Deep Brain Stimulation

Norton Neuroscience Institute is a leading center for deep brain stimulation (DBS) surgery for patients in Louisville and Southern Indiana, relieving the symptoms of movement disorders such as Parkinson’s disease, essential tremor and dystonia.

Early in the course of these disorders, patients may manage abnormal movements with medication. But as the disease progresses, patients may develop involuntary or disabling movements that medications cannot treat optimally. These symptoms can include tremors, motor fluctuations, slow movements, rigid muscles or erratic movements called dyskinesias.

DBS is a surgery for Parkinson’s disease, essential tremor, and dystonia that can reduce symptoms such as tremor of the hands, slow movements (bradykinesia), and rigid muscles. DBS does not slow the progression of movement disorders, nor does it cure the conditions, but it can improve quality of life.

Our board-certified and fellowship-trained specialists are experienced with deep brain stimulation and are at the forefront of new techniques that provide greater safety and better outcomes.

First in the Louisville Area to Routinely Perform ‘Asleep’ Deep Brain Stimulation

Historically, DBS surgery has been performed with the patient remaining awake during surgery. This is because the patient needed to respond or perform tasks to help the neurosurgeon correctly place the DBS electrodes in the brain. Many patients are anxious about being awake during brain surgery. They also must refrain from taking their medication on the day of surgery. Finally, the surgical risks are higher with the patient awake, compared with surgery under general anesthesia.

Abigail Rao, M.D., neurosurgeon with Norton Neuroscience Institute, was the first in the Louisville area to use advanced techniques that don’t require the patient to be awake during DBS surgery. This allows for greater patient comfort and lower surgical risks.

Patients considering DBS surgery are evaluated by our multidisciplinary team, which includes movement disorder neurologists and functional neurosurgeons and neuropsychologists, as well as physical therapists, occupational therapists and speech therapists.

At our monthly conference with all providers, the team discusses each patient’s case and makes recommendations. All these providers continue to care for DBS patients before, during, and after the surgery. Our dedicated DBS nurse navigator helps coordinate care and support our patients during the process. Our care team has specialized training and experience to provide a precise diagnosis of your condition and lay out a treatment plan customized for you.

Conditions We Treat With Deep Brain Stimulation

What to Expect If You Have Deep Brain Stimulation

  1. Meet with a neurologist, neurosurgeon or both. You meet with a movement disorder specialist to determine whether you could be a candidate for DBS. Your first appointment is with a neurologist who specializes in movement disorders, or neurosurgeon Dr. Rao, depending on your situation. During your first appointment, the doctor will review your complete medical history and do a neurological examination.
  2. Meet with the DBS team. In this step, you have a few appointments with different members of the DBS team. Norton Neuroscience Institute is unique in offering a dedicated DBS nurse navigator, who will help make, coordinate and explain these appointments. The visits are:
    • Physical therapy and occupational therapy — during these appointments, therapists who specialize in movement disorders will evaluate your fine motor movements, tone, stiffness, walking and balance. They will record video of your movement examination during two time periods (for a patient with Parkinson’s disease): when your medications have taken effect, and when you have withheld medications for a few hours.
    • Neuropsychology — this appointment evaluates your memory and thinking. We recommend you bring a caregiver or family member to this appointment.
    • Speech therapy — a speech therapist will evaluate your speech and swallowing function.
  3. Meet to discuss neurosurgery details. You will meet with our neurosurgeon to talk about the details of surgery and ask any questions. We will discuss what to expect after surgery, the risks of surgery, expected recovery and goals of surgery.
  4. Attend presurgery appointments. These appointments take place if, after the steps above, you decide to proceed with surgery.
  • MRI: This is a specialized scan with a 3 tesla (3T) magnetic resonance imaging (MRI) unit. The images allow your surgeon to plan where to place the electrodes during surgery. Your presurgery MRI usually is done without sedation. If you need sedation (medication to help you relax during the scan) for the MRI, or if the MRI images are not clear (for example, if you move), we will arrange for sedation.
  • Preanesthesia testing (PAT): You will have a general physical examination to make sure you are healthy enough for surgery and anesthesia.
  1. Undergo surgery in two stages: inpatient and outpatient. On the day of your inpatient surgery, you’ll come to Norton Brownsboro Hospital. In the operating room, you are placed under general anesthesia. Your surgeon takes a high-resolution computed tomography (CT) scan before surgery starts, to match up with your high-resolution MRI images from before surgery. This scan gives Dr. Rao additional information on placing the electrodes correctly.

After reviewing your scans in the operating room, the surgeon makes two small incisions, places the electrodes and uses CT scan to ensure the electrodes are in the correct place before leaving the operating room. Patients typically spend one night in intensive care and typically may be discharged the next day. This part is called stage 1.

The second part of your surgery (stage 2) happens three to 14 days after the electrodes are placed. You come to Norton Brownsboro Hospital and are placed under general anesthesia. Your surgeon puts the internal pulse generator (IPG), also called the stimulator, under the skin, usually just below the collarbone. Patients typically leave the hospital before the end of the day.

  1. Neurologists program your stimulator. Your stimulator is programmed in the neurologist’s office about two weeks after the stage 2 surgery. The neurologists will test your movements carefully during this initial programming. Programming is noninvasive and painless, and is done with wireless technology. The initial programming session takes about one hour, and typically a few programming sessions over the next few months are needed before you get the best symptom control from DBS.

You will get your own programmer device that will allow you to check the status of your stimulator, turn off the stimulator, and in some cases, make your own adjustments (under the safety guidelines of your neurologist).

Care That’s Focused on You

  • We have dedicated patient navigators who can help with transportation, schedule follow-up appointments and confirm that you can afford prescriptions.
  • We provide support groups and exercise classes, develop customized diet plans and help with issues such as access to disability assistance, housing, and financial and employment advice.
  • At Norton Neuroscience Institute, we want to help you get better as well as prevent you from getting sick in the first place. Get screened for numerous conditions and learn the signs of illness at Norton Healthcare Prevention & Wellness.
  • Communicate with your provider, manage appointments, refill prescriptions and more anytime from a computer or mobile device with a free MyNortonChart account.

About Norton Neuroscience Institute

More patients from Louisville and Southern Indiana seek treatment from Norton Neuroscience Institute’s nationally recognized neurologists and neurosurgeons than any other provider in the area.

  • We have more than 60 trained and experienced providers treating brain, spine and nervous system conditions.
  • We use advanced, minimally invasive neurosurgery equipment that can speed your recovery and help minimize pain.
  • We’ve created multidisciplinary clinics to give you the benefit of Norton Healthcare’s comprehensive range of experienced providers in oncology, cardiovascular, orthopedics and behavioral health.
  • Norton Neuroscience Institute patients have access to resource centers that include navigators to help with appointment booking, follow-up care, prescreening for clinical trials and tending to physical and emotional needs.
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