it’s a great great it’s therapy, it’s got like with imagine might be similar to kind of what you offer. You know, when you think about a heart pacemaker, you’re not really thinking of a surgical treatment for heart arrhythmia, right? It’s electrical therapy, but you need to not operate a hardening call a pacemaker placement as surgery. Right now, obviously, here, we’re drilling holes in the head, we’re putting leads in the brain. But the mechanics are very similar to that it is ultimately an electrical therapy. So my job is to offer the operation in a safe and consistently effective manner. So that enrolled artist can offer this just like without medication, right? Side effects may not be effective in the safer and more consistent outcomes I can offer with this therapy, the more popular it will be for the clinicians of actually managing the symptoms, the neurologists. And so the effort put into how to kind of go about packaging and delivering this therapy is how to address that journey a patient has in their lifetime, so that this part is done well and is accessible, so that afterwards their quality of life, just their enjoyment of living improves.

Dr. Mark Syms  11:27  

Yeah, I would imagine. I mean, you know, I don’t wear mascara, but you know that that type of fine motor coordination and being able not being able to do that must be especially if it’s something you did your whole life, I’m drinking a cup of coffee is a pretty normal functional thing to want to do.

Dr. Francisco Ponce  11:42  

Another one of my patients, a really dear patient of mine, His goal was to walk his daughter down the aisle. That was several years ago. No, that’s that

Dr. Mark Syms  11:52  

That’s why we do it. Right. I mean, that’s the human connection to the disease, right? I mean, we think about the therapy for the disease, they think about the benefit of the therapy, right? So you think of stopping the tremor, they think of walking my daughter down the aisle. And as you talk, think about it. Certainly stopping the tremor does not give me the emotional feeling of me contextualizing the need to walk in one of my daughters down the aisle and how important that would be. And that that’s, that’s awesome. I mean, that’s why we all get out of bed every day, right? You know, like, so there’s all this great stuff happening, like what’s the future in this field? So you’ve got essential tremor and Parkinson’s? What else are you guys working on?

Dr. Francisco Ponce  12:34  

Yes. The one that we’ve been working on a Barrow is Alzheimer’s disease. So I think that again, the frameshift kind of a paradigm shift to think of Parkinson’s as a surgical condition. Right, right. You know, really maximize your quality of life in it, you get surgery. But as this operation, you know, they would show in the news like futuristic oriented 21st century medicine, it was first done in 87. For movement disorders, it’s nothing new. And but it’s given because it’s worked, because we’ve had FDA approval for over two decades, all that 97 was for a central tremor 1987 approved, we’ve had the opportunity to kind of tap into these networks, through established on label treatments. And certainly listen and learn more about these networks, I think there’s been a shift in terms of how we understand brain disease, whether it be depression, Alzheimer’s, from targeted areas, degeneration to how the circuits go awry, become dysfunctional as a result of this degeneration. And so we’re looking at Alzheimer’s disease. We know about plaques, you know, the amyloid plaques, but looking to see how we can rev up the memory circuits with modulation, as a treatment for cognitive disorders. So we were one of the largest centers in the country. In the world, studying this, we’re actually the participants in a phase three trial, which as you know, is the last step you do before you would get FDA approval. And it’s called the advanced trial. And it’s a study looking at basically, it’s the same operation I do, except it’s all the planning on the MRI to get them Ryan, I pick a different target. So we’re using a memory target instead of a motor target. And we’ve traded about 16 patients so far Barrow for Alzheimer’s disease. So I think that’s exciting because there’s very little support and alternatives go to Alzheimers, nothing works right now. And I think that’s been one of the challenges we’ve had with other conditions like depression, or there’s so many medications and interventions that are approved that you need to exhaust because we started looking at experimental indications novel indications, you’re moving away, you’re going in the direction of treatment of last resort, right versus kind of the sweet spot we’re in with Parkinson’s and essential tremor, Which is where it’s not. We already know it works well and it’s safe, that you’re not waiting until it does use it as a last resort, you’re getting the hardest cases not the easiest. Well, that’s an issue with a with it with depression, we don’t have that issue as much with with Alzheimer’s disease, because of how little few options right now,

Dr. Mark Syms  15:18  

There’s no competitive therapy.

Dr. Francisco Ponce  15:21  

Right, exactly.

Dr. Mark Syms  15:22  

Yeah. So it’s interesting. I mean, we’re again, looking at the similarities, you know, the hearing spaces coming at, you know, dementia and Alzheimer’s from a cognitive load point of view, right. And so if you aren’t getting the information into your brain via hearing, you have to use secondary mechanisms to communicate and your cognitive with you have a cognitive load, overload plus social withdrawal. So, you know, we’re treating hearing loss with the same intention just coming from it from an acoustic stimulation point of view, and you’re coming from it from an electrical stimulation at the, perhaps the end organ of the disease. So it’s, I mean, that for us that the correlation is pretty clear that untreated hearing loss is associated with a higher incidence of dementia and memory problems. And so there’s actually a study in Lancet a couple years ago, where they talked about what you can do to reverse cognitive issues and dimension issues. And so it was like, you know, stopping smoking, cholesterol, obesity, those were all like point one point hearing was like, eat and eat factor improvement. So it’s so interesting, it’ll be interesting to see where you fall in that spectrum for specifically Alzheimer’s. And whether or not you guys change, you know, what upside you get, that’ll be great.

Dr. Francisco Ponce  16:37  

Yeah, another area that intersects, we’ve talked about this before, but people keep asking me about is tinnitus. Right? We’ve chatted about that. But where, ultimately, there’s been some studies looking at neuromodulation tinnitus, like

Dr. Mark Syms  16:53  

on the cochlear implant side, it does attenuate in a decent number of patients, you know, the harder part we all have is tinnitus, cochlear or Central. And certainly you’d be targeting central The problem is we don’t really have a good test to say, Oh, it’s, I guess, you know, there are I don’t know, are there functional electrical tests that you can do to show where there’s functional electrical brain activity or something? Can you? Can you measure that?

Dr. Francisco Ponce  17:19  

or hearing? Or while or anything?

Dr. Mark Syms  17:21

Like, is there a way you can measure the electrical activity of a person with an imaging technique of the brain? Now, I’m really getting out there? I don’t know.

Dr. Francisco Ponce  17:28  

Yeah, we go more with the glucose metabolism, you know, right.

Dr. Mark Syms  17:33  

So that might be what will eventually need is some sort of electrical mapping. So if you could get on that and have that by next week, I’d really appreciate it. Or maybe your dad can go to Xerox PARC, Xerox PARC, and do it for us there. So. So they tell me who some of the other colleagues are advancing or working on this brings brain wellness as you may be from other aspects, right. I mean, so I think even Alzheimer’s, you’d probably have to take a holistic approach, right? Like so for instance, I would hope that you know, I’m not even hoping I would know that those Alzheimer’s patients have their hearing loss treated, for instance. So who are the guys doing other work in this area? I mean, dementia is such a big issue, who are the guys who are doing that kind of work? Apparently.

Dr. Francisco Ponce  18:14  

So Annenberg cutter Annenberg, she’s been one of my key colleagues throughout that when she joined Barrow several years ago that she was with the banner and Alzheimer’s Institute prior to that, and that’s the person that actually started collaborating on the the phase two trial of deep brain stimulation for Alzheimer’s at that time, and then an Alex truster. He’s a neurosurgeon. So Anna Brooks, a psychiatrist who specializes in Alzheimer’s disease. And then Alex truster, has been a key colleague of mine for nine years now. And he recruited him right when I started here, and he’s kind of the premier expert on neuropsychology, neuro psychological neuropsychological screening and consequences of neuromodulation. That’s pretty much everything.

Dr. Mark Syms  19:02  

So you do pre therapy and post therapy testing. Do you see? Do you see any changes besides? Well, I guess it would be if your Parkinson’s goes away from your neuropsychology testing, should it maybe improve?

Francisco Ponce 19:13  

Yeah, well, we know there’s a reason we often think of Parkinson’s as being the motor component, a very large cognitive component. In the later stages, most of our patients that we do deep brain stimulation on have some mild cognitive impairment. So that is a huge part of sort of where they are in the course of the disease. How much of an impact cognition has in mood on the quality of life,

Dr. Mark Syms  19:41  

that’s probably where the idea to do it for Alzheimer’s might have come from right that you’re seeing some cognitive improvement and

Dr. Francisco Ponce  19:48  

we’re actually seeing up on out we have a pilot study, you know, smaller study looking at treating patients with mild cognitive impairment, with similar strategies for neuromodulation revving up those memory circuits. When They’re going to surgery already for their motor symptoms of Parkinson’s. That’s pretty cool.

