Many people with Parkinson’s disease or essential tremor reach a day when medication just doesn’t cut it anymore.
Sometimes the medication doesn’t provide the relief it once did. Or patients have to take such high doses that side effects spiral beyond what they can tolerate.
That’s when some turn to deep brain stimulation surgery, or DBS.
At OHSU, patients who have Parkinson’s or essential tremor and are considering DBS receive a step-by-step treatment plan. The steps include a thorough evaluation to make sure that only patients with a strong chance of success become candidates for surgery.
Here’s a guide to how the process works ─ for patients living inside and outside the Portland region ─ plus information on where to learn more.
The DBS process typically takes about three months from the first appointment to surgery.
Out-of-town patients can conduct many of the appointments in their home communities through OHSU’s Telemedicine Network, which offers a secure video link to OHSU specialists. Some patients come to Portland only for surgery.
The first step is to establish that the patient has a clear diagnosis. DBS helps idiopathic or classic Parkinson’s, for example, but not other types. In addition, the patient should be at a point where medication no longer effectively controls symptoms.
Parkinson’s patients: Next, Parkinson’s patients have a series of appointments over one or two days with movement-disorders experts. Specially trained psychologists test thinking abilities and memory. Physical therapists test movement abilities on and off medication. Patients may also meet with a speech therapist.
Essential tremor patients: Patients with essential tremor meet with a neurologist, neurosurgeon or both to go over medical history, risks and benefits.
Those found to be good candidates for DBS and who choose to go ahead have an MRI and a final appointment to make sure they’re healthy enough for surgery.
Patients come to OHSU Hospital on the day of surgery and are put under general anesthesia. They have a CT scan that’s matched with the pre-surgery MRI, giving the surgeon a down-to-the-millimeter roadmap for placing the electrodes. The surgeon makes two small incisions, places the electrodes, and takes another CT scan to make sure they’re in the right places.
The surgeon also places thin wires under the skin of the head, neck and shoulders for connection to the pacemaker-like device, called a stimulator or an implanted pulse generator. Patients typically spend one night in the hospital and are released the next day.
Two to seven days later, the patient comes to OHSU to have the stimulator implanted. The device is about the size of a tea bag and is placed under the skin, usually below the collarbone. The person is put under general anesthesia for the procedure and goes home that day.
Programming and follow-up
Out-of-town patients have an appointment a week after DBS surgery to have their incisions checked and to receive initial programming of their stimulator. After that, they have appointments at one, two and three months – at OHSU or in their home communities – to adjust their DBS settings.
Patients in the Portland area receive incision checks and initial programming one month after DBS surgery. Then they have appointments for DBS adjustments at two and three months.
Patients may require several programming sessions to achieve the best symptom control.
After that, both sets of patients see their neurologist every six months for routine care and any needed DBS adjustments. The stimulator battery is replaced in a minor outpatient procedure every three to five years.