9Before Surgery
If you are a good candidate for DBS, the team will plan details, such as:
+ Which device and battery to use Three DBS manufacturers offer several FDAapproved devices. While the components and effectiveness are the same, the capabilities and your clinicians’ experience may differ. Each device offers both rechargeable and non-rechargeable batteries.( For more, see pages 12 and 13.)
+ Where to place brain wires, called leads or electrodes There are several brain“ targets” for DBS wires. The two most common are the STN( subthalamic nucleus) and the GPi( globus pallidus interna). When deciding the best target, your team considers your symptoms, the need and / or goal to reduce medication, and your cognition and mood. Leads may be placed in one or both sides of the brain. Each side of the brain controls the opposite side of the body, so a lead in the left side of the brain
Researchers are working to better understand the complex brain circuitry involved in Parkinson’ s and how DBS impacts that circuitry. This may help identify new DBS targets or combinations of targets, such as both STN and GPi in the same person. And it could lead to ways to address a wider range of symptoms, including freezing of gait, which often does not respond to DBS, and maybe also lessen some of the potential nonmotor complications of DBS. eases symptoms on the right side of the body, and vice versa.
+ Where to put the battery The most common location is in the chest, below the collarbone. The battery typically goes on the right side in case there’ s a future need for a cardiac pacemaker, which goes on the left. In some people, especially those who are very thin, doctors may place the battery in the abdomen or, rarely, closer to the armpit. Depending on the device and number of leads, you could get two batteries, one on each side.
+ How to do the procedure Lead placement is most often done while a person is awake. This allows doctors to see benefits and side effects in real time. Some centers now offer DBS while a person sleeps, under general anesthesia, using real-time brain MRI to guide lead placement.
If you get a lead in each side of the brain, doctors may place them at the same time, in a single procedure, or one at a time, in two separate procedures spaced a month or so apart with observation and recovery between.
+ What medical conditions to monitor or treat These could include anxiety, blood pressure changes or other symptoms that might impact the procedure. Those with anxiety or claustrophobia may need additional calming medication for imaging tests or surgery. People with blood pressure problems may need closer monitoring during surgery.
+ What medications to adjust or hold You may need to stop aspirin, blood thinners or similar medications for a short period. You may also need to stop certain Parkinson’ s medications, such as selegiline or rasagiline( MAOB inhibitors) temporarily, as these could interact with anesthesia. Your DBS and anesthesia doctors will let you know which medications to hold and when prior to the procedure.