Deep Brain Stimulation Troubleshooting and DBS Failures Clinic

History of the DBS Troubleshooting Clinic

Our clinic space is comfortable and great for patient-doctor interactions
Our clinic space is comfortable and great for patient-doctor interactions

In 2005, University of Florida researchers published a seminal study on deep brain stimulation (DBS) failures.  The study examined all of the reasons why a DBS device may fail and identified and laid out for the field the potential causes of DBS failures and how to correct them.  Issues identified included problems with patient selection, the DBS procedure itself (misplaced DBS leads, sub-optimally placed DBS leads), post-operative programming, and/or post-operative medication adjustments.

Since 2005, UF doctors and scientists have been on a quest to improve the quality of DBS.  Dr. Okun teaches courses on DBS failures and the Center has many peer-reviewed papers and book chapters in this area.

The University of Florida responded to the demand of patients by introducing the concept of a Deep Brain Stimulation (DBS) troubleshooting clinic.  The clinic was introduced to create a systematic way to evaluate and treat DBS failures and DBS related problems.

How we help patients with sub-optimal Deep Brain Stimulation

The Deep Brain Stimulation Troubleshooting Clinic offers its services to patients from all over the United States and also to International patients– and to date has evaluated over 500 deep brain stimulation leads and has re-operated and re-programmed dozens of patients.

The secret to the success of the clinic is its systematic approach, and the amount of time spent sorting out all of the relevant issues.

Para-sagittal image of where the Deep Brain Stimulation lead is in the patient's brain
Para-sagittal image of where the Deep Brain Stimulation lead is in the patient’s brain

A patient is evaluated in the morning for 1-2 hours and has standardized rating scales in all medication and stimulation states (potentially four scales).  A MRI or imaging study is then performed and imported into a 3-D atlas of the brain (developed by UF researchers).  Finally thresholds for benefit and side effect on every lead and every contact site are checked and recorded– and medications adjusted.  When necessary all rehabilitative services are available to see the patient (PT/OT/Speech).

After the evaluation we always attempt to reprogram the patient, whether the lead is sub-optimally placed or not.

The patient is then presented in full to the complete interdisciplinary DBS and clinical team (neurologist, neurosurgeon, neuropsychologist, psychiatrist, PT, OT, speech/swallowing pathologist, social worker). Medications, programming and behavioral interventions as well as follow-up are discussed and set up.

If the patient requires an operation they are immediately referred to the renowned UF fast-track interdisciplinary evaluation for DBS surgery.

DBS Tinker Locations

Selected UF Center publications on DBS failures and DBS Troubleshooting:

  • Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CE 4th, Okun MS. Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery. 2008 Oct;63(4):754-60; discussion 760-1. PubMed PMID: 18981887.
  • Okun MS, Rodriguez RL, Foote KD, Sudhyadhom A, Bova F, Jacobson C, Bello B, Zeilman P, Fernandez HH. A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders. Parkinsonism Relat Disord. 2008 Nov;14(7):532-8. Epub 2008 Mar 5. Review. PubMed PMID: 18325819.
  • Okun MS, Fernandez HH, Foote KD, Murphy TK, Goodman WK. Avoiding deep brain stimulation failures in Tourette syndrome. J Neurol Neurosurg Psychiatry. 2008 Feb;79(2):111-2. PubMed PMID: 18202200.
  • Okun MS, Tagliati M, Pourfar M, Fernandez HH, Rodriguez RL, Alterman RL, Foote KD. Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol. 2005 Aug;62(8):1250-5. Epub 2005 Jun 13. PubMed PMID: 15956104.