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Moving Forward Together: Restorative Neurosurgery

Information for New Patients


How to Become a New Patient

What Should I Know About DBS?

Am I a Candidate for Deep Brain
Stimulation?

Patient Information

Frequently Asked Questions:

How to Become a New Patient

1. Contact your physician (primary care, neurology, or other) for a referral.

2. Have your physician’s office fill out a referral form or fax your demographic information. Your provider can obtain a referral form by downloading this form, calling us at 518-262-5088 or by emailing at movement@mail.amc.edu

3. Ask your provider’s office to fax us the following information:

  • Your demographic information
  • Copies of your insurance card(s)
  • Your recent medical records specific to your movement disorder
  • Faxed this information to (518) 262-5088

Please feel free to contact us by phone or e-mail if you do not hear from us within five business days.

Phone: (518) 262-5088
Email: movement@mail.amc.edu

 

What Should I Know About DBS?

A thin metal wire is placed in the brain through a dime size hole and attaches to a pacemaker-like battery in the chest. The procedure is generally done in two parts and the patient stays one overnight in the hospital each time. DBS is changed for each patient over the course of the following months while medication is decreased. This is done in an office setting.

DBS alters abnormal function of the brain tissue in the region of the stimulating wire. Success of the surgery is based on finding the specific area in the brain for stimulation. DBS reduces, but does not eliminate symptoms of disease. Our movement disorders team worksclosely with research scientists to bring new therapies from the laboratories to patient care.

There are more medical and surgical options than ever before for patients with Parkinson’s disease, essential tremor or other movement disorders. Deep brain stimulation (DBS) surgery offers important symptomatic relief when quality of life is no longer acceptable on optimal medical therapy.

If you have had symtoms of Parkinson’s disease for five years, or you are taking medications frequently and without the same benefit you once had, you may benefit from an evaluation for DBS.


Am I a Candidate for Deep Brain Stimulation?

Our services are offered in a multidisciplinary setting that includes the expertise of neurologist, neuropsychologists and neurosurgeons. Our dedicated staff is sensitive to patient needs, and delivers easy-access, high-quality service and exceptional care.
Most patients with movement disorders are initially treated with medications. But with long-term use of medications and with disease progression, disabling side effects can occur, including excessive movements. When patients no longer have an acceptable quality of life with medical therapy, surgical treatments may be considered, among them, deep brain stimulation, or DBS.

For patients with early Parkinson’s disease, levodopa (sinemet) and other antiparkinsonian medications are usually effective for maintaining a good quality of life.  However, over time medications can produce disabling side effects. Sometimes patients develop troublesome dyskinesias and/or their medications no longer last as long as they once did. It is generally at these times when DBS is considered. Please refer to Dr. Pilitsis’ webcast on DBS surgery from October 22, 2011 for more information.


Frequently Asked Questions

What are the benefits of DBS surgery? 

The major benefit of DBS surgery for Parkinson's disease is that it makes movement in the off-medication state more like the movement in the on-medication state.  It treats symptoms. The best result that you will have is the best you currently are when your medications are working. This will not make you like you were before Parkinson’s disease. It is very important to discuss this fully with your doctors prior to surgery.

What are the risks of DBS surgery?

The most serious potential risk of the surgical procedures is bleeding in the brain, producing a stroke.  This risk varies from patient to patient, depending on the overall medical condition, but the average risk is about 1%.  If stroke occurs, it usually occurs during, or within a few hours of, surgery.  The effects of stroke can range from mild weakness that recovers in a few weeks or months to severe, permanent weakness, intellectual impairment, or death.  The second most serious risk is infection, which occurs in about 5-8% of patients.  If an infection occurs, it is usually not life threatening, but it may require removal of the entire DBS system.  In most cases, a new DBS system can be re-implanted when the infection has cleared.  Finally, hardware may break or erode through the skin with normal usage, requiring it to be replaced.

In the first few days after surgery, it is normal to have some temporary swelling of the brain tissue around the electrode. This may produce no symptoms, but it can produce mild confusion. This confusion, which occurs in one-quarter of patients, is often very concerning to the family, but usually resolves within the first two weeks.  Patients should plan to have 24-7 help at home for the first one to two weeks after surgery.

What type of follow-up is needed after surgery?  Who will program the DBS unit?

Patients normally leave the hospital the day after surgery. Patients then come back approximately one week later to have the battery placed.  This operation is performed under general anesthesia.  Nothing should be taken by mouth after midnight the day of this surgery. Patients may take Parkinson's disease medications with a sip of water the morning of surgery for this second surgery. Patients should expect to have soreness from the procedure, but generally tolerate the procedure well and are discharged home that day or the following morning.  We ask the patients to return to our clinic two weeks later for suture removal and check of the incisions. Approximately two-four weeks later to see the neurologist for initial programming. The neurologist will then adjust the device and the medications. 

How long does it take before the full benefit of DBS is apparent?

For reasons that are not fully understood, the improvement in symptoms may take a few hours or days to reach its maximal level following a programming change.  Some problems may respond more quickly than others.  In addition, to realize the full benefit of DBS, medication changes and multiple programming sessions may be needed.  Thus it is usually three to six months after surgery before the final degree of benefit is actually realized.

Can patients control the DBS device themselves?

Following surgery, the patient is given the Access Review unit, a hand-held battery-operated unit that can be used to determine if the device is on or off, to turn it on or off, and to check battery life. 

Are there any restrictions on a person’s activity after a DBS system is implanted?

For one week after surgery, the incisions should be kept dry. It is OK to shower as long as the incisions are not washed. Do not put any creams, antibiotic ointment, vitamin E, etc. on the incision for six weeks after surgery. After the incisions are completely healed (six weeks), the patient may return to all normal activities, including exercise.  Normal physical activities will not harm the device.  Security devices (such as those in airports or stores) will not harm the device, although in rare cases they may activate the on-off switch, thus turning off a DBS system that had been on.  The loss of benefit to the patient may take minutes or hours to be apparent.  When traveling extensively away from home, patients should carry their Access Review unit so that they can easily re-activate the DBS system if it is de-activated by a security device.  Additionally, a patient may never have a body MRI.  Certain brain MRIs are possible, but should only be performed at Albany Medical Center on the MRI which has been set up according to device manufacturers regulations.  Diathermy should never be used.  If any other surgical procedure is scheduled in the future, the surgeon should be alerted that the patient has a DBS system in place.


Patient Information

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