40 questions about DBS surgery for Parkinson’s disease
1. What is deep brain stimulation?
Deep brain stimulation (DBS) is a surgical procedure to treat Parkinson’s disease, dystonia or tremor. This method involves the implantation of tiny electrodes at specific locations in the brain. This electrode is connected to a battery (i.e., a neurostimulator) under the collarbone. This neurostimulator is similar to a pacemaker, and once turned on, the stimulator sends continuous electrical pulses to specific areas of the brain to improve symptoms.
2. How does DBS work?
The mechanism of how DBS improves symptoms is still unknown. When the stimulator is turned off, the stimulating effect disappears and the Parkinson’s symptoms reappear.
3. Is the DBS procedure painful?
Local anesthesia is first applied to the bones of the head, or other forms of sedation are used to reduce arousal and anxiety during preoperative preparation and during the head MRI or CT scan. Sedation is usually applied in preparation for drilling, but each surgeon has his or her own experience with sedation during surgery. There is some pain associated with skull drilling, but anesthesia can reduce the discomfort during and after the procedure. Ice is very helpful in reducing the scalp’s after-effects to the nails and screws drilled into the skull. Finally, after the stimulator battery is implanted the patient usually reports feeling pain in the upper chest until the implant site is completely healed. Most patients require only a small amount of analgesia during the final healing phase (only under the supervision of the surgeon).
4. How do I know if I am a candidate for DBS surgery?
A neurologist trained in Parkinson’s disease and DBS can determine if DBS surgery is right for you. the evaluation of DBS includes an assessment of whether the surgery can help you improve your symptoms and an assessment of the risks of the surgery. You can read Chapter 2 of this book.
5. What symptoms can benefit from DBS?
Parkinson’s symptoms such as tremor, tonicity, bradykinesia, and gait disturbances all respond to DBS, which increases the duration of drug effectiveness (reduces off-time). Tremor is reduced by an average of 70%, depending on the type and location of the tremor. Dystonia has a complex presentation and is a very complicated condition. In some cases, dystonic posture, pain, and dystonic-type tremor all respond very well to stimulation.
6. Is DBS a cure?
The answer is no, DBS does not cure the disease. It is only a treatment to improve the specific symptoms of Parkinson’s, tremor and dystonia.
7. Should I choose unilateral DBS or bilateral DBS?
Unilateral DBS improves the symptoms on the opposite side of the body. If the patient has bilateral symptoms, then a bilaterally placed electrode will produce the best results and improve motor function overall. For patients with only unilateral symptoms, a DBS procedure on the contralateral side is also sufficient.
8. Can medication be stopped after DBS?
DBS is not a substitute for medication. After the DBS system is turned on, your neurologist may lower the dose of medication depending on the results of the stimulation. Although most patients will need to maintain a certain amount of medication after surgery, most patients are able to reduce their medication dosage. But the total amount of medication needed after surgery is difficult to predict. Most Parkinson’s patients are still unable to stop their medications. Patients with predominantly tremor and no symptom fluctuations are likely to have a greater reduction in medication dosage. Patients with dystonia and patients with idiopathic tremor are likely to have their dose reduced or discontinued.
9.What if DBS is not effective?
DBS stimulation can be effective in improving symptoms and solving problems if the indications are well managed. If DBS does not work or even worsens the symptoms after the procedure, then the cause should be explored. The wire may have been inadvertently damaged during the procedure or the electrodes may not have been placed in the ideal position. If you have no results within 6 months of surgery, talk to your doctor. For the best outcome, choose a DBS team that includes neurosurgeons and rehabilitation physicians trained in specialized DBS treatment, in addition to neurologists. See Chapter 5 for more details.
10. What should I do and what should I not do after DBS?
Generally speaking, you can return to your activities of daily living within a few weeks after surgery. You will want to listen to specific instructions from your neurologist. As a rule, you should avoid pushing or traction on the neck, massage, or puncture around the stimulator placement site, welding, MRI, heat therapy, and high intensity electromagnetic environments.
11.What electronic devices should I avoid at home or work?
Most household appliances are safe, including microwave ovens, radios and computers. Some high-voltage appliances are dangerous, such as welding equipment. If you want to apply larger electrical facilities should consult your DBS manufacturer or seek customer service support.
12. If new treatments for Parkinson’s disease become available, can the DBS be removed?
Yes, DBS is reversible. The implanted electrodes and stimulators can be removed from the brain without any damage to it.
13.Can I do exercises after DBS?
