Acknowledgement
We would like to thank Dr Tra Mi Phan, Movement Disorders, Medtronic Neurological Europe, for her contributions to this section.
The Surgical Procedure A Parkinson's care team consisting of a neurologist, neurosurgeon and team of nurses is involved in caring for DBS patients. The DBS system is implanted by a functional stereotactic neurosurgeon, that is, a neurosurgeon who specializes in treating central nervous system function disorders using stereotactic techniques. This means that a stereotactic head frame is used to keep the patient's head still during surgery and the neurosurgeon uses special imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) to map the brain and locate the site to be stimulated - either the STN or GPi.
There are two parts to the surgery: the procedure to implant the leads, and the surgery to implant the neurostimulator(s) and extensions. The duration of the procedure and the specific steps involved can vary. The surgery will last several hours. Some surgeries last up to eight hours or more.
Although the prospect of surgery can be scary, there is some comfort in knowing that patients who have the DBS system usually describe the surgery as demanding and exhausting, but not painful. Fortunately, the brain itself has no pain receptors and feels no pain.
The hospital stay is usually a few days for the pre-operative tests, implant surgery and recovery.
After surgery, follow up visits are necessary. This is because the computer chip inside the neurostimulator must be programmed to send the electrical pulses to help control Parkinson's disease symptoms.
The physician uses a programmer to non-invasively program (transmit instructions to) the DBS system. People respond to deep brain stimulation in their own way and the program for the neurostimulator is customized to each patient's needs.
Visits to the clinic for initial programming after surgery and periodic adjustments are a routine part of DBS therapy. It will take more than one visit to adjust the stimulation and medication before the right combination is determined. As the patient becomes accustomed to DBS therapy and the body fully heals, further adjustments will be needed. Over time as the disease progresses, further adjustments may be necessary. Ongoing, periodic visits are a routine part of the process.
