What are the other Names for the Procedure?
- DBS for Movement Disorders
What is the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
- Deep brain simulation (DBS) procedure involves placing electrodes in specific areas of the brain. These electrodes are connected to a stimulator device that functions like a pacemaker and sends out electrical impulses to the targeted areas of the brain
- These electrical pulses help block bad nerve signals to correct movement disorders such as Huntington disease, Parkinson’s disease, essential tremors, dystonia, etc.
What part of the Body does the Procedure involve?
Deep Brain Stimulation for Movement Disorders involves the skull, the tissue covering the brain called the dura, the brain, and the area underneath the skin of the chest or abdomen.
Why is the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure Performed?
The Deep Brain Stimulation for Movement Disorders procedure is performed for the following reasons:
- Parkinson’s disease
- Essential tremors
Movement disorders are conditions that affect one’s movement; a surgery is performed when medications prove to be insufficient to relieve the symptoms.
What are some Alternative Choices for the Procedure?
There are usually no alternatives to the procedure, as DBS is done only when medication has failed to control symptoms appropriately.
What are the Recent Advances in the Procedure?
Imaging and surgical techniques with respect to DBS have undergone further refinement.
What is the Cost of performing the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
The cost of Deep Brain Stimulation (DBS) for Movement Disorders procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding DBS for Movement Disorders procedure and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
http://www.mayfieldclinic.com/PE-DBS.htm#.VH1BBmdgrtA (accessed on 05/14/2015)
Prior to Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure:
How is the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure Performed?
The deep brain stimulation procedure is performed in the following manner:
- During implantation of the electrodes in the brain, the individual is awake. When skin incisions are made, a mild sedation may be used. During implantation of the simulator under the skin, general anesthesia may be used.
- Implantation of electrode:
- The surgeon determines the area for electrode placement within the brain by attaching a special frame to the head and taking CT/MRI images of the brain
- After the exact location of the targeted brain area has been determined, the surgeon makes an incision on the skin of the head to expose the skull
- Two small ‘burr’ holes are made on either side of the skull, and special electrodes called recording electrodes are introduced through these holes towards the brain regions that were identified by imaging
- With the help of these electrodes, the surgeon can observe the nerve cells as they fire-off signals. Using a recording of the nerve cell activity, as well as by assessing the ability of the individual to follow instructions, the precise brain areas for electrode implantation are identified
- After an accurate identification is made, the recording electrodes are replaced by permanent DBS electrodes. After placing the permanent electrodes, the surgeon tests to find out if the symptoms have reduced
- After ensuring proper placement and function, the electrode is held in place by placing a plastic cap on the burr hole. The skin incision is closed after leaving some wire beneath the scalp for attachment to the stimulator device
- Implantation of the stimulator:
- This is performed under general anesthesia
- The skin underneath the collar bone over the chest is incised, and the stimulator is placed just under the skin
- The scalp incision is opened partially to expose the electrodes and the length of extension wire
- The wire is then connected to the stimulator
- The skin incisions are closed
- The stimulator is programmed during the subsequent visit to the clinician’s office
Where is the Procedure Performed?
The Deep Brain Stimulation (DBS) for Movement Disorders is performed in a hospital.
Who Performs the Procedure?
The DBS for Movement Disorders procedure is performed by the following medical personnel, with or without assistance from an anesthesiologist:
- A neurosurgeon
How long will the Procedure take?
The procedure may take anywhere from 5-7 hours to perform.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Deep Brain Stimulation for Movement Disorders procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Deep Brain Stimulation for Movement Disorders procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure
What Tests are needed, before the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
Before a Deep Brain Stimulation for Movement Disorder procedure, the patient has to undergo certain tests such as:
- MRI or CT scan of the head
- Chest X-ray
- Routine blood and urine analysis
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Deep Brain Stimulation (DBS) for Movement Disorders procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
- What are the costs involved?
During the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure:
What kind of Anesthesia is given, during the Procedure?
Light sedation by injection may be used while making a skin incision during electrode implantation. General anesthesia by injection and inhalation is administered during implantation of the stimulator.
How much Blood will you lose, during the Procedure?
Minimal blood loss during an uncomplicated Deep Brain Stimulation for Movement Disorders procedure may be expected.
What are the possible Risks and Complications during the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Deep Brain Stimulation for Movement Disorders procedure are:
- Excessive bleeding
- Infection within the surgical wound
- Anesthetic complications
What Post-Operative Care is needed at the Healthcare Facility after the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
- After the DBS for Movement Disorders procedure, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
- Individuals are usually discharged from the hospital after an overnight stay if there are no complications
After the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure:
What are the possible Risks and Complications after the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
The possible risks and complications that may arise after a Deep Brain Stimulation (DBS) for Movement Disorders procedure are:
- Excessive bleeding
- Infection within surgical wound
- Disturbances of speech or balance
What is the Prognosis after the Surgery?
The prognosis after a Deep Brain Stimulation for Movement Disorders procedure depends on the proper selection of patient, proper identification of the brain areas to be targeted, and proper positioning of the electrodes. A vast majority of patients have improved symptoms after the procedure.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain that worsens and swelling of the surgical wound
- Bleeding or fluid drainage from the surgical wound
- The occurrence of any symptom that causes uneasiness such as nausea, vomiting, abdominal swelling, or constipation
- Signs of an infection
- Headache, muscle aches
- Fever, feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
At home, the following post-operative care is recommended after a Deep Brain Stimulation for Movement Disorders procedure:
- Slowly resume regular/daily activities
- Resume showering after the procedure, keeping the wound clean and dry. Avoid taking baths until the surgical wound is completely healed. Gently wash the surgical wound with mild or unscented soap
- Replace the dressings on the surgical wound after showering
- Avoid excessive neck stretching or vigorous arm movements, until the surgical wound heals
- Avoid driving until permitted by the physician
- Complete the course of prescribed medication under advice of the physician
- Take antibiotic medication to help combat or prevent infection, per your physician’s advice
- Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain (per the physician’s advice)
- Take proper note of instructions regarding making adjustments on the stimulator
How long does it normally take to fully recover, from the Procedure?
Good control of symptoms usually requires multiple adjustment sessions on the stimulator and may take a few weeks.
What happens to tissue (if any), taken out during the Procedure?
The DBS for Movement Disorder procedure does not involve the surgical removal of any tissue.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.
Who will you receive a Bill from, after the Deep Brain Stimulation (DBS) for Movement Disorders surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- A hospital
- An anesthesiologist (if anesthesia was administered)
- A neurosurgeon
The patient is advised to inquire and confirm the type of billing, before the Deep Brain Stimulation (DBS) for Movement Disorders procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA