Deep Brain Stimulation Surgery FAQ: Top Frequently Asked Questions

1. When is a good time to consider deep brain stimulation?

When medication or other therapies do not produce the desired results for a patient with a particular neurological problem, deep brain stimulation (DBS) is a therapy option that is usually explored. DBS may be investigated for several disorders, such as dystonia, essential tremor, Parkinson’s disease, and specific forms of epilepsy.

The following suggests that now is a good time to think about DBS:

• Insufficient symptom management with medication: DBS may be taken into consideration if a patient’s symptoms are not adequately controlled with medication or if they are suffering from severe side effects.
• Progressive worsening of symptoms: DBS can be a possibility if the problem gets worse over time even with medication therapy.
• Functional impairment: DBS may be taken into consideration as a means of enhancing function and independence if the condition is substantially affecting everyday functioning and quality of life despite therapy.
• Suitability of the patient: Individuals must be able to withstand surgery and have stable health. They must have reasonable expectations regarding the procedure’s possible advantages and disadvantages.
• Assessment by specialists: Neurological tests, imaging analyses, psychological examinations, and conversations regarding the patient’s expectations and aspirations are all possible components of this evaluation.
• Trial stimulation: Before committing to a permanent implantation, patients may occasionally go through a trial stimulation period during which time temporary electrodes are inserted into the brain to evaluate the possible advantages of DBS.

2. What percent have seizures after deep brain stimulation surgery?

The occurrence of seizures after deep brain stimulation (DBS) surgery varies based on several variables, such as the particular ailment being treated, the electrode implantation site, and the medical background of the individual patient. The risk of seizures following DBS surgery is generally quite low.

The frequency of seizures following DBS surgery for different diseases has been the subject of several studies:

• Parkinson’s Disease: The reported incidence of seizures in patients with Parkinson’s disease undergoing DBS surgery is typically modest, ranging from 1% to 5%.
• Essential Tremor: With reported rates of less than 5%, the risk of seizures following DBS surgery is likewise comparatively low for essential tremors.
• Dystonia: After DBS surgery, the incidence of seizures varies but is generally low in individuals with dystonia, usually <5%.
• Epilepsy: While the risk of seizures following DBS surgery may be slightly higher in individuals with epilepsy than in individuals with other disorders, it is still generally lower than that of other surgical treatments for epilepsy.

It’s essential to remember that, even though the chance of seizures following DBS surgery is minimal, it still exists.

3. Are you a candidate for DBS?

The following broad standards may suggest that you are a potential DBS candidate:

• Diagnosis: DBS is mainly used to treat specific forms of epilepsy and certain movement disorders include essential tremor, dystonia, and Parkinson’s disease.
• Symptom Severity: Even with the best possible medical care, your symptoms should be severe enough to adversely affect your everyday activities and quality of life.
• Medication Response: You ought to have participated in a trial of medications appropriate for your conditions and encountered either severe side effects, insufficient symptom relief, or both.
• Medical History: You should be able to withstand surgery and anesthesia, and your general health should be stable. Other factors that might be taken into account are mental health and cognitive function.
• Realistic Expectations: Although many people report great symptom reduction, not everyone will benefit from it, and there are hazards involved in the process.
• Willingness to Commit: Having a DBS necessitates a major time commitment, as it involves surgery, continuing programming, follow-up appointments, and maybe medication modifications.

4. What happens after deep brain stimulation surgery?

Following deep brain stimulation (DBS) surgery, patients go through numerous stages of care and recuperation in the post-operative phase.

• Immediate Post-Operative Care: Vital signs are closely watched, and any post-operative problems that arise right once are dealt with.
• Hospital Stay: Depending on the patient’s condition and the particular procedures followed by the medical facility, the length of the hospital stay can vary but is usually a few days to a week.
• Programming and Adjustment: This includes optimizing symptom control while reducing negative effects by adjusting the electrode settings using a programming device. If necessary, programming sessions can last for several weeks or months to adjust the settings.
• Rehabilitation and Therapy: Following DBS surgery, rehabilitation and therapy may be advised. To help patients maximize their motor function and general quality of life, this may involve speech, occupational, physical, or other types of rehabilitation.
• Follow-up: Follow-up visits can happen more or less frequently; however, if the ideal results are found, they usually happen less frequently over time.
• Medication Management: To enhance the benefits of DBS therapy, the medical team will keep an eye on the patient and make necessary medication adjustments.

