Evaluation and Scheduling Process for DBS Treatment
At the Parkinson's Disease Center and Movement Disorders Clinic, our deep brain stimulation team performs comprehensive evaluations to determine if someone is a good candidate for DBS. The preoperative process includes the following steps:
1. Discussion and Initiation: Discuss DBS surgery with your doctor and initiate the evaluation process when appropriate.
2. Preoperative motor examination: This is done in order to gain a better understanding of which motor symptoms do or don't improve with medications, to help guide patient expectations of outcomes after DBS, and to ensure that DBS really does have some benefit to offer an individual. For patients with Parkinson's disease, this examination is done both "OFF" and "ON" medication.
3. Preoperative neuropsychological evaluation: This testing is done in order to gain a better understanding of a patient’s baseline thinking skills and emotional state; these features may need to be better addressed before having surgery.
4. DBS consensus meeting: Each DBS candidate is reviewed by the team of neurologists, neuropsychologists and neurosurgeon to determine whether DBS is an appropriate choice, and recommend which part of the brain is the safest to stimulate to control symptoms.
Once a patient is determined by team consensus review to be a good candidate for surgery, he/she will be referred to see the neurosurgeon and will proceed with scheduling DBS surgery and programming. The following steps are needed to get scheduled for surgery and postoperative programming:
1. Consultation with the neurosurgeon: You will need to have a one-on-one consult with the Baylor Medicine Neurosurgeons who will be performing your surgery and obtain the necessary pre-op clearances. During the consultation, our goal is to ease any stress you might be feeling and help you to understand what you can expect. Below are some things we recommend discussing at your consultation:
- Be sure you understand exactly what surgery is planned, along with the risks, benefits, and other options.
- Make sure the list of ALL the medicines, vitamins, supplements, and herbal remedies you take is up-to-date. Some may increase the risk of problems during your surgery. Your surgeon will tell you if you should stop taking any of them before the surgery and how soon to do it.
- If you take aspirin or some other blood thinner, ask your surgeon if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
- Make sure your surgeon and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
When the necessary pre-op clearances have been obtained, you will be scheduled for surgery.
2. Schedule surgeries (Baylor St. Luke's Medical Center - TMC)
- Stage I: Implantation of the brain electrodes
- Stage II: Implantation of the extension wires and battery (one to two weeks after stage I)
3. First postoperative programming session: About one month after stage I the battery is turned on for the first time. This will be the longest session, during which the neurologist decides where to localize the stimulation therapy.
4. Follow-up programming sessions: Five monthly appointments are intended to optimize stimulation and adjust medications. The process of "fine-tuning" DBS therapy may take more or less than six months in some patients.
Routine care following these initial steps will then depend on the individual. Most patients will continue to see the neurologist every three to four months for routine care, battery checks and troubleshooting.
Patients interested in being evaluated to determine whether they are candidates for DBS or other treatments, should contact the Parkinson's Disease Center and Movement Disorders Clinic, Baylor Medicine, Department of Neurology at (713) 798-2273.
If you or one of your family members are interested in more information about DBS, please email us at email@example.com, with "DBS" in the subject line.