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Deep Brain Stimulation and Parkinson’ s
Once out of the hospital, you take some time to let your body and brain recover. Then you start the process of programming and adjusting to daily life with DBS.
Recovery
In the days and weeks following surgery many people feel significant relief from Parkinson’ s symptoms. Some don’ t, and that’ s normal too. Any benefit is thanks to mild, expected brain swelling around the ends of the brain leads. As the brain heals and swelling lessens, symptom benefit lessens too. But benefit returns when the device is turned on and programmed.
It can be tricky to manage medication during this time. At first, you might feel like you need less medication. As your brain heals, you might feel you need more, even what you were taking before surgery. Talk with your doctor about how to adjust medication during this time.
During this time, incisions heal and shaved hair begins to grow back. You might wish, like some, to wear head scarves or hats when going out. Make sure these are clean to prevent infection. The skin on the scalp may feel numb or itchy for a few months as small nerves regrow. Resist the urge to scratch or rub incisions to avoid infection. About two weeks after battery placement, you see your surgeon who will inspect the incisions.
You may gradually resume gentle movement, sometimes with the guidance of a physical therapist. But you probably won’ t restart many other activities, like work or exercise. Doctors may also limit driving and alcohol intake for at least two weeks while the brain recovers.
In the months following DBS, some people put on weight, often because they have less dyskinesia, tremor and other symptoms that required a lot of calories. For those who are underweight prior to surgery, these pounds may be welcome. But for others, weight gain is unwanted and frustrating. During your DBS evaluation, talk with your team about this possibility and what you can do to limit or avoid weight gain. Meet with a dietitian, if possible, who can monitor your weight, calculate calorie needs and help you plan an eating pattern to meet those needs.
Programming
A few weeks after battery placement, you have the initial DBS programming visit. At this appointment, your clinician will:
+ Turn on and program DBS Just as with lead placement surgery, you won’ t take Parkinson’ s and tremor medication the morning of this visit. But bring medications along so you can take a“ test” dose after programming. Have a loved one drive and join you.
Using a computer tablet, the clinician programs one lead at a time. They slowly increase electrical stimulation and test different combinations of electricity. Most people don’ t feel the stimulation; it’ s not like a“ jolt” or“ zap.” With each setting, the clinician watches you tap your fingers and toes, open and close your hands, or walk down the hall to check for benefit. They also ask whether you have side effects, like tingling or numbness in the arms or legs, which are easily fixable with programming adjustment.
Initial programming can take an hour or more. Once you find good settings, you take a low dose of medication to see how the medicine and DBS work together. This directs further DBS adjustments and medication changes.
+ Prescribe medication adjustments The clinician may tell you to decrease or discontinue certain medications following the initial programming. This begins the process