5. What is the duration of recovery?

The following is a general process for the healing process:

• Immediate Post-operative Period (Days to Weeks): Following DBS surgery, patients usually stay in the hospital for a few days to recuperate and be observed. They may feel some discomfort at the surgery site during this period, which is treated with painkillers.
• Healing and Recuperation (Weeks to Months): It’s critical to adhere to the post-operative care recommendations given by the medical staff, which include maintaining a dry and clean surgical site and taking any recommended drugs as instructed.
• Programming and Adjustment (Weeks to Months): Patients usually return to the clinic a few weeks following surgery to complete the DBS device’s first programming and adjustment.
• Rehabilitation and treatment (Ongoing):  Rehabilitation program to help patients maximize their motor function and general quality of life, this may involve speech, occupational and physical. Depending on the patient’s goals and level of development, rehabilitation may take a long time.
• Long-term Follow-up (Ongoing): Once the ideal conditions have been found, the number of follow-up appointments may gradually decline, but long-term monitoring is usually advised to guarantee the ongoing efficacy of the DBS therapy.

6. What are the tests done before and after DBS?

Below is an overview of some of the tests that are frequently run both before and after DBS:

• Imaging Studies: To see the structures of the brain and pinpoint the exact spot where electrodes should be positioned after surgery, MRIs or CT scans are usually carried out.
• Psychological Evaluation: To determine the patient’s capacity to handle the demands of DBS surgery and post-operative care, as well as their cognitive function and mental health, a psychological examination may be performed.
• Medical History and Physical Examination: To evaluate the patient’s general health and determine any possible contraindications or risk factors for surgery, a comprehensive medical history and physical examination are performed.
• Medication Trials: To determine which medications are most effective in managing side effects and reducing symptoms, patients may participate in trials of a variety of relevant medications.
• Baseline Evaluations: To create a benchmark for comparison following surgery, baseline evaluations of motor function, quality of life, and other pertinent variables are carried out.
• Neurological Evaluation: Neurologists evaluate patients regularly to watch their neurological condition, the resolution of their symptoms, and any possible side effects of DBS therapy.
• Visualization Follow-up: To evaluate the positioning and stability of the DBS electrodes and to identify any possible problems such as lead breakage or device migration, follow-up imaging investigations may be carried out.
• Psychological and Cognitive Evaluation: After DBS surgery, patients may experience recurring psychological and cognitive evaluations to track changes in their behavior, mood, and cognitive abilities.
• Functional Assessments: To gauge the long-term efficacy of DBS therapy, patients may be subjected to recurrent evaluations of their motor function, quality of life, and other pertinent parameters.
• Medication Management: To enhance the benefits of DBS therapy, patients’ medications may need to be adjusted. Medication management is still monitored for patients.
• Rehabilitation and Therapy: Following DBS surgery, patients can take part in rehabilitation and therapy programs to maximize their motor function and general quality of life.

7. Does your hair grow back after deep brain stimulation surgery?

Yes, hair usually grows back following deep brain stimulation (DBS) surgery in general. Nonetheless, the region where the DBS electrodes were inserted and the surgical incision was made may experience transient hair loss or thinning. This is often a transient phase of the healing process and is typical.

The size of the incision, the type of surgery performed, and individual variations in hair growth patterns can all affect how much hair is lost or thinned. After surgery, hair usually starts to come back a few weeks to months later as the scalp heals. To reduce the chance of infection and promote healing, patients should refrain from picking or scratching the area where they have an incision.

8. Can you have an MRI with the DBS device on?

The type of device and leads implanted, as well as the MRI machine’s compatibility with the DBS system, are some of the elements that determine whether or not you can undergo an MRI (magnetic resonance imaging) while having a deep brain stimulation (DBS) system in place. Here are some crucial things to remember: DBS System MRI Compatibility, type of deep brain stimulation (DBS), and DBS system’s MRI compatibility.