Dr. Mark Syms  20:05  

So, you know, tell me a fun fact about you.

Dr. Francisco Ponce  20:10  

Well, before I got so overwhelmed with home responsibilities, I used to be very, my thing was super long distance activities. So I’ve done an Ironman and I double crossed the Grand Canyon, that’s like a 43 times now a rim to rim to rim. I feel like it rim to rim to rim. But I feel like this There should be a statute of limitations on those kinds of feeds. The further away it’s been less than two years. So the last thing, I think I stopped going on the super long runs when I realized that my son became a teenager, and he didn’t have the time. All right, let’s go do a three mile run at one point like that, you’re gonna go to another 10 mile run. And I’m like, Oh, no, let’s let’s, let’s do a mile and a half.

Dr. Mark Syms  21:03  

Yes, I’ve done a rim to rim so our characterization was rim to rim to crazy. Right that second time back, you know, you’re you’re going out and people are coming back in. You know, it’s early, you know, early afternoon. It’s, it’s intense. So, the,

Dr. Francisco Ponce  21:19  

When I was a medical student, and I personally had room to run with Robert Spetzler, the chair of BNI, the world’s greatest neurosurgeon, we finished the orange room together. And I, you know, this is how I got to connect with them as a medical student. And he pulls out to icicle bud lights, and red as a bad one for me one, like I’m going to be with Robert Spencer, this is like medical students three, and rec for crack it open, we see these two hikers come to the rim with their walking sticks and turn around and just go right back, attempting and he’s like, what do you think and we crack open the beer. And I was like the best beer ever, especially after that height is his car complaints as they take off. And I end up waiting six hours for the last person for my car to arrive. And that was actually I was like, You know what, I’m never gonna wait on the North Rim again.

Dr. Mark Syms  22:09  

Just go back down to the south rim yourself. I stayed over at the North Rim. It was nice. So you could watch the sunset over and you’re looking at the sunset looking at the other side say, Well, I came all the way from there to here. So it’s a pretty amazing experience. Yeah, anybody who’s watching this is not from Arizona or been here. The Grand Canyon is a must do in life, I’d say it’s a bucket list thing. So

Dr. Francisco Ponce  22:33  

yeah, I think it’s a balance. I know that in terms of how you enjoy hiking, the Grand Canyon is an incredible way to experience the Grand Canyon. Correct. And, you know, you gotta stop and look up sometimes, especially when each step you take matters, you know, twist your ankle and ruin the rest of your day.

Dr. Mark Syms  22:50  

Right. So well. So it’s a question. I like that. So let’s say you’re giving, you know, the Lifetime Achievement Award or something. So who do you think when you think like, Who are those people? I think, for getting me here? Well,

Dr. Francisco Ponce  23:05  

I think like, like you, you know, I’ve got kind of a my wife and I were a team, you know, and it’s sort of this, this the enterprise, right? And we met in college, we’re a fire door, you know, in these dorms, they have these fire doors. So if there’s a fire, you could go next door, and we had a fire that separated us. And I met her halfway through the year. And, and she’s, you know, she’s a judge. So like, we’ve talked about the honorable because before the doctor, right. And that’s, that’s been kind of, you know, we’ve three sons. And that’s and she was actually the one who I had convinced to come to Phoenix. So after my wife. Next we have Dr. Kessler. And I think that he’s one of those inspiring figures that kind of shifts careers and draws out of you more than you could have drawn out of yourself. Had you not had some kind of mentor like that.

Dr. Mark Syms  24:03  

That’s great. That’s great. So we’ve been talking to Francisco Ponce, who is a world renowned neurosurgeon, and how do people get ahold of you or connect with you?

Dr. Francisco Ponce  24:12

Our website, you know, it’s Francisco Ponce Barrow and our office number 602-406-3242. So that’s a pretty good way to get away.

Dr. Mark Syms  24:20  

All right, Francisco. Thanks a lot. I really appreciate your time here. It’s been a great conversation. Thanks, Mark. Thanks, man.

Outro  24:32 

 Thanks for tuning in to the Listen Up! Podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.

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