Norton Neuroscience Institute is a leading center for deep brain stimulation surgery in Louisville and Southern Indiana. The minimally invasive procedure can relieve the symptoms of epilepsy and movement disorders such as Parkinson’s disease, essential tremor and dystonia.
If you have one of these conditions, typically you’ll manage bothersome symptoms with medication. As the disease progresses you may develop bothersome or disabling movements and side effects that don’t respond as well to medication. For movement disorders these symptoms can include tremors, changes in your ability to move, slow movements, rigid muscles or involuntary, excessive movements called dyskinesias.
Deep brain stimulation, or DBS for short, can reduce symptoms such as tremor of the hands, slow movements (bradykinesia) and rigid muscles caused by Parkinson’s disease, essential tremor and dystonia. DBS does not slow the progression of movement disorders and isn’t a cure. DBS surgery can improve quality of life.
If you have epilepsy, DBS surgery may help. The procedure does not cure epilepsy. It helps manage your seizures without impacting other parts of their brain.
DBS surgery is a minimally invasive procedure. Your neurosurgeon accesses your brain through one or more small holes in your skull. You won’t need to shave your head.
With highly specialized tools, your neurosurgeon places small wires inside your brain that are connected to a device implanted in your chest. The device sends impulses to the brain that provide electrical stimulation that interrupts nerve signals that cause symptoms such as tremors, rigidity and stiffness.
Deep brain stimulation can improve motor symptoms, which affect your ability to move, by up 50% in many cases. Sometimes, patients see symptoms improve by 80% or more.
Our board-certified and fellowship-trained neurosurgeons have extensive experience with deep brain stimulation and are at the forefront of new techniques that provide greater safety and better outcomes.
Historically, DBS surgery has been performed while the patient is awake. The patient would remain conscious to respond or perform simple tasks to help the neurosurgeon correctly place each electrode.
Being awake during brain surgery rightly made many patients anxious and required they skip their medication on the day of the surgery. Being awake during surgery also increases surgical risks.
Abigail J. Rao, M.D., neurosurgeon with Norton Neuroscience Institute, was the first in the Louisville area to use advanced techniques that allow the patient to be unconscious during DBS surgery.
If you are considering DBS surgery, you’ll be evaluated by our multidisciplinary team, which includes movement disorder neurologists, functional neurosurgeons and neuropsychologists, as well as physical therapists, occupational therapists and speech therapists.
At our monthly conference, the team of medical providers in the deep brain stimulation program reviews your medical records and other data. With their specific areas of expertise and experience with DBS devices, team members discuss each patient and make recommendations. Having multiple physicians bring their viewpoints is like getting multiple opinions at once.
The same team cares for you before, during and after the surgery. We have a patient navigator dedicated to DBS patients to help coordinate care and support you 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.
If you are a candidate for deep brain stimulation, you’ll go through six steps.
You’ll meet with a movement disorder specialist to determine whether you could be a candidate for DBS. Your first appointment may be with a neurologist or neurosurgeon, depending on your situation.
During your first appointment, the doctor will review your complete medical history and perform a neurological examination to determine your eligibility for DBS.
In this step, you have a few appointments with different members of the DBS team. The DBS patient navigator will help make, coordinate and explain these appointments. The visits are:
You will meet with our neurosurgeon to talk about the details of surgery and ask any questions you may have. We will discuss what to expect after surgery, the risks of surgery, expected recovery experience and goals of surgery.
Pre-surgery appointments: These appointments take place if, after the steps above, you and your medical team decide to proceed with surgery. They are:
Surgery occurs in two stages. The first stage places the electrodes in your brain under general anesthesia at Norton Brownsboro Hospital. Your surgeon takes a high-resolution CT scan before surgery starts, to match with high-resolution MRI images that were captured previously. This scan gives Dr. Rao additional information on placing each electrode correctly.
After reviewing your scans in the operating room, the surgeon makes two small incisions, places the electrodes and uses intraoperative CT scan to ensure the electrodes are in the correct place before leaving the operating room. Then you typically would spend one night in intensive care before being discharged, often the next day.
Stage 2 of the DBS procedure happens three to 14 days after the electrodes are placed. At Norton Brownsboro Hospital and under general anesthesia, your surgeon puts the internal pulse generator, also called the IPG or stimulator, under the skin, usually just below the collarbone. Typically, you would leave the hospital before the end of the day.
Your stimulator is programmed in the neurologist’s office about two weeks after Stage 2. 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 programming device that will allow you to check the status of your stimulator, turn off the stimulator, and in some cases, make your own adjustments within safety guidelines established by your neurologist.
It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.
More patients from Louisville and Southern Indiana seek their neurology and neurosurgery care from Norton Neuroscience Institute’s nationally recognized specialists than any other providers in the area.
Your Norton Neuroscience Institute medical provider has the expertise, experience, diagnostic tools and sophisticated treatments to provide care tailored to your needs.
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