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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Neuro, Rehab

Deep Brain Stimulators (5858)

Deep Brain Stimulators (5858) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Neuro, Rehab

5858



Deep Brain Stimulators


What is a deep brain stimulator (DBS)?
A DBS is a device which is placed under the
skin and used to treat Parkinson’s disease,
essential tremor, and dystonia. The device
consists of an electrode and a battery. The
electrode is placed into the brain through an
incision in the skull. It is attached under the
skin to a battery placed in the chest just
below the collar bone. It may be one-sided
or two-sided, based on the symptoms.

How do I know if I am a good candidate
for DBS?
The evaluation for DBS surgery requires
meeting with a movement disorders team.
The team includes a neurologist,
neurosurgeon, and neuropsychologist. You
will also need to have an MRI. Once this is
done, the team will meet to review the
findings. They will give you a
recommendation whether DBS will help
you.

How do I prepare for this surgery?
To prepare, you will have a physical exam at
the hospital to make sure you do not have
any health problems that would affect the
surgery. Please bring a list of your
medicines with you to this exam.

We will ask you to permit us to videotape
you during these clinic visits. The videos
will be used to compare the changes before
and after DBS placement.

If you wish to talk with someone who has
been through this, we will give to you the
name and phone number of a person to call.

You may be asked to take part in research
studies. These will be explained to you
during your first visit. You may choose to
take part or not.

Surgery Schedule
Placement of the DBS is done in two steps.
In the first step, the electrode will be placed
in your brain. You will be awake for this
step. You will usually be ready to go home
the following day. You will need to plan to
have someone with you at home the first 24-
48 hours. If you are having electrodes placed
on both sides of your brain, this may be
completed at 2 different times. Your doctor
will explain the schedule best for you.

During the second step, the battery will be
placed in your chest. You will be asleep for
this step. Usually, you are able to go home
the same day. The device will NOT be
turned on until you return to the neurology
clinic for programming.

Preparing for Surgery
Please refer to your booklet “Having
Surgery at UW Hospital” for general
instructions

Stop taking aspirin or products which
contain aspirin (such as ibuprofen, Advil ,
and Motrin ) one week before your surgery
date.


Plan to shampoo with an antibacterial soap
the night before and the morning of surgery
to lessen the risk of infection. Do not eat or
drink after midnight. During your pre-
surgery visit, you will be told which
medicines to take the morning of surgery.

What happens during electrode
placement surgery?
After the MRI, you will be taken to the
operating room (OR). You will be placed in
a reclining position. Your head will be
cleaned with an antiseptic soap. Drapes will
be put on your head to keep the area sterile.
After a numbing medicine is used, an
incision will be made on the top of your
head and behind your ear. The staff will
explain these things to you as they are doing
them.

It takes 3-4 hours to place the electrode on
one side of the head. During this time, the
doctor and staff will ask you questions to
make certain the electrode is in the right
place.

The OR staff will move your legs and arms
for you during this time. This will help you
avoid the stiffness that can happen when you
stay in one position too long.

What happens during the second
surgery?
You will be asleep for this placement which
will take 1-2 hours. An incision will be
made in your chest. The incision behind
your ear will be re-opened. The doctor will
insert the battery into your chest, bring the
wire behind your ear down your neck to
your chest, and connect the two devices.
Once this is done, all parts will be under the
skin.




After Surgery (At Home)

Activity
Walk often, and have someone help you. It
is best to build your strength by taking
frequent, short walks. Going for walks can
be as simple as walking laps around a
kitchen table, or up and down a hallway in
your home. It is very important to move
often, and increase as you are able.

Household Chores/Hobbies
It is more important to take frequent, short
walks than to spend your energy on
household chores. After getting home, you
will need to rely on friends/family to help
with household chores. Slowly increase the
amount you do. Be aware of safety risks
caused by being over tired, healing from
surgery, and possible memory problems.

Until you see your doctor at your follow-
up visit:
ξ No heavy lifting, sports, running, etc.
ξ Do not use heavy or high-speed
machinery.
ξ No ladder or high places.
ξ No swimming or tub baths.

Driving/Travel
Do not drive until cleared by your doctor.
Avoid flying for 2-4 weeks. If you plan air
travel within six weeks, you should discuss
this with your doctor.

