The device in your body: The DBS system has three main components, all of which are surgically implanted inside your body.
•The electrode: This is the part that goes into the brain. It is about 1.3mm in diameter, and 15 inches long, about the size (and flexibility) of a piece of cooked spaghetti. One end is placed in the brain, and the other extends out of the skull, through a small opening, and is connected to the next component: the lead extension.
•The lead extension: This part connects the electrode to the generator. It extends from the side of the head, and is tunneled under the skin down the side of the neck. You will be able to feel the connection as a small bump on the side of your head. This is then connected to the third component: the pulse generator.
•The pulse generator (or neurostimulator): This is the “brains” of the system and contains the battery, the microprocesser computer, and other circuitry to produce the electrical stimulation that goes to the electrode.

What DBS is

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Potential Complications: As with any implanted device, or surgical procedure, there is potential for infection. In the immediate postoperative period, the patient and caregiver should pay special attention to hygiene and be careful with the wounds. Wash your hands frequently, do not scratch or pick at the wounds, and use a freshly laundered pillowcase every night. Once the wounds have healed there should be very few problems over the life of the implanted device. Very rarely, there is an area of the wound that does not heal properly, this can appear as a small scab that does not resolve, or a little clear oozing after healing has occurred. This is called “skin erosion” and needs to be repaired as soon as possible to prevent infection. Our infection rate is less than 2%, and is highly preventable with good hygiene.
In the event of an infection, the device must be removed, and then reimplanted, once the infection has been resolved.

The programming: The pulse generator has circuitry that allows communication with a programming computer via a telemetry “wand” that is placed directly over the generator. The signals communicate right through your skin and clothing. Programming is non-invasive, and is done in the office setting; it requires no special preparation. It is best to attend programming visits in the “off” state, so that your symptoms and the effect of the programming can be properly assessed. Some of your symptoms will resolve almost immediately with programming, such as tremor and rigidity, but other symptoms may have a longer “lag” time response, such as dystonia and freezing. These can sometimes take hours or even days to respond to the stimulation, so patience is essential! We may have to try several programming combinations to achieve your best results so it’s important that you pay close attention to how you are feeling, and responding to your programming. Your feedback is the most important tool to a successful outcome.
•The Access Review device: You will receive a “remote” controller that will allow you to turn your stimulators on or off, or to check if they are on or off. This will not operate your TV or garage door :>) You will be given instruction on using this device after your implant.

How the DBS works: Movement disorders occur because of hyperactivity in specific structures of an area of the brain called the Basal Ganglia. This area includes the thalamus, globus pallidus, and subthalamic nucleus, all of which are established targets for deep brain stimulation depending on what condition you are being treated for. Microelectrode recording during the surgery will demonstrate the overactive discharge of the cells in these structures, and the pulses of the stimulation, set at a higher rate than the discharges, will effectively “neutralize” this hyperactivity, resulting in more normalized movement.

One side or both sides? Unless your symptoms are truly “unilateral” (on one side of the body only) you will need to have stimulators implanted in both sides of the brain. Our surgeons have learned through extensive experience that staging these implants one month apart significantly reduces the incidence of postoperative confusion and complications, and allows for a smoother recovery period.

External Magnetic fields: Our environment is full of electromagnetic activity, from cell phones, power lines, and all the devices in our homes and offices. Most of these signals are not powerful enough to interfere with the stimulators, and even if they do, the worst that can happen is it gets shut “off” and has to be restarted, using the access review device. It is extremely unlikely that you could suffer any permanent harm from exposure to magnetic fields in your normal daily life. Some of the more common EMFs you may encounter:
•Refrigerator magnets: Most people have these on the fridge to display pictures or hang documents. Problem is, every time the door is opened, and passes by the stimulator; it is exposed to the magnets. Suction-cup document holders can replace these magnets.
•Security terminals: People with stimulators should avoid the heavy-duty security terminals found at airports, sporting arenas, and courthouses. In addition to being shut off, some people have reported experiencing a “power surge” when passing through these devices. (Please note, the amount of stimulation that produces a surge is much less than the amount required to actually damage the brain.) Patients with pacemakers must follow the same precautions. You will be given a Medtronic ID card that will inform security personnel that you must be allowed to bypass these terminals.
•Cell phones: There have been no reported incidents of cell phone interference with DBS, however it is recommended that the phone not be held directly over the generator, so please do not store the phone in the chest pocket of your shirt!

•Home devices: The incidence is very low, but if you find your stimulator unexplainably off more than once, you must do some detective work around your enviroment, and figure out where the interference is coming from. With one patient, we traced it to the giant speakers in his 60-inch TV! Moving his chair two feet further back from the TV solved the problem.
•MRI: We have safely performed post implant MRI on hundreds of patients with no adverse effect. However, there are certain procedures and precautions that must be followed for patients with DBS. The MRI technicians at St. John’s are knowledgable and experienced with these techniques, so we prefer that you have any necessary scans at this facility. When this is not possible, we will communicate with the facility where you will be scanned, and make sure they know the proper procedure to follow.
•Medic Alert bracelet We strongly recommend that you purchase a bracelet that will identify your implant to health care providers. The office can assist you with purchasing one of these.

For the patient with Parkinson’s: DBS and dopaminergic drug treatment
After the implant, you must work closely with your movement disorder specialist or general neurologist to adjust your Parkinson medication to accommodate the changes in your symptom control and dopamine replacement needs. Each patient’s dosing must be managed individually. Some patients may reduce the medication from 50-70%, and others may remain on the same level they were before the surgery. Reduction of medication is not a measure of success, reduction in troubling symptoms and improvements in quality of life are.
For the first few months, keeping a diary of how much medication is consumed, along with a rating scale for activity, motor function, and feeling of well being, can be an extremely helpful tool for achieving this delicate balance.