Holiday meals

Holiday meals can be very stressful for caregivers for persons with dementia. Here are some tips to keep the meals pleasant.

  1. Tell your guests about the dementia diagnosis ahead of time. If can be very confusing for all if the diagnosis is kept as a secret.
  2. Consider the timing of the main meal. If your family member with dementia typically is anxious or agitated in the afternoon or evening, consider having a brunch for your holiday meal.
  3. Recruit family members to help. For example, if your family member typically carves the turkey, but now you feel nervous about this, ask a grandson or daughter to take “Dad” in another room to read a book, watch a football game, for look at family photos. Identify this helper ahead of time and coach him or her carefully.
  4. At the table, put your family member with dementia between two people he or she knows well. This will make him or her feel more comfortable.
  5. Avoid skipping meals. For example, don’t skip lunch in anticipation of a large evening meal. Stay on your familiar schedule. If you are too busy to think about lunch, have another family member take your care-recipient out for a slice of pizza, or sit with him while he eats a peanut butter sandwich.
  6. Avoid large amounts of alcohol. Your family member may like a glass of sparkling cider as much as a glass of wine, and he or she will be able to stay engaged with the event longer.
  7. Ask your family member to lead the family in the traditional prayer, song, or story. This communicates to him or her that she is valuable to the family.
  8. Plan to take the next day “off” so both you can recover.

Again, don’t hesitate to ask others for help. This gives others an opportunity to support you during the holidays and this can be very gratifying for them. They will also learn about your care-recipient and hopefully, can be more engaged in future events. This also teaches younger family members about the value of respecting elders and can give them a sense of accomplishment. Make sure to tell them how much you appreciate their help at the end of the event, or write them a note later.

For more help, visit the Alzheimer’s Association’s website: www.alz.org or call their helpline: 1-800-272-3900.

Allison Lindauer, PhD, NP, Assistant Professor; Director, Outreach, Recruitment & Education, Layton Aging and Alzheimer’s Disease Center, OHSU.  

Holiday Travel Tips

As the holidays approach, many of us look forward to traveling to visit friends and family. Many families ask me about traveling with family members with dementia. Here are my top tips.

  1. Plan your trip carefully. If flying, give yourself extra time at the airport to avoid stress. The airports can be busy and overwhelming over the holidays, so pace yourselves. Give yourself a cushion of time for extra bathroom and meal breaks. Consider asking for a wheelchair (even if your companion can walk). With a wheelchair, you may be able to get closer to the front of the TSA security line, thus reducing stress for both of you. 
  2. Tell your hostess and host about your situation. Close friends and family members such as daughters and sons will be able to tell that your companion is having memory trouble. It can be very stressful for them if they don’t understand the situation. They can be supportive of you if they know about the dementia.
  3. Stay on schedule. If you can, try to keep on your home schedule and get plenty of sleep.
  4. Consider getting signing up with the Safe Return Program through the Alzheimer’s Association (alz.org). Those with dementia may wander during travel. Safe Return can provide some reassurance for all of you.
  5. Plan for time to re-adjust back home. You may be looking forward to getting home so you can relax, but often the return can be stressful too. Ask friends to make a casserole for you, turn the lights on and turn up the heat in your house so it feels welcoming to both of you when you return. 
  6. If the trip feels too stressful for you, cancel it. Your gut feeling is probably right. Ask your family member’s health care provider to help with the decision or support. Sometimes advice or a letter from the provider can smooth hard feelings when you have to cancel.

 

 

 

 

Remember, pace yourself, get plenty of rest, and prepare for a pleasant homecoming. For more guidance, or to review these tips, visit the Alzheimer’s Association’s website: www.alz.org or call their helpline: 1-800-272-3900.

Allison Lindauer, PhD, NP, Assistant Professor; Director, Outreach, Recruitment & Education, Layton Aging and Alzheimer’s Disease Center, OHSU.

 

Fatal fits and nods affect us all

fred-age-14-tumanguA child with intractable seizures is heartbreaking for family, friends and the neurologist who searches for effective therapy. But a child with intractable seizures who lives in dire poverty, who is malnourished, who cannot obtain medications, and who is rejected by government, by school and eventually by a desperate family is utterly devastating to anyone with compassion for humanity.

