Posted on May 7th, 2008 by Administrator
Mov Disord. 2008 Jan 9; Deep brain stimulation hardware complications: The role of electrode impedance and current measurements.
Sierra Farris, Jerrold Vitek, Monique L Giroux
Deep brain stimulation (DBS) is an effective therapy for advanced Parkinson’s disease patients. Successful DBS outcomes depend on appropriate patient selection, surgical placement of the lead, intact hardware systems, optimal programming, and medical management. Despite its importance, there is little guidance in reference to hardware monitoring, hardware troubleshooting, and patient management. Technical manuals produced by the hardware manufacturer (Medtronic, Minneapolis, MN) are not presented in an applied clinical format, making impedance and current measurements difficult to interpret when the results are not straightforward. We present four patients with evolving DBS hardware complications that occurred during long-term follow-up, that shaped our clinical protocol for long-term care management and hardware troubleshooting. (c) 2007 Movement Disorder Society.
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Filed under: General
Posted on May 3rd, 2008 by Administrator
Questions for the surgical team:
- Who is on your team?
- Are you fellowship trained, if not, where did you get your training for DBS?
- Who will be in the operating room?
- How do you measure your outcomes and are they accessible?
- How long until the surgery can be scheduled?
- How many trips will I have to make?
- What are the steps involved in the surgical process, am I admitted the night before, will I be sedated for the burr holes, if not can I be sedated for the burr holes?
- How long does your typical surgery last?
- Can I have a counselor in the operating room if I get nervous?
- Will you shave my whole head?
- Do you use the small or bigger battery, (soletra versus kinetra)? why?
- Will you do one or both sides of my brain, do I need both sides?
- How many people have you implanted with STN? GPi? Vim?
- What are you complication percentages?
- How many hemorrhages, infections, broken wires, short circuits, nerve damage from tunneling, pneumonia, deaths?
- Has anyone died or experience difficulty waking up after the surgery?
- What percentage of improvement is average for your patients in the off medication state?
- Who do I call if I have problems after surgery, how do I reach them?
- What is plan B if I can’t reach the on call person or the person has no idea what to do?
- How many of your patients required repositioning of the wire?
- How long have you been doing DBS surgery?
- Is DBS the focus of your practice?
- Who provides DBS programming for your patients?
- How long until I can drive or fly?
- When can I go back to work?
- When can I have sex?
Questions to ask your programmer:
-
How long after surgery should I wait for the first programming? Why?
- How long will the first and consecutive programming appointments last?
- How often can I come in for programming?
- Is there a place to get lunch near the clinic?
- Are there wheelchairs accessible at the clinic?
- Will I be able to lie down if needed during programming?
- Is DBS the focus of your practice?
- Who provides supervision if a non-MD?
- How many patients have you programmed?
- How many different brain targets have you programmed?
- What are your goals for stimulation? (ie. Tremor, stiffness, etc.)
- What are your outcomes programming in the medication off state?
- Will you refer if you don’t know what to do next?
- About how many broken wires or short circuits have you diagnosed?
- Do you know someone that can help with programming if needed?
- What if I have too much dyskinesia, do you program more often?
- Who will make medication adjustments?
- What kind of training have you had?
- What was your most difficult programming and why? What did you do?
- Will I need to come in off medications and how many times will I need to do this?
- Who do I call if I have problems?
- Can I be seen the next day if problems come up, if not how long until I can get in?
- Who takes your place if you are on vacation?
- Where did you learn to program?
- Who is or was your mentor for programming?
- When my programming is optimized, do I go back to my Neurologist?
- Will you work with my Neurologist with medication changes?
Questions to ask yourself:
-
What are my goals for DBS stimulation?
- Can DBS meet my goals?
- Except for tremor, which symptoms that are bothersome to me respond to my PD medications?
- Do I understand what symptoms will and will not improve with stimulation?
- Can I make it to the required programming appointments?
- Is there a programmer in my area or will I have to drive or fly to see a programmer?
- Does my lifestyle allow for living with implanted hardware?
- How many patients have I met with DBS?
- Is my family supportive with my decision to have DBS?
- Do I have any mood problems that may interfere during the procedure since I will be awake?
- Can I commit to long term follow-up care?
- Do I have any joints that may need replacement since I cannot have an MRI after DBS?
- Do I have back pain that may need a MRI in the near future?
- Can I avoid magnetic devices within inches of my chest, ie electric hand tools?
- I am not an arc welder.
- Now that I have had DBS for a while, do I need rehab to get tuned up?
- Now that I have had DBS for a while, will the symptoms that bother me respond to medication or can a physical therapist help, such as gait freezing?
