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Deep Brain Stimulation
Deep Brain Stimulation is a revolutionary surgical technique that uses electrical stimulation to improve symptoms of patients with neurological and psychiatric disorders such as Parkinsons’s disease, Essential Tremors, Dystonia and Obsessive Compulsive Disorder. Using a battery pack and wires the size of an angel hair pasta, this technique can control abnormal brain circuits in the same way a pacemaker controls an abnormal heart rhythm. Deep Brain Stimulation is a safe procedure, approved by FDA, and is effective in treating neurological symptoms in patients with movement disorders. At the University of Miami Movement Disorders Center over 600 patients have been implanted in the past 10 years. We are using the most innovative techniques in surgical planning, brain imaging and microelectrode recordings to obtain excellent outcomes.
To establish if you are a good candidate for DBS you will need to undergo an evaluation at the University of Miami Movement Disorders Center. We will try to accommodate these visits in the shortest amount of time possible.
- Evaluation by Movement Disorders Neurologist - You will be evaluated to make sure you have the proper diagnosis and that you are a good candidate for surgery. You will discuss the procedure in detail with the neurologist and you will have time to ask questions. You will be asked to stop your Parkinson’s medications 12 hours prior the visit. Motor symptoms will be assessed by the movement disorders neurologist before and after taking your Parkinson’s medications.
- Evaluation by Functional Stereotactic Neurosurgeon - In the same day you will be seen by the neurosurgeon and you will discuss the surgical technique and possible risks.
- Evaluation by Neuropsychologist - You will undergo a detailed neuropsychological evaluation to determine if you have memory problems. The tests will last 3-4 hours and will be done in a different day.
- MRI of Brain - A 3 Tesla MRI with DBS protocol will be performed at University of Miami before the surgery. Once these visit are performed, your case will be discussed in the in the Multidisciplinary DBS Meeting with the movement disorders neurologists, neuropsychologists and neurosurgeon to decide if you are a good candidate for surgery.
Deep Brain Stimulation Surgery
If you are considered a good candidate for surgery you will be scheduled by our coordinator for surgery. You will need proper clearance for surgery (chest x-ray, blood work, EKG). The surgery will be done in 2 stages.
Stage 1 - In the morning of surgery you will come to the hospital and will meet the surgical team. A metal frame will be applied on your head using local anesthesia and a CT scan will be done. This will be used together with the MRI to find the exact spot where the DBS lead will be placed. After the CT, you will be taken to the operating room and you will be slightly sedated. A small hole will be drilled in your skull by the neurosurgeon and a tiny microelectrode will be inserted in your brain. For this part of procedure you will be awake and the neurologist will listen to the electrical signal in your brain to identify precisely the best place for stimulation. Once this is done the DBS lead is placed and effects of stimulation are checked in operating room while you are awake.
Stage 2 - A week later you will come for the placement of a battery pack under you collar bone and to connect the wires in the brain with the battery.
Deep Brain Stimulation Surgery Programming
One to two weeks after the stage 2 you will come for activation of your device. Adjustment of the device may take from couple of weeks to months. Your neurologist will increase the stimulation and select the best parameters and will adjust your medication as well. After these adjustments you will need to follow up every 3-6 months for battery checks.
Frequently Asked Questions
The ideal candidate for surgery is a PD patient who has responded well to levodopa but started experiencing wearing off or dyskinesia. To be a candidate for surgery you must be in good health and have no cognitive impairment. The evaluation by the multidisciplinary team at University of Miami Movement Disorders Center will determine if you are a candidate or not.
DBS surgery increases the ON time without dyskinesia and improves tremor, rigidity, slowness and dystonia. If you have poor balance, cognitive impairment, trouble speaking, you may not benefit from the surgery.
You should identify an academic center with good track record and long experience with DBS. University of Miami Movement Disorders Center has a dedicated clinical team with a neurosurgeon specially trained in stereotactic surgery, movement disorders neurologists that perform intra-operative brain mapping and neuropsychologists specialized in PD. Our nursing personnel is trained in post-operative care and programming the deep brain stimulator and available to respond immediately if needed.
DBS surgery will reduce the medication by 50 percent or more in the months following surgery, so it is likely that you will need to take some medications in addition to the stimulation.
NO, deep brain stimulation is not a cure. The surgery will be able to control some of the PD symptoms such as such as dyskinesia, tremor, slowness, rigidity and wearing off but the disease will still progress.
Battery life depends on the intensity of the stimulation. It may last anywhere from 3 to 10 years depending on the type of battery you have.
Since DBS is an approved FDA therapy and considered standard of care most private insurers, Medicaid and Medicare will cover the expenses of deep brain stimulation surgery, including the operation, anesthesia, neuroimaging, hospital care, physician’s fees, and the stimulator devices.
Recommended Resources
- Smart technology helping patients with Parkinsons Disease
- Deep Brain Stimulation – Dr. Luca"
- Health Beat: Deep brain stimulation for Parkinson’s video
- Deep Brain Stimulation brochure
- Deep Brain Stimulation flyer
- Bike riding, surgery help control Parkinson’s tremors / Miami Herald
To schedule a DBS evaluation at University of Miami please call 305-243-2781.
UHealth Spine & Brain Center
1321 NW 14 Street, Suite 306,
Miami, FL, 33125
First Program in South Florida to Implant Stimulator
The University of Miami is the first Deep Brain Stimulation program in South Florida to implant a new FDA approved state of the art Deep Brain Stimulator system using steerable current leads and Bluetooth generators allowing for easier patient-device interaction and more precise stimulation. The program is the first in the state of Florida to implant these new bluetooth enabled generators.
To schedule an appointment with a board-certified DBS specialist, please call 305-243-2781, Monday through Friday, 8 a.m. to 5:30 p.m., Eastern Time.