It’s crucial to speak with both your healthcare practitioner and the DBS system maker if you have an implanted DBS device and need an MRI to find out if it can be done safely.

9. Will others be able to hear the DBS device?

The DBS stimulator and wires are barely visible from the outside because they are positioned beneath the skin. The stimulator site will be more elevated in thin people, and the wire may look like a slightly larger vein, although this shouldn’t be seen through clothing. Usually, the incision has a slight scar.

10. Can I travel with my DBS Implant?

Yes, your DBS System is compatible with travel. Although they might inadvertently stimulate the implant, metal detectors, X-ray machines, security scanners, and other security equipment won’t harm it. Keeping your patient ID card on you at all times is advised because the implant has the potential to set off metal detector alerts. To charge your device while traveling overseas, you might require an outlet adaptor.

11. Is DBS only for tremor shaking?

No, the following are some circumstances in which DBS may be applied:

• Parkinson’s Disease: Tremors, stiffness (rigidity), slowness of movement (bradykinesia), and dyskinesias (involuntary movements) are among the motor symptoms of Parkinson’s disease that are frequently treated with DBS.
• Essential Tremor: DBS is frequently a successful treatment for essential tremor, a neurological condition marked by cyclical hand, head, or body shaking.
• Dystonia: Different types of dystonia, a movement disorder marked by involuntary muscular contractions that result in repetitive or twisting movements and abnormal postures, can be treated with DBS.
• DBS is occasionally used as a treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD), especially when conventional therapies have failed.
• Epilepsy: If your epilepsy is not responding to medicine or other therapies, DBS may be a possibility for you. To lessen seizure activity, certain brain regions are stimulated.
• Tourette Syndrome: DBS is being researched as a possible therapy for severe, unresponsive Tourette syndrome, a neurological condition marked by tics, or uncontrollable movements and vocalizations.

While many people with these disorders find great relief from their symptoms thanks to DBS, individual results may differ and it is not a cure.

12. Can I have a DBS implant if I have a pacemaker?

When you have a pacemaker or other implanted electronic devices, such as implantable cardioverter defibrillators (ICDs), the decision to have deep brain stimulation (DBS) surgery depends on several factors:
Safety of Coexisting Devices: While some DBS systems may not be appropriate for use in individuals who already have pacemakers or other implants, others may be made to work in conjunction with other implanted devices.

• Interference and Programming: Electromagnetic interference poses a risk to the DBS system and other implanted electronic devices, potentially impairing their respective functionality.
• Medical team’s expertise is crucial: Assessment of both DBS and cardiac devices can assess your particular circumstance, balance the advantages and disadvantages, and create a customized treatment plan that meets your requirements.
• Other Treatment Options: Since you already have a pacemaker, there might be safer alternatives available that don’t require DBS, depending on your medical history and condition.

13. How long does the battery last?

The model of the deep brain stimulation (DBS) device, the programming parameters, and the user’s usage habits are some of the variables that affect how long the battery lasts. However, a DBS device’s battery life usually lasts between three and seven years on average.

A DBS device’s battery life can be impacted by various circumstances, including:

• Device Model and Manufacturer
• Programming Settings
• Individual Use Patterns
• Battery Status Monitoring

Patients may experience changes in the control of their symptoms or receive notifications from the device indicating low battery status when the battery in a DBS device starts to run low.

14. How many programming sessions and follow-ups will you need?

Following deep brain stimulation (DBS) surgery, the number of programming sessions and follow-up appointments needed might vary based on a variety of factors, including the patient’s particular condition, reaction to treatment, and level of experience on the healthcare team. Here is a broad summary of what to anticipate:

• First Programming: To modify the DBS device’s settings, patients usually go through the first programming session once the surgical site has sufficiently healed.
• Follow-up Programming: Follow-up programming sessions can take place as often as every few weeks at first, and then less frequently as the ideal parameters are determined.
• Follow-up Appointments: Temporary Observation after Patients usually have multiple follow-up consultations with the healthcare team in the immediate post-operative period to track their healing, evaluate wound healing, and treat any urgent concerns or complications.
• Long-term Follow-Up: Long-term follow-up sessions might vary in frequency, although they are usually more frequent at first and gradually less frequent after the ideal conditions are determined.