What Are The Risks Or Complications Of Dbs
Because DBS does involve surgery, there are some possible complications and risks. Your healthcare provider is the best person to tell you about the possible risks and complications. They’re the best source of information because they can consider your medical history, circumstances and more.
The possible complications of surgery include:
What You Need To Know
- Surgeons implant one or more small wires in the brain during a surgical procedure.
- The leads receive mild electrical stimulation from a small pulse generator implanted in the chest.
- Proper patient selection, precise placement of the electrodes and adjustment of the pulse generator are essential for successful DBS surgery.
- DBS does not fully resolve the symptoms of PD or other conditions, but it can decrease a patients need for medications and improve quality of life.
When Should I See My Healthcare Provider
Your healthcare provider will schedule visits to see you after your procedures. Programming visits occur with your neurologist, and youll need to make appointments to see them. The goal of those visits is to find the settings that work best and don’t cause side effects that disrupt your life.
Regular visits with your healthcare provider are also common to monitor your condition, symptoms and to adjust medications or other treatments as needed. The schedule for these visits is something that your provider will discuss with you.
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When Should I Call My Healthcare Provider Or Go To The Hospital
Because DBS involves surgery especially the procedure on your brain there are some warning signs you shouldn’t ignore. You should call your healthcare provider immediately or go to the hospital outside of business hours if you have the following symptoms:
- Severe headache that happens suddenly or wont go away.
- Bleeding from your incisions.
- Redness, swelling or unusual warmth which are signs of infection around your incisions.
- Sudden changes in your vision, such as seeing double, blurred vision or loss of vision.
- Fever of 101 degrees F or higher.
Resources For More Information
- Surgical option a potential life-changer for patients with OCD: Read and watch Erins story as she, a lively 21-year-old woman, fought her battle with OCD. This article explores how deep brain stimulation gave Erin her life back. The procedure was the first of its kind performed at Albany Medical Center the only facility offering this treatment between New York and Boston. In Erins own words, “Now, I can be who I really am and tell people my story and hopefully inspire people and help people along the way.
- Karen and Jims Story: A Shared Journey of Life, Love and DBS: Read about Karen and Jim. They were each diagnosed with Parkinsons before they met. Follow them on their journey as they fall in love after meeting each other from an online support group. See how they embraced each other and DBS.
- Kays Story A Parkinsons Disease Patient: Read about Kay, a 68-year-old woman suffering from Parkinsons disease. The article and video explore how DBS helped her regain her life. In Kays own words, Its like I had been turned on again. It was like a miracle.
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What Happens During Dbs For Parkinsons Surgery
A neurosurgeon will implant the DBS system in two steps. First, he or she will place the thin wires that will carry electrical signals to precise areas of your brain. Second, the surgeon will place the small pacemaker-like device, or neurostimulator, under the skin of your chest.
Depending on your surgeon’s preference these steps can be either done in one day or two days over the course of a couple weeks.
The neurosurgeon will implant the following parts of your Medtronic DBS system under your skin:
- Very thin wires called leads deliver electrical signals from the neurostimulator to the brain
- The neurostimulator, also sometimes called a “battery” or “device”, that creates the electrical pulses that help control movement symptoms of Parkinson’s, including tremor, slowed movement, and stiffness
What Is Deep Brain Stimulation
Deep brain stimulation is a medical procedure that involves a mild electrical current delivered to a specific part of your brain. The electricity in that current stimulates the brain cells in that area, which can help several conditions. The current reaches your brain through one or more wires attached to a small device implanted underneath your skin near your collarbone.
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Study Population And Design
Patients were recruited at the University Hospital Dresden between December 2018 and April 2021. The study was approved by the institutional review board of the Technische Universität Dresden . Written informed consent was obtained from all participants before inclusion in the study. All experiments were performed in accordance with relevant guidelines and regulations.
The study includes three different cohorts of PD patients: 57 patients on best medical treatment, 92 patients on chronic DBS treatment, and longitudinal measurements in 21 patients undergoing DBS surgery. Serum NFL for groups A and B was measured once while NFL for group C was measured on five consecutive time points. For the longitudinal measurements, the following numbers of blood samples were available: within 30 days before surgery , 35 days postoperatively , 68 weeks postoperatively, before activating STN stimulation , 35 days after activating STN stimulation and 8 months after DBS implantation . The differing numbers result from organizational issues such as treatment in another facility before or after surgery. A spaghetti plot showing the NFL time course in individual patients is included as Supplemental Fig. .
Surgery To Implant The Deep Brain Stimulation Device
Deep brain stimulation requires the surgical implantation of an electrical device into the brain. A neurosurgeon uses imaging scans to pinpoint the right spot in the brain for implanting the electrode.