Most patients can exercise within 4-6 weeks of incision healing. Extensive or high intensity exercise may increase the risk of hardware damage. Exercise is beneficial for health, improves neuroplasticity, and helps control weight. If you have any questions about exercise you can consult your DBS team.
14. How long does the battery last?
The battery of the stimulator usually lasts 2-5 years. The life of the battery depends on the intensity of the stimulation parameters set. If the battery runs out of power, your symptoms may worsen or you will need more medication to maintain them until the battery is replaced. Your neurologist will expect to test the battery and then notify you when the stimulator needs to be replaced.
15. Will the DBS stop working after a few months or years?
Yes, the most common reasons for failure are battery depletion or damage to the device. For example, there may be damage to the electrodes. If your symptoms suddenly get worse, you should contact your DBS team immediately.
16. Is it asleep during the DBS procedure?
The surgeon may or may not need you to be awake during the electrode implantation procedure. If your symptoms need to be evaluated intraoperatively, then you will be awake and during the intraoperative testing, you will be asked if your symptoms are reduced and you may experience both a reduction in symptoms and some mild sensations. Afterwards you are asleep at the time of the battery implantation.
17. What are the complications after DBS?
Postoperative brain tissue hemorrhage is the most common complication associated with the procedure. Epilepsy is very rare. Infection of the skin and implant hardware are also possible post-operative complications. Other complications include muscle weakness, changes in speech, problems with walking and balance, difficulty finding words, and psychiatric symptoms. When the stimulator is tested, they also include include dysarthria, vertigo, numbness, dizziness, visual changes, and muscle contractions. Death is one of the possible outcomes during any surgery, although it is very rare in DBS surgery. These risks can be minimized with the evaluation and attention of an experienced DBS team. Your neurosurgeon will talk to you about the risks and complications of DBS surgery as described above.
18. What about DBS?
DBS is a treatment that is as effective as medication in extending the open period and shortening the closed period for patients. One symptom that responds well to it is tremor. dbs can relieve tremor symptoms that are not well treated with medication in Parkinson’s patients. Some other types of tremor, such as idiopathic tremor, can reduce symptoms by an average of about 70% and can be maintained for many years. dbs is also very effective in strictly screened cases of dystonia. Whether DBS is effective for you depends on a proper preoperative evaluation, accurate electrode positioning, excellent state of the art DBS system hardware, proper DBS programming, and the use of medications.
19.How long can DBS work?
DBS can be useful for more than 10 years. Studies have confirmed that symptoms that can be improved at the beginning of the procedure can continue to be improved. However, for symptoms to be relieved, proper program control (i.e., electrode parameter adjustment) must be in place for many years after surgery, and the battery must be replaced in a timely manner before it is depleted. When the neurostimulator is turned off, symptoms can reappear within a very short period of time. In addition, Parkinson’s disease can progress and the progression of symptoms will continue. Review with your neurologist the disease progression patterns specific to post-DBS.
20. Can I turn off my stimulator?
If you have Parkinson’s disease or dystonia, the stimulator should always be turned on. Many patients with tremor turn off their stimulators at night. Do not turn off the stimulator unless you have discussed it with your doctor.
21. Does DBS have any advantages over other brain surgeries?
DBS is an advancement in surgical treatments for Parkinson’s disease, tremor and dystonia, especially symptom-based Parkinson’s disease. DBS has several advantages over other surgical procedures (including ultrasound, gamma knife and pallidotomy) that cause permanent damage to brain tissue: 1. The damage caused by other surgical procedures is permanent, irreversible and non-adjustable. Any side effects caused by electrode stimulation can be reversed by changing the stimulation parameters. The DBS hardware can be removed and replaced if the wires are inappropriately positioned.
22. What are the limitations after the procedure?
Your neurosurgeon will advise you of any necessary restrictions. Consult your surgeon about driving or lifting heavy objects or strenuous exercise or activity. You should not take a bath in the tub until the incision has healed.
23. Who will take care of my incision?
Your neurosurgeon will remove any fixation stitches or sutures afterwards. Remember, the skin is held together by the fixation stitches or sutures, do not remove them without permission. Ask your surgeon to inspect any visible suture ends. Do not remove the sutures yourself or pull any raised suture tips or knots with your fingertips.
24. What can cause damage to my DBS device?
It is helpful to make sure you understand where the various components of the DBS system are located in your body to reduce the risk of hardware damage. Ask your doctor to show you the actual hardware that will be placed. Trauma can damage wires or batteries. Messing with wires or batteries can damage the system. A fall or blow to the head can also cause damage to the wires. If you are concerned that hardware has been damaged, return to the hospital promptly to have the system checked. Avoid including head massage or acupuncture around the placement of the DBS, thinking that the wires are coiled around your head.
