GETTING DBS DBS Therapy for Parkinson’s Disease

Your neurologist will evaluate you to see if DBS is a good option for you. The evaluation usually includes:

• Medical history
• Neurological exam of your movements, both on and off medications
• MRI of the brain to check whether there are any issues that would pose a risk during the surgery
• Lab tests, such as a blood test to make sure your blood clots properly
• Neuropsychological tests

The doctor will share the results with you, and together you will decide whether to go forward with the therapy.

Before the Procedure

Your doctor will give you instructions about preparing for your surgery, including instructions for medications, eating, or drinking before surgery, and how long they anticipate you will be staying in the hospital. Your doctor may want to shave a portion of or your entire head for the procedure. Ask your doctor about everything to expect at your procedure.

Imaging and Mapping the Brain

You will have an MRI or CT scan to provide your surgeon with images and maps of your brain. Your doctor may attach a frame, or halo, to your head to help hold it steady during the scan. Your doctor will use these images to calculate 3-dimensional coordinates of brain locations for lead placement.

A neurosurgeon will implant the DBS system in two steps:

1. Placing the Lead(s): Implanting very thin wires (leads) that will carry electrical signals to precise areas of your brain.
2. Implanting the Neurostimulator: Placing a small pacemaker-like device (also sometimes called the "battery" or "device") under the skin of the chest. This creates the electrical pulses that help control movement symptoms of Parkinson's, including tremor, slowed movement, and stiffness.

Depending on your surgeon's preference these steps can either be done in one day or two separate days over the course of a few weeks.

Placing the Lead(s)

Your neurosurgeon will place the lead(s) first, guided by the images and maps of your brain. For this part of the surgery, you will be awake so you can confirm that the lead(s) are placed in the best location to control your movement symptoms. Though you will be awake, and could feel some pressure, you should feel no pain.

The surgeon may ask you to move your arms or legs, tap your fingers, move your hands, or pretend to drink from a cup, then stimulate an area of the brain to test results.

Implanting the Neurostimulator (Battery)

The neurostimulator may be placed at this time, or on a different day. For this part of the surgery, you will be under general anesthesia.

After checking that the lead(s) are properly positioned, your surgeon will place the neurostimulator under the skin of your chest, just below the collarbone. Then your surgeon will connect the lead(s) to the neurostimulator using extensions that run under the skin from the chest to your neck and head.

Healing and Care After Surgery

Most people spend a day or two at the hospital. Healing may take several weeks. You will have pain medications for any discomfort you may have at the incision sites.

While healing, avoid strenuous activities and heavy lifting. Don't raise your arms above your shoulders, and don't bend or stretch your neck excessively. As always follow your doctor's instructions.

Your doctor will help you decide when you're ready to return to activities and will turn your device on at your first programming session a couple weeks after your surgery.

Risks of the Surgery

DBS Therapy requires brain surgery. Risks of brain surgery may include serious complications such as coma, bleeding inside the brain, stroke, seizures, and infection. Some of these may be fatal.

Once implanted, the system may become infected, parts may wear through your skin, and the lead or lead/extension connector may move. DBS Therapy could stop suddenly because of mechanical or electrical problems. Any of these situations may require additional surgery or cause your symptoms to return or worsen.

Talk to your doctor about the risks that may be applicable to your specific situation.

A few weeks later, your doctor will turn on the neurostimulator and adjust the stimulation to best control your symptoms while minimizing side effects.

• Most people don't feel the stimulation at all when it’s first turned on, but some feel a brief tingling.
• It will take a few programming sessions to find the stimulation levels that work best for you — so don't get discouraged if it takes a few sessions.
• You'll have follow-up visits to check your results and adjust as needed. These appointments are key to getting the results you want over time.

Then it's time to get back to your life!

• Return to your usual activities, always following your doctor's guidance on what's okay and what to avoid.
• Unlike the external drug pump sometimes used to treat Parkinson's symptoms, DBS has only minimal impact on your daily activities, the clothes you can wear, or how you travel.
• DBS delivers therapy 24 hours a day, so it's working to control your symptoms when you wake up first thing in the morning.
• DBS doesn't require any maintenance from you (except for recharging if you have a rechargeable system).

It's extremely important to attend all of your checkups with the doctor who manages your DBS therapy. Your doctor will:

• Make sure that your DBS system is working properly.
• Adjust your stimulation to best control your symptoms.
• Check the battery of your neurostimulator to see if you will soon need a device replacement.

Living with DBS Therapy