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Filed under: General
Posted on May 3rd, 2008 by medicinedog
Anyone know a good DBS for dystonia programmer in the Little Rock Arkansas area?
Thanks,
Dee
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Filed under: General
Posted on April 19th, 2008 by Lynne Slat
I am looking for a DBS programmer who works in the Oshkosh/ Fox Cities or Milwaukee area. Ceratinly, I would love to blog with ANY DBS programmers!
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Filed under: General
Posted on March 15th, 2008 by Administrator
Visit http://www.neuralinterfaces2008.com/ for information about the upcoming Neural Interfaces Conference. One day is devoted to DBS!
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Filed under: General, DBS Conferences
Posted on March 15th, 2008 by Administrator
Help other people find DBS programmers. Programmers are in short supply and many people have difficulty finding experienced programmers. This service is free to patients and open to any medical professional that programs neurostimulator devices.
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Filed under: General
Posted on March 15th, 2008 by Administrator
Posted on February 29th, 2008 by Administrator
Posted on February 13th, 2008 by Administrator
I will be having DBS surgery in March. My tremors have been getting substantially worse over the past several months. I decided to see a neurologist to see if “new” meds are now available since I was first diagnosed 30+ years ago. After much research I made an appointment with Dr. Siddiqui at Wake Forest University in Winston-Salem, NC. Needless to say I was delighted to learn of DBS. I now have an appointment next Mon. 2/18 to see the neurosurgeon who will perform the surgery. The tremors now are affecting most areas of my life from typing on the computer keyboard to putting on makeup and most importantly affecting my passion for art and crafting. I am so looking forward to being able to again paint and woodburn the fine details I enjoy in my art and cross stitch and sew etc. I will submit another comment after the surgery for those who would like a first-hand explaination of the procedure. (See North Carolina Page link to leave comments for this member)
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Filed under: My Story, Newly Added Programmers
Posted on February 10th, 2008 by Administrator
http://www.dbsprogrammer.com/ohio.html
Please see the link above, if any blog members can respond with personal experience with any programmers in Ohio, please respond.
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Filed under: General
Posted on February 2nd, 2008 by Administrator
Starting over from scratch can potentially uncover more effective stimulation settings or in many cases eliminate stimulation side effects without jeapardizing benefit. We discover the most common problems or changes in stimulation include:
- a different electrode is found to provide better symptom control
- overuse of voltage and other stimulation parameters
- trying to target symptoms that will not respond
- underlying side effects that impair function including gait and speech
- electrodes are not in the target
- other conditions such as stroke is the culprit for worsening symptoms
- at least 50% of patients with problems have broken or malfunctioning hardware systems
- person is undermedicated
Any person that has lost benefit, never attained the benefit noted by medications before surgery or seems to be getting worse faster than the years before surgery may benefit from a detailed close look at their programming to meticulously review all the factors that can affect the benefits of deep brain stimulation therapy.
Check back for personal stories from individuals that have been re-programmed and their outcomes. Sierra
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Filed under: General
Posted on January 18th, 2008 by Administrator
Question:
What are the typical criteria dor DBS implant for Essential Tremor and do most insurance companies cover the cost?
Answer:
Essential Tremor was approved for DBS implantation in the thalamus in 1997 and was the first condition approved by the FDA allowing for insurance coverage. Insurance typically covers the cost of the surgery with the exception of copays.
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Filed under: General
Posted on January 8th, 2008 by Administrator
Move your mouse over the category ‘How to use this site’.
If you have problems, post here or send the webmaster and email, webmaster@dbsprogrammer.com
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Filed under: How to use this site
Posted on January 6th, 2008 by Administrator
The time period varies depending on the diagnosis, medication changes, battery life. Most people likely see their programmer when they notice symptoms re-emerge or change significantly. Best to have an evaluation if symptoms are returning or feel unusual, small programming changes do occur over the long-term, depending on the diagnosis and brain target.
Moderator
QUESTION:
What is the normal period of time between “tuneups”? I am grateful for having received the stimulator but lately I have noticed a wavering or unsteadiness in the affected hand. What causes this? Thank you!
Annonymous
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Filed under: General
Posted on January 5th, 2008 by Administrator
Patient stories help other people learn about what to expect with DBS.
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Filed under: My Story
Posted on January 2nd, 2008 by Administrator
New Blog for improved communication and information sharing.
Continue to ask questions using the Blog for faster responses.
Start a DBS support group, post your meeting times and locations.
Find a DBS support group or other people living with DBS.
Find a local programmer.
Learn about surgical programs through patient stories.
Watch for downloadable presentations about DBS; we will continue to update the blog with our seminars.
Write a comment, sign into a State and help others with questions about DBS or how to find a programmer, Neurologist or surgical center.
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Filed under: General, About the Prog Blog
