Is deep brain stimulation a cure for Parkinson's disease or the other movement disorders discussed above?
Deep brain stimulation should not be looked at as a cure for any of these diseases. It can, however, provide a great degree of improvement in the associated symptoms and often eliminate side effects associated with commonly used medications.
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Are there risks associated with DBS surgery?
As with all surgical procedures, there is always a risk of complications. Thankfully, however, most of these are temporary and relatively mild. The reversible nature of DBS helps to minimize the risk of permanent complications.
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What type of follow-up is necessary following surgery?
In addition to routine post-surgical follow-up (to confirm healing of the incisions, etc) the patient will need to follow-up with the treating neurologist for programming of the DBS system and optimization of stimulator settings and medication dosage and schedule. This usually takes between a few weeks and a few months and involves several office visits.
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What if I want to keep seeing my own neurologist? Can he or she do the programming of the stimulator systems?
This is absolutely fine. We encourage all patients to continue to see their regular neurologist on a regular basis. If your regular neurologist wishes to perform the stimulator programming and optimization, this is perfectly acceptable also. We can come to an arrangement that satisfies all parties.
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Is the procedure painful? Why is it performed with the patient awake?
The procedure should not be painful. The patient is given a local anesthetic. This involves minimal discomfort when administered, but renders the area numb and allows us to proceed with surgery without further sensation. The procedure is performed awake to allow for effective microelectrode recording. This ensures optimal placement of the electrodes and maximizes the potential for benefit from the stimulator systems.
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Following surgery, is the stimulator system visible?
Not really. There will be four small scars on the scalp that will usually be covered by the patient's hair. The generators are placed under the skin just beneath the clavicle (collarbone) in the same region where a cardiac pacemaker is usually placed. There will be small scars in this region as well. These generators are less than a half-inch thick. Neither the generators nor the electrodes will be noticeable on most patients but the outline may be visible beneath the skin on very thin patients.
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Why is the procedure performed in multiple stages?
This is done to minimize side effects associated with the surgery. When we performed this surgery as a one-stage procedure (placement of the electrodes and generators on the same day) a higher percentage of patients suffered from complications such as temporary confusion and other neurological effects. We feel that separating the procedure into two different days minimizes the chance of such problems.
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Will I still be able to swim, exercise, etc?
The stimulators should not prevent participation in any reasonable activity.
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Can I get an MRI after I undergo placement of a DBS system?
There are strict guidelines in place for obtaining MRI scans following DBS implantation. Getting an MRI with correct attention to these requirements is perfectly safe, however, an MRI done incorrectly can be dangerous. The presence of the stimulator systems must be discussed with the radiologist performing the MRI as well as with your neurosurgeon and/or neurologist prior to obtaining such a scan.
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Do I need to stop taking my medications for this procedure?
Yes, on the day(s) of electrode placement, the patient should not take any of his or her usual movement disorder medications. The reason for this is that they may interfere with microelectrode recording and decrease the chance of a successful procedure. So, in addition to the usual requirement of no food or drink after midnight, the patient should refrain from taking these medications on the morning of surgery. Any other medications should be discussed with the surgeon prior to the day of surgery.
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What if I already had a different surgical procedure such as a pallidotomy?
Although this can complicate the situation somewhat, many patients that have previously undergone some other surgical procedure have now undergone DBS with good effects.
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Does DBS prevent progression of Parkinson's disease?
There has been speculation that DBS may prevent progression of Parkinson's disease. We now know that this is probably not the case. It does, however continue to provide good control of symptoms and suppression of side effects such as dyskinesias over the long term. So, even though the underlying disease may be progressing, patients can continue to function at a high level.
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How long do the effects of DBS last?
We now have data out beyond 5 years. Although most studies show some progression of symptoms during this time, virtually all continue to demonstrate good symptom control. One big advantage to stimulation over destructive surgical techniques is that the stimulator settings can be changed as the patient's symptoms evolve, maintaining good symptom relief. Analysis of the necessary stimulation settings done at NYU demonstrates that we are nowhere near reaching the limits of the device and we anticipate continued beneficial effects into the future.
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Does the battery ever have to be replaced?
Yes. Current battery technology limits the useful life of the device to approximately 5 years. This is somewhat dependant on the stimulation settings and the individual patient. Turning off the stimulators at night, as many patients with essential tremor do, will extend the lifespan of the battery. Fortunately, replacement of the pulse generators is a relatively simple procedure. It takes less than an hour and is done as an outpatient.
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