Deep Brain Stimulators
What is a deep brain stimulator (DBS)?
A DBS is a device which is placed under the skin and used to treat Parkinson’s disease, essential tremor, and dystonia. The device consists of an electrode and a battery. The electrode is placed into the brain through an incision in the skull. It is attached under the skin to a battery placed in the chest just below the collar bone. It may be one-sided or two-sided, based on the symptoms.
How do I know if I am a good candidate for DBS?
The evaluation for DBS surgery requires meeting with a movement disorders team. The team includes a neurologist, neurosurgeon, and neuropsychologist. You will also need to have an MRI. Once this is done, the team will meet to review the findings. They will give you a recommendation whether DBS will help you.
How do I prepare for this surgery?
To prepare, you will have a physical exam at the hospital to make sure you do not have any health problems that would affect the surgery. Please bring a list of your medicines with you to this exam.
We will ask you to permit us to videotape you during these clinic visits. The videos will be used to compare the changes before and after DBS placement.
If you wish to talk with someone who has been through this, we will give to you the name and phone number of a person to call.
You may be asked to take part in research studies. These will be explained to you during your first visit. You may choose to take part or not.
What do I do before surgery?
Stop taking aspirin or products which contain aspirin (such as ibuprofen, Advil®,and Motrin®) one to two weeks before your surgery date.
Plan to shampoo with an antibacterial soap the night before and the morning of surgery to lessen the risk of infection. Do not eat or drink after midnight. During your pre-surgery visit, you will be told which medicines to take the morning of surgery.
What will happen during placement of the DBS?
Placement of the DBS is done in two steps. In the first step, the electrode will be placed in your brain. You will be awake for this step. You will spend the first night in an intensive care unit (ICU). You will be on a general care unit for one or two more days before you go home. Some patients may find the symptoms improve for a short time after this placement, even though the electrode will not be turned on at this time.
During the second step, the battery will be placed in your chest. You will be asleep for this step. You will go to the general care floor after the placement. The next day, you can go home. The device will NOT be turned on until you return to the neurology clinic for programming within 1 to 2 weeks.
What happens during the first surgery?
If you have Parkinson’s disease, you will come to the hospital on the day before surgery. Your medicine will be adjusted.
If you have essential tremor or dystonia, you will be asked to arrive at the hospital at 6:00 am and go to the First Day Surgery Unit (FDS). Enter the main hospital entrance and follow “Main Street” to the left to the “D” elevators. Take the “D” elevator to the 3rd floor, turn left and follow the signs to the FDS entrance.
In the FDS, an IV will be started for giving you fluids. The nurse will also place a tube into your bladder to drain the urine. You will be taken to MRI for a scan of your brain. Before the MRI scan is done, you will have a frame placed on your head. We will shave your head at this time.
After the MRI, you will be taken to the operating room (OR). You will be placed in a reclining position. Your head will be cleaned with an antiseptic soap. Drapes will be put on your head to keep the area sterile. After a numbing medicine is used, an incision will be made on the top of your head and behind your ear. The staff will explain these things to you as they are doing them.
It takes 3-4 hours to place the electrode on one side of the head. During this time, the doctor and staff will ask you questions to make certain the electrode is in the right place.
The OR staff will move your legs and arms for you during this time. This will help you avoid the stiffness that can happen when you stay in one position too long.
What happens during the second surgery?
A nurse from the FDS Unit will call you to tell you what time to arrive. Plan to shampoo and bathe with an antibacterial soap the night before and the morning of surgery to help lessen the risk of infection. Do not eat or drink after midnight. You should take your Parkinson’s or tremor medicine before surgery. Take all medicines with small sips of water only.
You will be asleep for this placement which will take 2 – 3 hours. An incision will be made in your chest. The incision behind your ear will be re-opened. The doctor will insert the battery into your chest, bring the wire behind your ear down your neck to your chest, and connect the two devices. Once this is done, all parts will be under the skin.
What should I do at home after surgery?
- After the first surgery you will have dressings on top of your head and behind your ear. You may notice a lump near the incision behind your ear. This is a cap at the end of the electrode, and will be taken out at the second surgery. The head dressings should remain on for 2 days after surgery. After that, the dressing should be changed daily for 5 days. On day 6 the incision no longer needs a dressing. You may shower but should not submerge your head under water. You may use a gentle shampoo such as baby shampoo and then pat the incision dry. You should not use a comb or brush near the incision. You will visit the neurosurgery clinic to have the stitches removed in 10 – 14 days.
- Avoid driving until after your two week follow-up visit.
- Do not lift items weighing more than 10 pounds (a gallon of milk).
- Avoid bending forward with your head down.
- Walk as much as you can each day.
- Watch for these signs and symptoms
- Increased drainage from the incision sites.
- Change in the amount of pain at the sites. Expect some tenderness at the sites for a couple of weeks. You will be given a prescription for pain medicine when you leave the hospital
- Temperature greater than 101.5° F by mouth.
If you notice any of these symptoms, call the numbers below.
About 10 days after the second surgery, you will see the doctor. Your stitches will be taken out. You should keep watching for the signs and symptoms listed above.
When will the DBS be turned on?
The first programming session will be scheduled no sooner than two weeks after your electrodes are placed. You will be seen by the nurse practitioner in the neurology clinic who will work closely with you to evaluate how you respond to the DBS. It may take many programming visits over a few months before you notice an improvement in your symptoms.
What if the DBS is turned off accidentally after programming?
You will be given a Patient Programmer the day of your surgery. This device allows you to check if your battery is on or off. You will be shown how to use it by our staff.
Will my medicines be changed after surgery?
Each person has a different response to DBS. Your neurologist, nurse practitioner, and clinic nurse will work with you closely to decide what changes need to be made in your medicines. You may be able to decrease the amount of medicine that you take, but this will depend on your symptoms.
Many medicines have side effects that may affect how you feel and function after surgery. Contact the neurology clinic if you have concerns regarding any of these.
- Increased involuntary movements (dyskinesia)
- Confusion or memory loss.
Are there any restrictions after I have the DBS?
We do not recommend MRI scans after your DBS is implanted. You may have an MRI scan of your head done to check placement of the DBS electrodes after surgery. The battery will have to be turned off before the scan and turned back on when the scan is complete. The settings of the batteries must be checked after they are turned back on in case the MRI causes any changes.
The DBS affects the reading of an ECG. You will not get a correct ECG reading with the DBS on. It should be turned off before the ECG is done. Once the ECG is finished, it can be turned on.
You will need to take antibiotics before having any dental work done for the first six months after your DBS is placed. Tell your dentist that you have an implanted device.
Neurosurgery clinic nurse practitioner (608) 263-1410
Neurology clinic nurse practitioner (608) 262-0550
After hours, holidays and weekend, you will reach the hospital paging operator. Ask for the neurosurgery resident on call if you are having signs of infection or increased pain. Ask for the neurology resident on call if you are having problems with confusion, dyskinesia, or other medicine questions. Leave your name and phone number with the area code. The doctor will call you back.
If you live out of the area, please call 1-800-323-8942.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 07/20/2011
Copyright © 07/20/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5858
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