What To Expect After Dbs
Surgery to implant the leads generally entails an overnight stay, while the IPG is usually implanted as same-day surgery. During recovery, your surgeon will talk to you about caring for your wounds, when you can shower, and any activity restrictions. Its usually recommended that any heavy lifting be avoided for a few weeks.
After another two to four weeks, youll return to have your device programmed. This process will continue for several weeks to ensure the stimulation settings are optimal to control your symptoms. During these visits, you will be shown how to turn the device on and off with the handheld device and check the battery level.
Once the programming has been completed, you will have regular follow-up visits to check and adjust the stimulation to maintain the most benefit for your symptoms.
Comparison With Conventional Dbs
In a 2021 research study conducted by Priori, a comparative analysis was presented between the impacts on motor symptoms between conventional deep brain stimulation and closed-loop adaptive deep brain stimulation in patients with Parkinsons disease. This work highlighted the safety and effectiveness of aDBS stimulation compared to cDBS in a daily session, both in terms of motor performance and TEED to the patient. Simon Little has regarded aDBS approach to be superior to conventional DBS in PD in primates using cortical neuronal spike triggering and in humans employing local field potential biomarkers. While presenting a protocol for a pseudo-randomised clinical study for adaptive deep brain stimulation as advanced Parkinsons disease treatment, it was shown that aDBS do not induce dysarthria, in contrast to cDBS. Also it has been suggested that aDBS and cDBS can improve patient’s axial symptoms to a similar extent, but compared with cDBS, aDBS significantly improves its main symptom, bradykinesia.
Rechargeable Vs Nonrechargeable Ipgs
The most common nonrechargeable IPG, the Medtronic Activa PC, has an average battery lifespan ranging from 2.6 to 4.5 years , which is approximately 2.5 years shorter than its predecessor, the Kinetra . This is considerably shorter than the marketed lifespan of the PC, which is advertised as approximately 5 years. The lifespan of an IPG is largely dependent on the current demands of the patientâs stimulation settings, with high-voltage stimulation necessitating more frequent battery changes. Rechargeable IPGs were first introduced in 2008, and the predicted lifespan of rechargeable IPGs according the manufacturers ranges from 10 for Brio to 15 , up to 25 years, which has yet to be confirmed.
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Sites Of Deep Brain Stimulation And Symptom Control
While both subthalamic nucleus and globus pallidus internus stimulation help improve the motor symptoms of Parkinsons disease, studies have found a few differences.
DBS of the third target, the ventral intermediate nucleus, can be beneficial for controlling tremors but does not work as well at addressing the other motor symptoms of Parkinsons disease.
In a Canadian study, targeting the subthalamic nucleus allowed people to reduce the doses of their medications to a greater degree, while targeting the globus pallidus internus was more effective for abnormal movements .
In another study, STN deep brain stimulation also led to a greater reduction in medication dosages. However, GPi stimulation resulted in greater improvement in quality of life, and also appeared to help with the fluency of speech and depression symptoms.
Side effects of DBS can sometimes include subtle cognitive changes . A different study compared these effects with regard to these different areas.
GPi showed smaller neurocognitive declines than STN, though the effects were small with both. On a positive note, both procedures seemed to reduce symptoms of depression following surgery.
Rigorous Testing For Safe Access To Mri
Approximately seven out of 10 DBS-eligible patients with movement disorders may need an MRI within 10 years of receiving their device.1 Only Medtronic provides safe* access to MRI anywhere on the body with some systems under certain conditions giving your doctor an important tool for diagnosis. We know it’s important that you have safe access to MRI. That’s why we performed rigorous testing of Medtronic DBS systems.
- 14 years of MRI research and testing
- 10 million simulated patient scans performed using 38,800 scan conditions such as patient size and patient position within the MRI machine
Some Medtronic DBS devices may remain on while you have an MRI. You may take comfort in knowing that the device can remain on to control your symptoms. Talk with your doctor before having an MRI.
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A Complete System That Brings Complete Benefits
With a complete Medtronic system lead, extension, and neurostimulator you get:
- Warranty coverage
- World-class support
- A system backed by safety and clinical evidence: Your safety is our priority, which is why Medtronic DBS Therapy is backed by decades of research and the highest level of clinical evidence.
Tailoring Treatment To A Single Patient
These types of technologies are new for nearly everyone, says Gaetano Leogrande, a senior research and development engineer who helped develop the technology behind the Percept PC neurostimulator BrainSense.
Leogrande supports healthcare practitioners like Dr Contarino to understand and use the BrainSense technology, offering training and answering any questions.
In the future, Leogrande says, it is hoped that the stimulation will be adaptive. This means that the stimulation will be automatically and frequently adapted according to the needs of a specific patient at a specific point in time.
This is important because we hope that it will reduce symptom fluctuations, reduce side effects and extend the longevity of the device, so we wont have to bother the patient with as many replacement sessions, he explains.
Tailoring DBS to the needs of each patient is necessary because every patient has a different form of the disease, says Dr Contarino. There are some patients who have more tremors, some who are slower, some with symptoms that are more on one side of the body There are patients of all ages young and old. And, even within the same patient, symptoms can change as the disease progresses.