When surgeons have determined the correct location, they create a small opening in the skull and insert a thin, insulated wire, through which they insert the electrode. Surgery to implant the electrode takes about four hours and requires general anesthesia. You may then stay overnight in the hospital for observation.
The next day, doctors perform the second part of the surgery, which involves connecting the insulated wire to a battery-operated pulse generator that is implanted under the skin near the collarbone. Most people can return home after this procedure.
Several days after the surgery, you meet with your neurologist, who programs the pulse generator. Pushing a button on an external remote control sends electrical impulses from the pulse generator to the electrode in the brain.
People who use deep brain stimulation work closely with their neurologist to find the combination of settings that best controls their symptoms. After several visits, they are able to control the strength of the electrical impulses on their own. Following this adjustment period, most people require only occasional maintenance visits.
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What Are The Results
Successful DBS is related to 1) appropriate patient selection, 2) appropriate selection of the brain area for stimulation, 3) precise positioning of the electrode during surgery, and 4) experienced programming and medication management.
For Parkinson’s disease, DBS of the subthalamic nucleus improves the symptoms of slowness, tremor, and rigidity in about 70% of patients . Most people are able to reduce their medications and lessen their side effects, including dyskinesias. It has also been shown to be superior in long term management of symptoms than medications .
For essential tremor, DBS of the thalamus may significantly reduce hand tremor in 60 to 90% of patients and may improve head and voice tremor.
DBS of the globus pallidus is most useful in treatment of dyskinesias , dystonias, as well as other tremors. For dystonia, DBS of the GPi may be the only effective treatment for debilitating symptoms. Though recent studies show little difference between GPi-DBS and STN-DBS.
Patients report other benefits of DBS. For example, better sleep, more involvement in physical activity, and improved quality of life .
Research suggests that DBS may “protect” or slow the Parkinson’s disease process .
Strengths And Limitations Of This Study
This is the first review and synthesis of qualitative research examining patients experience of deep brain stimulation for Parkinson’s disease.
The synthesis identifies core overarching concepts that facilitate our understanding of the experience of deep brain stimulation.
Two papers were of low quality based on methodological reporting but were conceptually rich.
To date, only seven qualitative studies focusing on the experience of deep brain stimulation have been undertaken.
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What Are The Advantages Of Deep Brain Stimulation
DBS has several advantages. These include:
- It can offer a treatment option when medications arent helpful: DBS is an option when medications don’t work or are no longer effective. With Parkinsons disease, medications lose effectiveness over time, so your healthcare provider has to increase your dosage. That leads to other side effects. With DBS, lower medication dosages are often effective again, which means your symptoms are under control with reduced side effects.
- It can be a life-changing treatment: Some of the conditions that DBS treats can cause severe effects that keep you from doing even the most routine activities. DBS can treat your condition and improve your symptoms, improving your overall quality of life. For conditions like medication-resistant epilepsy, where surgical resection isn’t an option, DBS can offer hope and reduction in seizure frequency.
- Its adjustable: Your healthcare provider can fine-tune the pulse generator settings to find what works best for you.
- Its reversible: A follow-up surgery can remove the leads and pulse generator if DBS doesn’t work or causes side effects that you can’t tolerate.
Deep Brain Stimulation Surgery And Implantation
DBS consists of two surgeries, spaced approximately three to six weeks apart to ensure the patient has adequate time to recover. Throughout your experience, you will be attended to by a top team of physicians and other medical experts including a neurosurgeon, an electrophysiologist, and an anesthesiologist.
It should be noted that DBS offers many benefits. The generator can be programmed by a neurologist, and customized to each individual patient. The procedure is also reversible. Most patients experience a significant improvement of symptoms. However, as with any brain surgery, there are risks. With DBS, the risk of stroke is 1 in 100 and infection is 1 in 50.
Today, many more patients could be helped by DBS than are currently benefiting from the procedure. Statistics show only 7 percent of Parkinsons disease and 1 percent of tremor patients in Michigan who would benefit from the procedure have undergone DBS. At U-M, we are proud to have one of the superior DBS programs in the country. We have developed a wide array of ways to improve DBS, including special imaging tools that help doctors more accurately place the electrodes, and lead intraoperative motor and speech testing that result in fewer side effects for the patient.
U-M is also home to an active research program, where our team of experts is always working on ways to make DBS faster and more accurate. We also regularly have clinical trials available for patients interested in participating.
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What Is The Recovery Time
Your healthcare provider is the best person to tell you what to expect regarding your recovery time and when you will notice changes in your symptoms and how you feel. They can tell you the likely recovery time you’ll need, which can vary depending on other factors like your overall health, other conditions you have and your personal circumstances.
Most people will need to stay in the hospital for one day after surgery to implant the DBS leads in their brain. Surgery to implant the pulse generator is usually a procedure where you go home the same day.
