This year, Vanderbilt Clinical Neurosciences is marking two important milestones: It is the 20th anniversary of our Deep Brain Stimulation (DBS) program, and the program is on track for the 1,000th patient to undergo DBS surgery by year’s end. We were one of the first centers in the country to perform DBS, and we are poised for more growth with a recent decision by the U.S. Food and Drug Administration to approve the surgery for people with earlier stages of Parkinson’s disease.
WHICH PATIENTS ARE GOOD DBS CANDIDATES?
Deep brain stimulation is not a cure nor a last resort for patients with movement disorders, but it is something to strongly consider when medications are not adequately controlling symptoms and quality of life is suffering. In the 20 years since the procedure received FDA approval, we have discovered that DBS is most effective in treating three types of patients:
- Essential Tremor – Patients who are not responding to a beta blocker or primidone; if two medicines fail, DBS should be considered.
- Dystonia – Patients who don’t respond to medicine or only respond for a brief period – and who are not responding to Botox.
- Parkinson’s – Patients who don’t respond to levodopa or other medicines. While DBS may improve movement, it does not address other symptoms of PD such as walking, thinking, and constipation problems – if these symptoms are not addressed by medicine. Because of the complexity of PD and its varying impact on the individual, it is important to rule out other conditions before turning to DBS.
CRITERIA FOR DBS SUCCESS
For patients to be considered for deep brain stimulation, they must be in good health for surgery; today’s bilateral surgery lasts approximately 4 hours. Other key criteria include:
- The patient cannot have a medical condition that requires routine MRI scans of the body; MRI interferes with DBS.
- The patient is willing and able to participate in the programming of the device, can travel to programming sessions and provide feedback.
- The patient must not have comorbid symptoms like heart failure that may be adversely affected by the surgery.
- The patient can be any age if these other criteria are met. Our youngest DBS patient has been a 12-year-old with dystonia; the oldest, an 86-year-old with Parkinson’s disease.
DBS SURGICAL PROCESS
Our advanced surgical targeting – using imaging, microelectrode recordings and data from nearly 1,000 DBS patients – has helped us refine the surgical process and improve outcomes. The DBS procedure occurs in a staged approach:
- Pre-Surgical Workup – If the patient meets the requirements in initial neurological evaluation, he/she undergoes neuropsychological testing to assess mood and memory, as well as a motor skills assessment.
- Stage 1 – For surgical planning, bone markers (small screws) are placed in the skull, followed by a special MRI and/or CT scan on the same day.
- Stage 2 – DBS electrodes are placed at the optimal target, with the patient awake and off medications (overnight hospital stay).
- Stage 3 – The DBS battery is implanted and connected to the brain wire (same day procedure).
- Stage 4 – Initial programming of stimulators (4-6 weeks after Stage 2).
- Stage 5 – Periodic appointments to adjust stimulator.
To refer a patient, please contact one of our DBS coordinators at (615) 875-5645 or (615) 322-0141.