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 .