This is precisely the situation today for thousands of children affected by Nodding Syndrome in northern Uganda and South Sudan. A child with this illness visibly nods their head up and down when stimulated by food or cold. The child may develop mental and behavioral problems, develop generalized seizures, have lapses in consciousness, fall into fires or drown in a river. It can affect multiple children in a single family, which itself seeks to survive with meager food, dirty water and no social support. They resort to tying their sick children to trees to stop them wandering but, eventually, neglect sets in as they turn their attention to survival of the fittest: themselves and their remaining healthy children.

How did this happen? What is the cause? How can it be prevented?

The setting is one of prolonged politics-driven human conflict, civil unrest, population migration to internal displacement camps and the provision of emergency food supplies.

In Uganda, an important component was the war between the separatist movement known as the Lord’s Resistance Army (LRA) and the Ugandan government, which resulted in LRA recruitment of large numbers of child soldiers who were required to perform unspeakable acts of violence on their own families and communities. Yet, none of these children are known to have developed Nodding Syndrome.

In South Sudan, the children of cattle herders were spared, the epidemic falling on sessile subsistence farmers who grew crops for their own use with leftover sold at market. Families who lived by fast-flowing rivers where black flies breed had children more at risk for Nodding Syndrome, and a nematode parasite transmitted from insect to child was prominent in children with the brain disease. Some thought this parasite, which causes River Blindness, also causes Nodding Syndrome but it now seems likely this is a secondary infection because of a compromised immune system.

Peter Spencer, Ph.D., a professor of Neurology at OHSU, together with Valerie Palmer, OHSU Instructor of Neurology, has researched Nodding Syndrome in the three affected countries: South Sudan, Tanzania and Uganda.

Spencer participated in a World Health Organization outbreak investigation team in then-southern Sudan that first defined the illness [1].  In Tanzania, Spencer and Palmer surveyed the high-incidence focus of Nodding Syndrome and, with original clinical notes dating from 1960, demonstrated that head nodding was recorded as early as 1934 [2]. Then, in Uganda, they worked with OHSU students to show the relationship between civil war, population internment, and the outbreak of Nodding Syndrome [3]. In 2014, with dedicated NIH grant support, they joined with OHSU, OSU, and Ugandan researchers to carry out a case-control study of Nodding Syndrome in the devastated community described above. They announced their preliminary findings at an international conference on Nodding Syndrome in northern Uganda [4] and recently published in the Journal of Neurological Sciences, an official journal of the World Federation of Neurology [5].

The case-control study revealed that children with Nodding Syndrome had a significantly higher history of measles infection in Internal Displacement Camps, where population density was high, immunization was unavailable and food in very short supply such that affected families relied more on moldy maize.

Drawing on publicly available data, they showed that a measles epidemic had preceded the Nodding Syndrome by several years, a temporal relationship similar to that of measles and a devastating neurodegenerative disease called subacute sclerosing panencephalitis (SSPE).

They pointed out the similar clinical features of Nodding Syndrome and SSPE and called for detailed neuropathological studies to prove or disprove the relationship between measles and Nodding Syndrome.  The CDC had found crystalline structures in the brains of three affected children but the results had been uncertain and never published. However, cellular crystalline structures are found in SSPE and correspond to huge numbers of measles virus nucleocapsids that migrate to and then hide in the brain after the initial infant illness.  What causes their release from the brain years later is unknown, but Spencer and colleagues raise the possibility that immunosuppressive fungal toxins in moldy food may be key.

Nodding Syndrome is a devastating degenerative disease of the brain that nevertheless can be stabilized with the anti-seizure medication and proper nutrition. This has been demonstrated by the remarkable successes of a U.S. charity, Hope for Humans, that has cared and nurtured affected children in Uganda. However, their successes have not been widely recognized and their activities in Uganda are now threatened by financial shortages and lack of government support.

Hope for Humans partners with Dr. Spencer’s team in their effort to understand and prevent Nodding Syndrome, but this dreadful illness will not be overcome unless public support is forthcoming. While Hope for Humans seeks your support, Dr. Spencer’s international team continues to seek NIH support to test their hypothesis that Nodding Syndrome is a parameasles disorder that can be prevented by proper infant vaccination.

If true, this is an important lesson for all societies, our own included, to ensure that all infants receive recommended vaccinations not only to prevent childhood illnesses but also the devastating consequences later in life. Measles is just one of many so-called neurotropic viruses that can hide in the brain for years or decades before they reactivate and cause neurodegenerative disease.

