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 bothersome abnormal movements with medication. But as the disease progresses, patients may develop bothersome or disabling movements that medications cannot treat optimally. These symptoms can include tremors, motor fluctuations, slow movements or rigid muscles, or involuntary, excessive 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.
1st in Louisville Area to Perform ‘Asleep’ Deep Brain Stimulation Routinely
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 can be anxious about being awake during brain surgery. Patients 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, 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 care for patients with DBS before, during and after the surgery. Our dedicated DBS nurse navigator helps to 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
Think of having DBS in six steps. They are:
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 are in 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. Neurosurgery – 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. Presurgery appointments – These appointments take place if, after the steps above, you decide to proceed with surgery. They are:
- 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 – You will have a general physical examination to make sure you are healthy enough for surgery and anesthesia.
5. Surgery – Surgery occurs in two stages. On the day of your 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 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 as soon as 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, 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.
6. Programming your stimulator – Your stimulator is programmed in the neurologist’s office about two weeks after Stage 2. The neurologists will carefully test your movements 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 (under the safety guidelines of your neurologist).