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DBS is a treatment for many movement disorders (particularly for Parkinson's disease, dystonia, tremor and other involuntary movements) that can help patients when medication does not work well enough.
The target areas for DBS are small parts of the brain involved in making and controlling movements. DBS cannot cure these conditions or change the progression of the disease, but it can relieve symptoms and improve quality of life.
After all your screening assessments are done, your neurology team will:
A few months after the referral to your neurosurgeon, you will meet them to:
Once you have met the neurosurgeon, all of the health care practitioners that have assessed you will meet to discuss your case and decide together whether you should have surgery. A member of the neurology team will call you to explain the decision.
If you agree to have DBS surgery, your neurosurgeon's office will schedule:
You have your pre-admission clinic appointment a few days or weeks before your surgery. This visit takes about 3 to 4 hours in order to obtain blood work, an ECG, an x-ray and a consultation with an anesthetist. The pre-admit nurse will review instructions on how to prepare for the surgery.
Please bring the following with you:
If there are any changes in the booking of your surgery, you will be called by the pre-admission department.
If you cannot go to your surgery, call the doctor's office as soon as you know. If you are unable to reach the doctor, then leave a message at the surgeon's office.
Part of planning for your surgery is making arrangements for someone to:
When you arrive at the Pre-Operative Care Unit (POCU) in the Fell Pavilion (2nd floor) at 6:00 am, check-in at the reception desk. Please have the following ready:
After check in, the nurse will admit you and help you get ready for surgery. They will check your blood pressure, pulse, temperature and breathing. They will also put an intravenous (IV) in your arm and help you change into a hospital gown.
We put a special frame on your head. This frame has 2 pins at the front and 2 at the back to keep your head still during surgery. We give you medication (local anesthetic) with a small needle to numb the areas where the pins are put in.
You will have pictures taken of your brain. You will have a brain MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scan. These tests create detailed images of your brain that help your neurosurgeon position the DBS electrodes. Please try to stay as still as possible. This helps the technician get the clearest pictures of your brain.
After the tests, you will go to the holding area. A nurse will check that everything is ready for your surgery. You will see the anesthetist, who will give your anesthetic and monitor you during your surgery.
When everything is ready, you go to the operating room. The surgical team helps you move onto the operating table and get comfortable. The table is angled so your back is raised, but not all the way. Your head frame is attached to the table to keep your head still.
You may be given a sedative to make you relaxed but awake enough to answer questions about how and what you feel when the electrodes are stimulated. Your answers help the neurosurgeon confirm the right placement of the electrodes.
The neurosurgeon will:
The anesthetist will give you medication (general anesthetic) so you will be asleep during this part of the surgery.
The surgeon will:
Step 1 takes 4 to 6 hours, depending on the number of electrodes needed and the complexity of the surgery. Some patients have Steps 1 and 2 done together. Others have Steps 1 and 2 done separately, two or three days apart. If you are having Step 2 later, the end of your electrodes will be left outside of your head and covered by a bandage.
Step 2 takes about 45 minutes.
When the surgery is finished, you will go to the Post Anesthetic Care Unit (PACU) for 1 to 3 hours to recover.
When you are ready, you will go to your room in the Neurosurgery Unit 5A or 5B.
The day after your surgery, we may invite you to take part in research studies to help us learn more about how the brain works. You can decide whether or not you wish to take part. Your decision will not affect your care in any way.
You can expect to go home 1 or 2 days after the IPG is placed in your chest.
Before you leave the hospital, we will:
On the day you go home, please arrange to be picked up before 11:00 am.
Go to the nearest emergency department or call 911 if you have any of the following:
At home, your medications will remain the same until your DBS is turned on.
In the weeks following surgery, you may feel a temporary improvement in your symptoms, even though your DBS system has not been turned on yet. This is due to swelling caused by the electrodes. As the swelling goes away, your symptoms will likely return.
