What a Patient needs to Know About DBS
What is Deep Brain Stimulation?
Deep brain stimulation, or DBS, a surgical therapy that involves the implantation of stimulating electrodes into select targets of the brain. These electrodes are used to interrupt faulty communication between brain regions that result in the disabling symptoms of Parkinson’s disease.
Why the UF Center For Movement Disorders & Neurorestoration for DBS?
The University of Florida (UF) Center for Movement Disorders & Neurorestoration is an international leader in the use of DBS implants for treating Parkinson disease and other movement disorders. We have performed more DBS procedures annually than most medical centers in the United States. The program is supported by the National Institutes of Health and several other funding agencies, and performs cutting edge research. The FDA has approved DBS for the treatment of Parkinson’s disease, Essential Tremor, and certain Dystonias. Use of DBS in other disorders is an active area of research here at UF (Tourette, OCD, Depression, others).
How does DBS work?
Understanding DBS for Parkinson’s disease requires a look at certain parts of the brain. Like electrical wiring in an appliance, if one or more circuits fails, the machine malfunctions or stops working. Research has shown that in Parkinson’s disease, there are faulty “circuits” that send abnormal signals to certain brain regions that result in disease symptoms. Interrupting these faulty signals using DBS improves symptoms in select cases. DBS is thus said to modulate neuronal circuits, but its exact mechanism of action remains unclear.
Am I a candidate?
At the UF Center for Movement Disorders & Neurorestoration (CMDNR), DBS is performed by an experienced team including Dr. Michael Okun in Neurology and Dr. Kelly Foote in Neurosurgery. A preliminary evaluation in Neurology is the first step in becoming a patient. A potential candidate for DBS is typically scheduled for a Fast Track Evaluation. Fast Track involves a comprehensive two day evaluation usually scheduled on Monday and Tuesday. The Fast Track begins with an appointment with the neurosurgeon, Dr. Kelly Foote, followed by a 4 hour neuropsychological exam with a Neuropsychologist that measures your memory, thinking and cognition. The second day includes meeting with a Psychiatrist, physical therapist, occupational therapist, a Speech and Swallow evaluation and a data collection visit at the McKnight Brain Institute.
Following the Fast Track evaluation, the DBS team meets to discuss evaluations and make recommendations. These meetings occur monthly and surgery is typically scheduled 1-3 months following the Fast Track evaluation.
Things to consider
DBS is an elective surgery that you may choose as a treatment. Following your Fast Track evaluation, our team will contact you about your candidacy. If you are an appropriate candidate, you will need to be sure to discuss the risks/benefits with your doctors and your family. Like any surgery, DBS comes with the risk of complications. Although the risk of serious or permanent injury from DBS is low, it is important for you to understand that you could develop permanent side effects.
The DBS surgery and subsequent visits also require a commitment of time (once a month visits for the first six months and regular visits thereafter), energy, travel time and depending on your insurance, you may be required to cover some of the expenses.
Preparing for surgery
If you decide to pursue DBS surgery, your next step is to plan and prepare for the operative procedure and recovery. The CMDNR staff specializes in DBS therapy for the treatment of Parkinson’s disease, and will provide you with support throughout your recovery.
As your surgery date approaches, it is normal for you to experience nervousness or anxiety. The best recommendation is to plan ahead, stay organized, speak with other patients who have had the surgery and plan to bring a friend or family member to be with you before, during and for at least a month or two following your surgery.
The day prior to your surgery you will visit our Neurosurgery clinic for a pre-operative evaluation and if you are going to be under anesthesia for the procedure, you will have an appointment with anesthesiology. Your pre-operative MRI may be taken the day before surgery.
On the day of your surgery, the neurosurgeon will administer local anesthesia to areas of your head and secure a temporary head frame to your skull to guide electrode placement during surgery. Next, you will get a head CT (CAT scan).
Once in the operating room, the neurosurgeon will inject anesthesia into your scalp and then use a drill to create a dime size hole in the skull where the microelectrode will be inserted. The microelectrode recording, a critical part of surgery, is then performed by the neurologist. The recording guides the neurosurgeon and neurologist in placing the lead in the exact area of the brain that will give optimal results. This part of the surgery can take several hours, depending upon the number of microelectrode passes needed to pinpoint the target site.
During the microelectrode recording, you will be awake and the neurologist will ask you to move your face, arm or leg. You may feel twitches, pulling or tingling as electrical current goes through the microelectrode. This is normal. After the microelectrode recording has precisely located the target, the permanent DBS leads will be placed, connected to an external generator, and tested in the operating room by administrating brief electrical pulses. The actual implantable pulse generator (IPG) is often placed several weeks later during a second surgery.
Adjustment of stimulation
Programming of the stimulator is performed in an outpatient setting and begins approximately one week following the IPG surgery. Programming is performed by a trained nurse, physician assistant and/or a neurologist who will use a small handheld device to adjust the settings of the DBS system. Most Parkinson’s disease patients undergoing DBS therapy will require numerous programming sessions to achieve optimized symptom control. We ask our Parkinson’s disease patients to plan on visiting clinic once a month for the first six months.
Once the DBS system has been implanted, there are some strict rules to follow regarding other electrical devices. Be sure to speak to your doctor about magnetic and electrical devices as well as magnetic currents in the environment, as they can cause the DBS system to malfunction and potentially be dangerous.
You will receive a hand-held magnet and/or patient control device that will allow you to turn your DBS system on and off as well as check the battery power in your device. It is important to carry your handheld device with you as some types of electromagnet or magnetic fields, including theft detection devices in department stores, may turn off the DBS system.
You should never have diathermy or body MRI’s as these may cause permanent injury. Head MRI’s must be supervised by an experienced team with a head receive coil and under FDA specified conditions.
For a deeper examination of some of these issues,read through our “Who is a candidate for DBS?” and question pages.