Overall, recovery time generally takes several weeks. Your healthcare provider will likely have you do the following:
- Avoid any kind of activity for about two weeks after each procedure: This includes things as minor as household chores or sexual activity. You should not lift anything heavier than 5 pounds .
- Avoid moderate- or high-intensity activity for at least four to six weeks: This includes exercise and physical labor. Most people can return to work or their usual routine after this.
- Use caution when moving or stretching: You should avoid making certain movements, like raising your hands over your head, for several days after surgery to implant the pulse generator. Your healthcare provider will tell you how long youll need to restrict your movements.
How should I care for the surgical area once I’m home?
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What Is The Success Rate Of Deep Brain Stimulation
In general, deep brain stimulation is usually successful. The success rate depends on the condition involved. For conditions like epilepsy and Parkinson’s disease, DBS is very effective. More research is necessary for conditions where DBS is experimental before experts know if DBS is likely to help.
What Happens Before Surgery
In the doctor’s office you will sign consent forms and complete paperwork to inform the surgeon about your medical history, including allergies, medicines, anesthesia reactions, and previous surgeries. Presurgical tests may need to be done several days before surgery. Consult your primary care physician about stopping certain medications and ensure you are cleared for surgery.You may also need clearance from your cardiologist if you have a history of heart conditions.
Stop taking all non-steroidal anti-inflammatory medicines and blood thinners 7 days before surgery. Stop using nicotine and drinking alcohol 1 week before and 2 weeks after surgery to avoid bleeding and healing problems.
You may be asked to wash your skin and hair with Hibiclens or Dial soap before surgery. It kills bacteria and reduces surgical site infections.
No food or drink, including your Parkinson’s medication, is permitted after midnight the night before surgery.
Try to get a good night’s sleep. The DBS surgery involves multiple steps and lasts most of the day, during which you may be awake and off medication.
Morning of surgery
Arrive at the hospital 2 hours before your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks.
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Why Is Dbs Used
There are billions of neurons in each human brain, and these cells communicate with each other using electrical and chemical signals. Several brain conditions can make neurons in different parts of your brain less active. When that happens, those parts of your brain dont work as well. Depending on the part of the brain affected, you can have disruptions in the abilities controlled in that area.
DBS uses an artificial electrical current to make those neurons more active, which can help with the symptoms of several different brain conditions. However, researchers still dont know exactly how or why this works.
Why A Doctor May Choose Deep Brain Stimulation
According to the National Parkinson Foundation, the ideal Parkinsons disease candidate for DBS surgery has:
PD symptoms that interfere with activities of daily living.
Fluctuations in mobility due to PD medications with or without dyskinesia .
Continued good response to PD medications, even if the medication effects may wear off sooner than they have in the past.
A history of several different combinations of PD medications while under the supervision of a neurologist specializing in movement disorders.
These factors* may make a person a less than ideal candidate for DBS surgery:
Difficulty with balance, walking, or freezing as the main disabling symptom.
A primary symptom of speech difficulty.
Continuous confusion and problems with memory and thinking.
A psychiatric condition such as depression or anxiety that has not improved or stabilized with other treatment.
Another condition that increases the risk for surgery complications.
*Some of these factors may be treatable. Having one or more does not disqualify a person for future DBS surgery, but the doctor may recommend more aggressive therapy focused on these issues before surgery takes place.
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What Can We Learn From The Honeymoon Phase
Although Dad is experiencing the honeymoon phase, the idea that his body is responding to the electrode placement is fascinating. Why has there been a change in the way his body reacts to Parkinsons? What causes the honeymoon effect? And why does it affect individual patients in different ways?
What we do know is that when the honeymoon period ends, Parkinsons symptoms return to their original state. And once you start DBS, it generally takes several months to experience the full effects, since you and your neurologist have to program the electrodes to operate according to your unique symptoms.
Systematic Reprogramming Of Dbs Settings
This study demonstrated for the first time that a systematic evaluation and optimization of stimulator settings is valuable and may result in significant improvements 8 to 15years after surgery. These patients had been followed in our outpatient clinic on a regular basis. Nevertheless, we found an effect on the shortterm outcome, as a positive effect was seen on all UPDRS subitems after 2 to 5weeks.
An effect of systematic reprogramming has previously been reported also by Moro and colleagues14 in a younger group 3.5years after surgery. Of the patients, 89% received a new setting, and a sustained effect was found in more than half of the patients after up to 14months. In contrast, our group was older, and we demonstrated an effect of reprogramming in a group of more advanced patients with a mean stimulation period of 12years. The results have changed the treatment strategy in our clinic, where reprogramming has been implemented more regularly as of today and also after a long treatment period.
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