Please allow 4 to 6 weeks to recover from the surgery. Then you may return to your usual activities. Please talk with us if you have any questions or concerns about returning to work.
Don't ever do any activity that could overheat your stimulator (such as using tanning beds, hot tubs, saunas and steam rooms) until your incisions are completely healed.
Look at your incisions every day and watch for these signs of infection:
If you notice any of these signs or symptoms, please tell your neurosurgeon, nurse coordinator or nurse practitioner as soon a possible.
It is important to check mood and behaviour after surgery and after DBS programming sessions.
You or your family members need to report any changes to your health care providers.
Your DBS system will be off for several weeks. Once it is turned on, it will deliver continuous stimulation to the target area of your brain. This helps relieve your symptoms all day and night.
Programming means adjusting the electrical impulses from your IPG. This can begin when your brain has recovered completely, which is usually within 8 weeks after surgery.
Programming is done in a series of clinic visits over several months.
Stop taking your PD or tremor medications at midnight, the night before each programming appointment, unless you are given other instructions.
As your symptoms improve, your neurology team may begin to reduce your PD medications. Your medications must not be stopped suddenly, so carefully follow any instructions to slowly reduce your medications.
Programming your DBS and adjusting your medications takes time. The result will be the best relief of PD or tremor symptoms with the least side effects.
Make an appointment with your family doctor to have your staples removed 10 to 14 days after surgery.
You will see your neurosurgeon 6 to 8 weeks after your surgery. They will check your condition and incisions.
After your IPG is programmed to the best setting, you will have follow-up visits with the neurology team every 4 to 6 months.
You may have videotaped assessments of your symptoms (while OFF and ON Levodopa) at 1, 3, 5 and 10 years after surgery to monitor your PD or tremor symptoms and responses to brain stimulation over time.
You may have follow-up visits to make sure there are no concerns about your mental health after surgery.
You may have follow-up appointments and neuropsychological tests to assess your memory and mental abilities after surgery.
You may have more brain imaging during your recovery and follow-up care.
Your Neurology team will compare the results of all your follow-up tests with the ones you had before surgery to see how well the DBS treatment is working for you.
Some batteries are rechargeable and can last 9 years or longer. If you have this type of battery,
you must recharge it regularly (every day for close to 1 hour or every week for many hours).
You must follow these rules for your health and safety.
Check with your doctor or the manufacturer of your device before having other medical procedures.
You will be contacted with information about your first appointment.
Please bring the following to your appointment. Not all of these items may be needed for your appointment. Our clinic or your referring doctor will let you know what you must bring.
Please arrive 15 minutes before your appointment.
When you arrive, you will sign in with the receptionist. You will need your health card (OHIP card) to sign-in. If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver’s license or passport.
You may be given a Measuring Health Equity Questionnaire to fill out. This form contains questions about your background. We collect this information to find out who we serve and what unique needs you may have. The form is voluntary and you can choose ‘prefer not to answer’ to any or all questions. However, the information you choose to give us will help us improve the quality of care for you and others.
First appointments take longer than follow-up appointments. Your first appointment can take 2 hours or more. Follow-up appointments usually take 15 to 30 minutes. We do everything we can to stay on time but sometimes unforeseen circumstances may delay your appointment.
At the end of your first appointment, the nurse or doctor will give you a contact list for your health care team. If you don’t get a contact list, feel free to ask for it.
After every appointment, a member of your health care team will tell you about your next visit. Be sure you understand what is going to happen next. For example, know the time and place of your next visit or if someone will call you with this information.
If you are unsure about what your next steps are, don’t be afraid to ask a member of your team. We are here to help you.
We understand that reaching us by phone can sometimes be difficult. Often our phone lines are busy or are turned over to the message centre so our staff can prepare for clinic visits or help other patients. We make every effort to return your call within 24 hours. Our staff will try to reach you 2 times. If we are not able to reach you directly you may need to call us again.