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.
How to program your DBS
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.
- Your first programming appointment will take 2 to 3 hours. During this visit, we will test your response to stimulation and record what levels of stimulation cause side effects.
- You will need about 4 to 6 more visits to program your stimulator to the best setting. Getting to the best setting can take as long as 6 to 8 months.
- We will give you a remote control to check that your stimulator is on. The team will teach you how and when to use it during your programming appointments.
Stop taking your PD or tremor medications at midnight, the night before each programming appointment, unless you are given other instructions.
Adjusting your medications
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.
Follow-up care
Family Doctor
Make an appointment with your family doctor to have your staples removed 10 to 14 days after surgery.
Neurosurgeon
You will see your neurosurgeon 6 to 8 weeks after your surgery. They will check your condition and incisions.
Neurology Team
After your IPG is programmed to the best setting, you will have follow-up visits with the neurology team every 4 to 6 months.
Levodopa Challenge Tests
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.
Psychiatrist
You may have follow-up visits to make sure there are no concerns about your mental health after surgery.
Neuropsychiatrist
You may have follow-up appointments and neuropsychological tests to assess your memory and mental abilities after surgery/
Brain MRI
You may have more brain imaging during your recovery and follow-up care.
Your Neurology team will compare the results for all your follow-up tests with ones you had before surgery to see how well the DBS treatment is working for you.
IPG Battery
Checking the battery
- The IPG battery lasts about 3 to 5 years, depending on the amount of energy used.
- Each time you visit the DBS clinic, they will check the battery. You will learn how to check it with your own remote control.
Low battery
- The DBS team will refer you to the neurosurgeon to replace the battery. This will be done in day surgery.
- Your neurosurgeon's office will send you some forms to be filled by your family doctor. They will arrange for blood tests, and echocardiogram and chest x-ray to be done at the hospital.
- If you do not live near the hospital, they will send you requisitions to have these tests done in your community.
- You may need to see your neurosurgeon to sign a consent form for surgery.
Changing the battery
- The neurosurgeon replaces the battery during surgery. After surgery, you will go to the Day Surgery Unit.
- A member of the DBS team will program your IPG with the stimulation settings you had before the battery was changed.
- You will go home the same day, usually within 4 hours.
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).
Staying safe with DBS system
You must follow these rules for your health and safety.
Always carry your DBS Registration Card
- Before you leave the hospital, you will get a temporary registration card for your DBS system from the company that makes it. A permanent card will be mailed to you. Carry this card with you at all times.
Tell all your health care providers that you have a DBS system
- All your health care providers need to know that you have a DBS system implanted in your body so they can take steps to keep you safe.
- Consider getting a Medic Alert bracelet. In an emergency, the bracelet tells medical staff that you have a DBS system.
NEVER apply heat to your DBS system
- Do not put heat on any part of your DBS system as this could damage it and harm you.
- Do not have diathermy treatments (heat therapy), which deliver energy to heat and heal tissues in your body.
Check with your doctors before having an MRI
- The safety of having MRI of your brain or body depends on the type of DBS system you have and the MRI services. This chart is a general guide.
| DBS Manufacturer | Head MRI | Rest of the body MRI |
|---|
| Medtronic – Old systems | Only allowed at Toronto Western Hospital | Not allowed |
| Medtronic – New systems | Allowed in any radiologic service but with restrictions | Allowed in any radiologic service but with restrictions |
| Boston Scientific | Not allowed | Not allowed |
| St. Jude Medical | Not allowed | Not allowed |
Check with your doctor or the manufacturer of your device before having other medical procedures.
- Most medical procedures are safe (such as CT scan or x-rays), but some need extra precautions, and others are not possible because they could cause serious harm.