25. Can I get a medical warning bracelet or necklace?
This is recommended for your safety. Warnings include: warnings against deep brain electrical stimulation, MRI, electrotherapy (baking), and ultrasound therapy. Also include your doctor’s name and Medtronic’s phone number.
26. Are there any precautions for sun exposure?
Protect the skin around your incision from excessive sun exposure. Sunburn can cause skin breakouts or infections. If you do need other surgery or disposition of the head or skin, please seek guidance from your neurosurgeon, as the placement wire is under the scalp.
27. When can I start driving again after DBS?
Your surgeon will decide when you can start driving again. If you have a seizure after surgery, your driving restriction will be extended.
28. Can I use electrolysis?
Electrolysis cannot be applied near the DBS stimulator that is implanted in the body.
29. Who will inform the other doctors that I have had a DBS procedure?
You should inform all your doctors and health care providers that you have had DBS surgery, especially dentists, chiropractors, surgeons and dermatologists.
30. Are there any special considerations for medical tests or treatments?
MRI of the body (any body part except the head) is not allowed. Body MRI can lead to brain damage or death. Head MRI is allowed if the MRI scan is done with the correct equipment in accordance with Medtronic’s safety protocol. Talk to your doctor before having any type of MRI. If a brain MRI is needed, the DBS system needs to be turned off after the exam. If there is hardware damage then a head MRI may not be appropriate. the DBS neurostimulator should be turned off during any surgical procedure. Routine x-rays are safe and unrestricted. Your healthcare provider should ask Medtronic about the necessary safety measures during any surgical procedure.
31. Can I have electromagnetic therapy?
Electromagnetic therapy, especially high-frequency current electromagnetic heating, such as transcranial magnetic stimulation, is contraindicated after DBS. It can cause serious brain damage or even death. Electromagnetic therapy, i.e. heat generation by electricity (using high frequency electromagnetic waves), is usually used to treat traumatic injuries or wounds.
32. Are there any restrictions on the implantation of a pacemaker or defibrillator before or after a DBS procedure?
Implanted cardiac devices can be used with DBS, but if that patient also has a cardiac hardware device, the DBS neurostimulator will require a special stimulation setup. Your physician can contact Medtronic for advice and compatibility information.
33. Will transcutaneous electrical nerve stimulation (TENS) interfere with my DBS?
TENS is widely used for muscle injuries to relieve pain. TENS may or may not be appropriate and should be applied with caution and only after your physician has consulted with Medtronic. the electrode pads for TENS should be kept away from the DBS system and your physician or Medtronic should be consulted before application.
34. Do magnets interfere with my DBS?
Magnetic devices can interfere with the implanted hardware and the patient’s procedural equipment (especially old batteries). It is best to avoid strong magnetic field devices and do everything possible to minimize potential interference.
35. What if I need treatment with another medical device after the DBS implantation?
Medtronic Customer Service will provide your physician with the most up-to-date information on safety and compatibility with other devices and treatments. This includes kidney stone lithotripsy, radiation therapy, cardiac and other pacemakers and surgeries.
36. What happens when I’m at the airport or going through other security checks?
Follow the instructions of your DBS neurologist. Make sure you carry your Medtronic ID card when you travel. You will be issued your ID card within 3-4 weeks after surgery.
37. Can I perform arc welding?
No. Arc welding is not currently recommended by Medtronic and should be avoided.
38, Should I stay away from pets after DBS?
Avoid direct contact of pets with the skin near the incision until the skin has completely healed. Take care to wash your hands after touching any animal to reduce the risk of infection. Avoid sleeping with pets until the incision is completely healed.
39. Can I safely use industrial equipment?
Industrial equipment can emit strong electromagnetic emissions. Check with the equipment manufacturer to see if medical equipment can be safely applied in the vicinity of that industrial equipment. If the device manufacturer is unsure about the safety of you and your implanted hardware, consult Medtronic Customer Service. If you are exposed to high-energy electromagnetic fields, check your neurostimulator frequently.
40. Can I continue to dive, sky dive, wind surf, sea surf, ski, hike, or go to high altitudes?
Medtronic does not recommend diving below ten meters. High-intensity exercise can cause damage to the hardware. High altitude will not affect the neurostimulator, although it may affect your judgment of safety. Falling, pulling hard, and twisting can damage the implanted hardware. Talk to your DBS team before performing these activities.