Work
You and your doctor will decide when you
are ready to go back to work. Most people
need 4-6 weeks to heal; but this varies based
on the type of surgery you had, how you are
feeling and the type of work you do.

Incision Care
Please follow the instructions in your
discharge packet for incision care. When it
is OK to get your incision wet, please use a


mild shampoo such as baby shampoo.
Avoid using a conditioner, dandruff
shampoo, or any combined
shampoo/conditioner products for 3 months.
These products can slow healing by causing
a build-up of dry skin.

If you are unable to shower, be sure to clean
the incision daily with mild soap and water.
You may have numbness, itching or slight
scabbing at the site. This is normal. It may
take months for the numbness to go away.

Look at your incision daily. Keep it clean and
dry. Do not rub the incision. Pat dry. Do not
apply creams.

Signs of Infection
ξ Increased redness, swelling.
ξ Drainage.
ξ Marked increase in pain.
ξ Fever greater than 100ºF.

After your sutures are removed, you should
still avoid dandruff shampoo and conditioners
for 3 months. Avoid use of permanent curling
solutions and hair dyes for 3 months. Protect
the area from sun and cold.

Some incisions have sutures that will dissolve
on their own. These make look like clear
fishing line. They will fall out gradually, and
may take 2-3 weeks. This incision requires the
same care as described above.

Pain
As your pain improves, you should decrease
the amount of narcotic pain medicine you
take. Your discharge medicines include other
medicines that you may take for postoperative
pain.
If you still have severe or increasing
headaches, call the Neurosurgery clinic at the
number below.

Reasons to Call Your Doctor
ξ Severe or increasing headaches
ξ Changes in your vision
ξ Continued nausea or vomiting
ξ Increased sleepiness
ξ Change in behavior
ξ Problems with walking or balance
ξ Any drainage from your incision or
any signs of infection, as listed above
When will the DBS be turned on?
You will be seen by the nurse practitioner in
the neurology clinic who will work closely
with you to evaluate how you respond to the
DBS. It may take many programming visits
over a few months before you notice an
improvement in your symptoms.

What if the DBS is turned off accidentally
after programming?
You will be given a Patient Programmer the
day of your surgery. This device allows you
to check if your battery is on or off. You
will be shown how to use it by our staff.

Will my medicines be changed after
surgery?
Each person has a different response to
DBS. Your neurologist, nurse practitioner,
and clinic nurse will work with you closely
to decide what changes need to be made in
your medicines. You may be able to
decrease the amount of medicine that you
take, but this will depend on your
symptoms.

Many medicines have side effects that may
affect how you feel and function after
surgery. Contact the neurology clinic if you
have concerns regarding any of these.

▪ Increased involuntary
movements (dyskinesia)
▪ Hallucinations
▪ Confusion or memory loss.


Are there any restrictions after I have the
DBS?
We do not recommend MRI scans after your
DBS is implanted. You may have an MRI
scan of your head done to check placement
of the DBS electrodes after surgery. The
battery will have to be turned off before the
scan and turned back on when the scan is
complete. The settings of the batteries must
be checked after they are turned back on in
case the MRI causes any changes.

The DBS affects the reading of an ECG.
You will not get a correct ECG reading with
the DBS on. It should be turned off before
the ECG is done. Once the ECG is finished,
it can be turned on.

You will need to take antibiotics before
having any dental work done for the first six
months after your DBS is placed. Tell your
dentist that you have an implanted device.

Phone Numbers

Neurosurgery clinic physican assistant
(608) 263-7502
Neurology clinic nurse practitioner
(608) 263-5442

If you have any questions or concerns once
you are home, please call the Neurosurgery
clinic. The clinic is open Monday – Friday
8:00am-5:00pm. The phone number is 608-
263-7502. After hours, this phone number will
reach the paging operator.

Ask for the neurosurgery resident on call if
you are having signs of infection or
increased pain. Ask for the neurology
resident on call if you are having problems
with confusion, dyskinesia, or other
medicine questions. Leave your name and
phone number with the area code. The
doctor will call you back.

If you live out of the area, please call 1-800-
323-8942.

















Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 8/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5858.