Gaetano Leogrande is a senior research and development engineer at Medtronic.
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Get Back To Your Life
Now that you’re receiving DBS therapy, it’s time to get back to your life! By choosing Medtronic, you’ve joined the more than 175,000 people benefiting from decades of research, innovation, and experience in DBS therapy.
DBS therapy for Parkinson’s is a big step towards living a more independent life.
- Under your doctor’s guidance, you will be able to gradually return to most activities.
- DBS will have minimal impact on your daily activities, the clothes you can wear, or how you travel.
- DBS delivers therapy 24 hours a day, so it will be working to control your symptoms when you wake up first thing in the morning.
- DBS doesn’t require any maintenance from you .
Reduces Dyskinesia And Fluctuations
Medtronic DBS therapy reduces complications of drug therapy, such as dyskinesia and fluctuations in on and off time.3,4,5,6 Medtronic DBS therapy reduces complications of drug therapy by 37% to 61% compared to medication alone.4,5 Without DBS, people receiving best medical therapy experience between a 5.4% reduction to a 13% increase in drug-related complications compared with their baseline.4,5
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Planning Preparing For Surgery
Before the ProcedureYour 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 BrainYou 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.
Less Medication More You
DBS therapy is an implanted solution that provides more relief, not more medication. Many people with Parkinsons disease take multiple doses of multiple medications. Keeping track of medications can be difficult. Some find that they must increase the number and frequency of doses to get the same relief. Others find that the more medications they take, the less the medications seem to work. DBS is not a medication and it does not contain medication. In many cases, DBS therapy helps patients reduce the amount of their Parkinsons drugs by up to 50%.2
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Benefits Of Medtronic Dbs
HELPS CONTROL MOTOR FUNCTION AND IMPROVES QUALITY OF LIFE
- Improves motor function and reduce medication for patients with recent or longer-standing motor complications1,2
- Improves quality of life and activities of daily living for Parkinsons patients with recent or longer-standing onset of motor complications.1,2
- Reduces medication and improves drug-related complications1
- Offers the first safe* access to MRI anywhere on the body for diagnosing health conditions in patients with deep brain stimulation
- Allows therapy to be turned off or reversed, preserving options for future therapies and treatments
Leading The Way In Dbs
Medtronic is a global leader in medical technology, services, and solutions serving millions of people around the world every day.
DBS development started in 1987, and Medtronic has been leading the way ever since. So far, more than 175,000 Medtronic DBS devices have been implanted for Parkinson’s symptoms and other conditions. We are committed to making sure you have the information and support you need to decide whether Medtronic DBS Therapy is right for you.
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Stimulation Data And Safety
All patients had received subthalamic deep brain stimulation. Three months after surgery mean stimulation settings were 2.4 ± 1.0 mA, 128.4 ± 9.5 Hz, 59.3 ± 3.3 s for the left STN and 2.2 ± 0.9 mA, 154.7 ± 176.4 Hz, 59.8 ± 3.3 s for the right STN. At 12-MFU the settings were 3.0 ± 1.0 mA, 133.6 ± 23.1 Hz, 57.6 ± 8 s for the left STN and 2.8 ± 0.9 mA, 133.6 ± 23.1 Hz, 60 ± 9 s for the right STN. In the first year after implantation, seven adverse events occurred including dyskinesia , dysarthria and accidental STIM-OFF . One patient with dyskinesia needed a transient stimulation pause directly after stimulation. Dyskinesia and dysarthria was each responsive to stimulation adjustments. In the patient with accidental STIM-OFF, no defect could be found after reactivation of stimulation and AE did not occur again. Nine serious adverse events occurred in this cohort: One patient with impaired wound-healing improved under antibiotics, one patient needed 24 h observation time after a fall with associated head trauma but without damage to the system, three patients experienced postoperative confusion that resolved spontaneously after 35 days and one patient suffered from intracranial bleeding around one electrode with associated aphasia that remitted incompletely up to 12 MFU. One patient attempted suicide after newly started DA-therapy and resulting impulsivity 11 months after electrode implantation.
Be More Active Like Gilles
“Since I had the operation my life is much, much better. I’ve got a kind of energy again, the way others look at me has completely changed.”
Gilles from France, Deep Brain Stimulation story –
Gilles has been able to reduce his Parkinson’s medication and continue working as a journalist after having DBS surgery.
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Up To Five Additional Hours Of Good Movement Without Dyskinesia
Good movement control means no troubling symptoms like shaking, stiffness, and difficulty moving. DBS therapy can provide up to five additional hours of good movement control without dyskinesia per day, compared with medication alone.*2,3,4 What would you do with five additional hours every day?
*Measured by the UPDRS IV
Living With A Dbs Device
Batteries most often last three to five years, but this can vary. Rechargeable batteries may last up to 15 years.
There are several precautions related to electrical/magnetic devices that are important, but usually easy to accommodate. Items such as cell phones, computers, and home appliances do not generally interfere with the stimulator. Keep your stimulator identification card handy when you are out and about, in your wallet or purse.
Theft Detectors
Be aware that some devices may cause your transmitter to turn on or off. This includes security monitors that might be found at the library and retail shops.
If this occurs accidentally, it is not usually serious, but may be uncomfortable or result in your symptoms worsening if the stimulator is turned off. When you visit stores with these devices, you can ask to bypass the device by presenting your stimulator identification card.
Home Electronics
Keep the magnet used to activate and deactivate the stimulator at least 12 inches away from televisions, computer disks, and credit cards, as the magnet could potentially damage these items.
Air Travel/Metal Detectors
Talk to TSA personnel when traveling by plane, as the metal in the stimulator may set off the detector. If you are asked to go through additional screening with a detector wand, its important to talk to the person screening you about your stimulator.
Medical Diagnosis and Treatment
Occupational Electromagnetic Concerns
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Correlation Of Motor And Non
Motor improvements 12 months after DBS correlated significantly with initial levodopa response in the initial BL-levodopa challenge and improvements of mood but not with apathy, impulsivity, cognition, QoL, DD or AOO. BDI changes correlated also with reduction of apathy, impulsivity and QoL at 12 MFU . Postoperative LEDD and DA reduction did neither correlate with motor nor with non-motor score changes.
The Pros And Cons Of Microelectrode Recording For Precise Neuro Navigation
It is an old debate whether MER increases the accuracy of the DBS lead placement.37 MER may help identify anatomical targets via the detection of characteristic cellular firing patterns.38 Experienced centers on MER report that an alternative trajectory is preferred over the initially predefined target in about 25% of cases, leading to more preferable motor outcomes.39 Also, intraoperative test stimulation via microelectrodes may predict the risk of early capsular side effects at a given target and therefore may also enhance decision-making on the DBS electrode placement.40 Consequently, MER is a useful technique to optimize placement of the final DBS electrode and routinely utilized in most DBS centers, including our own.
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Percept Pc Neurostimulator Features
- Uses BrainSense technology* to personalize your therapy for the best possible outcome.*
- A sensing-enabled lead, the SenSight Directional Lead, precisely directs stimulation so you get therapy right where you need it.
- MRI access should you need one in the future. Percept PC Neurostimulator provides full-body MR Conditional access for both 3T and 1.5T MRI scans.
- Battery lasts over five years on average, before needing to be replaced.
- A smartphone-like patient programmer that allows you to easily and conveniently manage your therapy and check the battery.
- A Digital Diary on your patient programmer that enables you to track your events, such as when you took medication. It can eliminate the need to carry a notebook or diary.
Experience Fewer Symptoms With Deep Brainstimulation
For patients with movement disorders, such as Parkinson’s disease and essential tremor, an effective treatment is available to help significantly reduce their symptoms and make performing daily activities easier.
For appointments
Deep brain stimulation is a therapy used to treat multiple disorders. The most common disorders include Parkinsons disease and essential tremor. It can be used to improve a patients:
- Abnormal muscle activation
It is also being studied in a few psychiatric conditions such as obsessive-compulsive disorder, Tourettes syndrome, depression and addiction.
About DBS surgery
The procedure involves placement of an electrode or lead into a deep structure of the brain typically, one on each side of the brain. These electrodes are secured in place with a plastic cap and connected to extension wires that are tunneled underneath the skin to an implanted generator placed under the skin just below the collar bone, similar to a pacemaker.
The generators last for 3-15 years depending on type implanted and patient use. They are replaced with a simple outpatient surgery. The overall risk of the operation is very low but not zero. In depth discussion with your neurologist and surgeon is needed to determine if you are an appropriate candidate and your risk of the operation.
For above images: ©2021 Medtronic. All rights reserved. Used with the permission of Medtronic.
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Supporting You Throughout Treatment
When you have Medtronic DBS Therapy , our world-class support team is always available to ensure you are getting the most out of your therapy. Our representatives are located all over the United States so youre never far from someone who can help.
- As always with your medical care, your doctor should be your first call. We support your doctor with 24/7 technical support, training, therapy updates, extensive online resources, and local Medtronic representatives.
- Our online directory of neurologists who specialize in Parkinsons and DBS therapy will continue to be a great resource if you move or travel.
The Window Of Opportunity For Dbs6
The window of opportunity for your patients to receive DBS therapy begins as early as four years after the appearance of their first Parkinsons symptomsso knowing when to have the conversation about further treatment options can make a significant difference in the preservation of your patients daily function, and their quality of life.2
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Spectrum Of Applicable Pulse Widths
Many studies suggest that activation of neural fibers but not cell bodies is crucial to gain therapeutic effects of DBS.116,121 It is well known that myelinated axons have a much lower chronaxie, compared with less or unmyelinated fibers or cell bodies.134 Up-to-date IPGs account for these insights and offer even shorter pulse widths than traditional IPGs, which were restricted to a minimum value of 60 µs. Indeed, pulse width reduction increases the therapeutic window for DBS and hence is particularly useful in patients who experience side effects even with low stimulation amplitudes.88,135Table 1 summarizes the features of IPGs currently available in clinical standard of care.