Professional Drummer With Musician’s Focal Dystonia Can Play Again After Deep Brain Stimulation Treatment
In 2010, professional drummer Frank Funaro started to suffer from severe pain in his left arm. He carried on playing through the pain, but started to develop some unusual spasmodic movements in his arm. Initially, he self-diagnosed tennis elbow and sought treatment from physicians, alternative medicine practitioners, and masseurs. However, it became clear that the condition was something different. An MRI scan revealed that he had torn his tendon, but despite tendon reattachment surgery and physiotherapy for the injury, the unusual movements became constant, rather than just when he was playing drums. Eventually, the condition started to affect his left side overall and his ability to walk.
“I was knocked off the road by this,” Frank says. “I played drums since I was 15 years old, and then at the age of about 50, all of this stuff started coming at me. There was this crisis of self that I went through, because I pretty much defined myself as a musician, as a drummer, as an artist, and I couldn't be that anymore.”
In 2014, he visited a New York hospital neurologist and was diagnosed with focal dystonia, a neurological disorder that causes involuntary muscle movements or contractions. In the case of musicians, the condition can be triggered by the constant use of precise, repetitive movement patterns and can be made worse by injury. Frank initially took part in a clinical trial of Botox injections, which reduced the muscle spasms to a certain extent, but by 2017 the effects of the injections were starting to wane. Further treatment with trihexyphenidyl only gave temporary relief and came with extreme side effects. “I felt like I was underwater. I couldn't think straight, I couldn't walk straight, it was awful,” Frank says.
A good candidate for DBS
In August 2020, Frank was referred to Joohi Jimenez-Shahed, MD, Medical Director, Movement Disorders Neuromodulation and Brain Circuit Therapeutics at Mount Sinai. Dr. Jimenez-Shahed is an expert in the use of deep brain stimulation (DBS) as a treatment of neurological movement disorders, including focal dystonia.
“Deep brain stimulation is a way of delivering small amounts of electrical current to a very focused area within the brain circuitry that is responsible for movement,” says Dr. Jimenez-Shahed, Associate Professor of Neurology at the Icahn school of Medicine at Mount Sinai. “Although we don’t know exactly what the specific changes are in the brain of a patient with dystonia, we know that by modifying this circuit with electricity, we can improve their symptoms.”
Dr. Jimenez-Shahed considered Frank a good candidate for DBS. “Because he had already taken all the usual medical treatments for dystonia and since he was no longer getting benefit from the Botox, we felt that deep brain stimulation was the appropriate next treatment option,” she says.
“Dr. Shahed took me under her wing and said, ‘We can get you approved for this,’” Frank says. “After all the drugs, the alternative medicine, ‘I said just do it.’ I was not afraid of it at all. I welcomed the chance to be normal again. I was just about at the end of my rope.”
In March 2021, Frank underwent implantation surgery carried out by Brian Kopell, MD, Professor of Neurosurgery, Neurology, Psychiatry, and Neuroscience, Director of the Center for Neuromodulation and Co-Director of the Bonnie and Tom Strauss Center for Movement Disorders at Mount Sinai.
“Using DBS to treat dystonia is among the more challenging of the movement disorders cases. They are fewer in number and more complex,” Dr. Kopell explains.
In the multistep procedure, insertion holes were made on either side of his skull, with wires implanted for the delivery of the electrical current. The final step involved inserting a pacemaker device into his chest, with a connection wire running down his neck to connect the electrodes to the pacemaker. The level of current being sent to the brain would be controlled through the pacemaker battery.
Grateful for a team of experts
“Given the multidisciplinary nature of our Center for Neuromodulation, we are uniquely poised to take on these challenging movement disorders cases, as evidenced by Mr. Funaro’s experience at Mount Sinai,” Dr. Kopell says. In addition to Dr. Kopell's expertise, Frank was also evaluated by a neuropsychologist, Christina Palmese, PhD; a psychiatrist, Martijn Figee, MD, PhD; and a psychologist, Shannon O'Neill, PhD. This comprehensive approach ensures that all aspects of the patient's condition are thoroughly assessed and addressed, providing the best possible outcomes.
“I have the utmost respect and gratitude for the entire team,” Frank says. “And a special shout-out goes to my rock star brain surgeon, Dr. Kopell.”
A few weeks after the final procedure, Frank returned to Dr. Jimenez-Shahed to have the device activated and to begin the programming process. “During the first programming visit, we look to find the best location on the wires to deliver symptom benefit without any side effects,” Dr. Jimenez-Shahed explains. “What was also interesting about Frank’s case is that we actually implanted him with a deep brain stimulator system that is also capable of recording activity in the brain once we are delivering the electronic stimulation.”
There was no immediate improvement to his symptoms after the first visit, although the recording device was able to pick up brain activity related to dystonia. At Frank’s second session in April 2021, Dr. Jimenez-Shahed increased the level of electrical stimulation and over the next few weeks, this started to bring about positive results.
“Dr. Shahed had told me it would take about a month,” Frank says. “And sure enough, one day, I was standing outside of a hardware store with a dear friend of mine, who had lived through every step of my career, including this awful, dystonic chapter, and she was practically crying, because I was holding my hand out in front of me, and it wasn't moving! It was such a big step.”
Back on stage for a benefit
By July 2021, the spasms had been reduced significantly, and Frank started to walk more normally. He was also taken off the trihexyphenidyl medication. During this time, with the help of Long Island jazz drummer and instructor Frank Bellucci, who specializes in ergonomic drumming techniques, Frank started playing drums for short periods of time. By January 2022, his practice sessions were 45 minutes long. However, it would take time for him to build up the confidence to consider playing professionally again. “I think it was because I was afraid that I was going to fail. It just seemed so risky to do that to my psyche, and I knew it was gonna be a long way back.”
In early 2024, Frank was invited to take part in a tribute concert for Scott Kempner, a friend and fellow former band member of 80s rock band The Del-Lords, who had tragically died from early-onset dementia. The concert gave Frank the ideal opportunity to overcome his fears of performing live again. After some initial misgivings, he agreed to play at the concert on February 5, 2024.
“With my personality, if I get a running start at something, I'm really good. Momentum is everything to me. So I decided to use this celebration and use the passing of my dear friend, to motivate me. I wound up doing 11 songs as a drummer and two songs up front as a singer.”
Dr. Jimenez-Shahed attended the concert, and captured photos and videos of Frank’s performance. “I wanted to support him—we’ve taken him through this whole journey—and this was the reason. This was the motivation he needed to get out there, and I think he proved to himself he could. Also, on a personal level, seeing this kind of improvement is why I do what I do and why I love deep brain stimulation so much. Giving people their lives back, that's why we love this therapy.”
Frank still has a check-up with Dr. Jimenez-Shahed every six months, and appreciates her continuing support. “You couldn’t have a better neurologist than Dr. Shahed. She’s just marvelous, I can’t say enough about her. I have a great support system—I wasn’t just sent out into the world alone, I feel totally cared for to this day.”