Surgical Options for PD Treatment
By Dr. Dean P. Sutherland
Deep Brain Stimulation
Risks & Expectations
DBS Surgery & Followup
Surgery & Initial Programming
Surgical implantation is complicated. Following surgery, patients stay in the hospital overnight just to make sure that they have no complications. There is typically a 1-3 day “honeymoon period” during which the patient feels significant relief of symptoms of PD; this effect is due to the insertion of the DBS electrode, even though it is not activated yet. This effect, which is a good hint of success, usually wears off prior to the actual initial programming of the DBS.
Careful initial programming and close follow-up are the keys to success in DBS patients. At all programming sessions, it is important that the patient take NO PD MEDS within 4 hours of coming into the clinic. The first step is to check the Internal Pulse Generator or IPG (also called the “Battery Pack” by some) to make sure it is working properly. Then, all of the electrodes are checked for effectiveness of therapy as well as for side effects.
After an effective setting has been reached, the patient is allowed to take his or her medications and wait in the clinic to see what the combination of a new DBS unit and the PD medications will be, then the patient is re-evaluated prior to leaving the clinic.
Surgery & Initial Programming
Access Review Device
All About Deep Brain Stimulators
Many patients are benefiting from a surgical procedure known as deep brain stimulation, which entails implanting one or two stimulators in the brain to deliver precisely targeted electrical impulses. The past ten years have brought significant advances in the treatment of Parkinson Disease, a progressive and degenerative neurological disorder that causes loss of control of body movements. New medications help, but some patients experience significant side effects.
Deep brain stimulation gives neurologists and neurosurgeons another treatment option in our fight against Parkinson Disease. As a neurologist, Dr. Sutherland specializes in identifying good candidates for deep brain stimulation. Skilled and experienced neurosurgeons perform the procedure. Dr. Sutherland makes postoperative adjustments to the stimulators using a portable programmer that controls and monitors the neurostimulator function. The stimulators may require one or two adjustments in the month following the procedure. Later adjustments occur four to six times a year.
Unilateral (one-sided) deep brain stimulation was approved by the Food and Drug Administration (FDA) in 1997 for essential tremor and tremor in Parkinson Disease. In January 2002, the FDA approved the bilateral therapy for advanced Parkinson Disease motor symptoms. Medicare provides coverage for unilateral deep-brain stimulation in all 50 states and for bilateral deep-brain stimulation in more than 30 states. Many other payers cover deep-brain stimulationas well.