If DBS is planned for both sides of the brain, there will be two surgeries approximately one to two weeks apart. The total time for the first day is typically six to eight hours, and includes anesthesia evaluation, placement of a halo (see #5 below), brain imaging, surgical planning, placing the electrodes, and time in the recovery room. An overnight stay in the hospital is required for monitoring. A brain scan is performed (often in the operating room) to check for complications and electrode location. Patients are discharged home the next day provided they are feeling well and there are no problems seen on the scan. If any difficulties are experienced, the hospital stay may be extended.
The second surgery is to implant the pulse generator (IPG) which also contains the battery and connect it the wires that are already in the brain. This is typically done one to two weeks later as an outpatient day surgery, and takes about two hours. Patients go home that same afternoon or evening.
If a unilateral (one-sided) surgery is planned, the entire procedure (electrode implantation and battery placement) can be done on a single day.
There are no formal recovery or rehabilitation recommendations after DBS surgery. The surgeon will provide care instructions for the incision sites, medications to prevent infection and manage pain, and activity restrictions at the time of discharge after each procedure. Patients are advised to "take it easy" and to use common sense and their best judgment about returning to work or other usual activities.
The DBS is turned on at the neurologist’s office during the first programming session, about four weeks after the electrode implantation, to allow for any potential swelling to subside. Early activation before return to an established postoperative state may result in insufficient programming or side effects.
We are fortunate to have three different devices available for the surgical treatment of patients with movement disorders: Medtronic Activa®, St. Jude Infinity® and Boston Scientific Vercise® therapy can all be implanted at Baylor Medicine. Each of these devices has different specifications and may be considered on a case-by-case basis. Device selection is usually made in conjunction with your neurologist during the preoperative assessment.
A "halo" is a metal frame placed on the head that is required by the neurosurgeon to optimize placement of the electrodes inside the brain. This is typically attached to the skull the morning of the surgery and is kept in place until the electrode placement surgery is complete. If patients are uncomfortable with the halo, the anesthesiologist can administer medications to ease the discomfort. As mentioned, procedures can be performed without the halo, and are managed on a case-by-case basis.
Most patients are kept in a state of conscious sedation so that they are comfortable during the procedure. However, this sedation is lifted during the time that the electrodes are being placed in the brain so that the neurosurgeon can hear the electrical activity of the brain (microelectrode recording). After the target brain structure is reached, the targeted brain structure will be stimulated with electricity while the patient is asked to perform simple tasks to assess the degree of symptom control and for side effects. These steps are also essential to ensuring that the electrodes are placed in the best location to address the condition.
In some cases, it may be recommended that the electrode surgery be performed under general anesthesia. Additionally, patients participating in certain research protocols may also undergo the surgery under general anesthesia, and with MRI guidance only. No testing or microelectrode recording are performed in these situations.
During the surgery where the battery is placed and connected, general anesthesia is used.
The brain is the only part of the body that has no sensation, so even though conscious sedation is used, patients do not feel the electrode being inserted. There may be some sensations of pressure as the holes are made in the skull through which the electrodes are placed. However, most people say that the most uncomfortable part of the procedure is when the halo is placed. There will likely be some soreness over the incision sites after each surgical procedure.
At minimum, a portion of the scalp will need to be shaved on either side in order to ensure clean access to the brain for the neurosurgeon and to prevent infections. Some patients and some surgeons prefer to shave the whole scalp, but this can be discussed on an individual basis with the neurosurgeon.
A postoperative wound check with be scheduled with the neurosurgeon about two weeks after the surgery. This appointment will be coordinated alongside the surgery scheduling.
The first programming session in the neurologist's office takes place about four weeks after the stage I electrode surgery, and is scheduled once the OR date is finalized. It is imperative for patients with PD to present to the neurologist's office OFF all PD medications past midnight the night before for ALL programming sessions. This is the only way to assure that effects and side effects are coming from the DBS alone.
We will make every effort to coordinate visits for our out-of-town patients.
Medications for the neurologic condition or general health issues will not change after surgery. Patients are usually given an antibiotic and pain medications after brain surgery. Medications for management of the movement disorder are not adjusted until after the first programming session.
Immediately following surgery, the surgical area should be kept clean and dry until the wound has fully healed. Heavy lifting or over-strenuous activities should be avoided. Specific care instructions for the surgical sites will be provided at the time of hospital discharge.
Once the electrodes and battery are implanted, MRI scans can be performed with certain device types and under specialized protocols. The appropriate specifications are in place at the Baylor Radiology suites, but are not reliably in place elsewhere. Please contact us directly if such scanning is requested by other doctors.
Patients should not undergo diathermy after DBS implantation. Diathermy is a technique used in physical therapy in which deep heating of tissues is accomplished by a high frequency electrical current. Ultrasonic treatments or investigations without diathermy can be performed. Patients should check with their neurologist first if a therapist is recommending this type of treatment.
Initial device activation must be performed in the neurologist's office at the first programming session. This is not done immediately after surgery to allow time for the brain to recover from the procedure itself. All patients undergoing DBS will have a control device that allows them to turn the system on and off, and check the status of the battery. This capability will be explained at the first programming appointment. Depending on the particular condition and situation, the neurologist may program the device to allow the patient to adjust specific parameters at home.
After the first programming session, patients should expect to come in on a monthly basis for up to five more visits to optimize DBS settings and medications. In PD cases, it generally takes about six months to go through the process of DBS and medication adjustment. For ET, this process may be shorter. For dystonia and TS, this process will probably take longer. Each case is different, but regardless of the situation, this process should not be rushed because it may take a few days or weeks to see the full effect of a programming session.
Follow-up appointments after this initial optimization period may occur every three to four months, depending on the needs of the patient, the disease being treated, or other factors. The battery needs to be checked at least annually to determine when it is time for a battery exchange.
Brain and body MRIs can be performed safely with some device types under specialized protocols. The appropriate specifications are in place at the Baylor Medicine Radiology suites, but are not reliably in place elsewhere. Please contact us directly if such scanning is requested by other doctors.
A brain MRI scan to check the electrode location may be requested if difficulties are encountered with programming.
All questions related to preoperative neurological evaluations, programming appointments, DBS adjustment, medication adjustment, and the underlying neurologic condition should be directed to the neurologist's office:
Parkinson's Disease Center and Movement Disorders Clinic
Phone: (713) 798-2273
All questions related to surgery scheduling and care of the surgical site should be directed to the neurosurgeon's office:
Baylor Medicine Neurosurgery
Phone: (713) 798-4696
All questions related to preoperative neuropsychological assessments should be directed to Baylor Medicine Neuropsychology:
Baylor Medicine Neuropsychology
Phone: (713) 798-8673
More about DBS
Click on the links below to find out more about DBS for Parkinson's Disease and Movement Disorders