Read more about this OHSU group’s global health studies, including research on a remarkable environmentally caused neurodegenerative disease that combines features of ALS, parkinsonism and Alzheimer-like dementia [6] and Palmer’s creative interprofessional educational course for OHSU health professional students right here in Portland [7].

***

Citations
1.     Spencer, P.S., Vandemaele, K., Richer, M., Palmer, V.S., Chungong S., Anker, M., Ayana, Y., Ayana, Y., Opoka, M.L, Klaucke, D.N, Quarello and Tumwine, J.K. Nodding Syndrome in Mundri County, South Sudan: Environmental, nutritional and infectious factors. African Health Sciences, 13:183-204, 2013.

2.     Spencer, P.S., Palmer, V.S. and Jilek-Aall, L. Nodding Syndrome: Origins and natural history of a longstanding epileptic disorder in sub-Sahara. African Health Sciences 13:176-82, 2013.

3.     Landis, J.L., Palmer, V.S., and Spencer, P.S. Nodding Syndrome in Kitgum District, Uganda: Association with conflict and displacement. BMJ Open, 2014 Nov 4;4(11):e006195. doi: 10.1136/bmjopen-2014-006195.

4.     Spencer, P.S., Kitara, D.L., Gazda S, and Winkler, A. Nodding Syndrome: 2015 International Conference Report and Gulu Accord. eNeurologicalSci 2016, pp. 80-83.  doi 10.1016/j.ensci.2015.11.001

5.     Spencer, P.S., Mazumder, R., Palmer, V.S., Lasarev, M.L., Stadnik, R.C.; King, P., Kabahenda, M., Kitara, D.L., Stadler, D., and Tumwine, J.K. Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition? Journal of Neurological Sciences, 369:191-203, 2016.

6.     Spencer, P.S., Palmer, V.S., and Kisby, G.E. Seeking environmental causes of neurodegenerative disease and envisioning primary prevention. NeuroToxicology 2016 Apr 2. pii: S0161-813X(16)30039-0. doi: 10.1016/j.neuro.2016.03.017. [Epub ahead of print]

7.     Palmer, V.S., Mazumder, R., and Spencer, P.S. Interprofessional global health education in a cosmopolitan community of North America: The iCHEE experience. Academic Medicine 2014 Aug;89(8):1149-52. doi: 10.1097/ACM.0000000000000363..  Initially epublished as: Interprofessional Global Health Education at Oregon Health & Science University: The interprofessional Community Health and Education Exchange (iCHEE) Experience. Academic Medicine, June 10, 2014 [Epub ahead of print].

Sleep expert shares his secrets for easing into the upcoming time change

The end of daylight saving time is soon approaching, and while most of us look forward to that “extra” hour of sleep, there are a few things to think about when society’s clock changes, but our biological clock doesn’t.Autumn leafs and alarm clock on wooden table.

With the time change, our streets and roads become darker closer to rush hour. This poses increased danger for drivers, bicyclists and pedestrians alike.

Studies have shown increased accidents due to poor visibility and possibly because of increased drowsiness in darker environments.

Here are some tips to help you get through the upcoming time change.

1. Preparation

Generally speaking, it is easier for us to adapt to the fall time change because it is easier to stay up later than to sleep earlier. However, there are those that do have difficulty staying up later than their usual time, and if time allows, they should try to do so as the days approach the end of daylight saving time. The principle is to keep roughly the same schedule you normally did before the time change.

2. Get a good night’s sleep

Sometimes people try to “take advantage” of the extra hour by staying up late and partaking in things that are known to disrupt sleep further such as alcohol and caffeine close to bedtime.

3. Use light to your advantage

The strongest determinant of your biological clock (or your “circadian rhythm”) is light. The fall time change heralds shorter and darker days. For some, this can lead to disrupted sleep schedules and even depression. If there is natural sunlight, this can be helpful to combat these problems. In the absence of natural light, light box therapy has been used to both adjust people’s biological clocks and to combat seasonal affective disorder, which is a type of depression associated with darker days.

4. Remember safety

Remember that time changes are associated with increased automobile, bicycle and pedestrian accidents. Be careful out there. Also use this time to remind you to make your home safer. Check your batteries on your smoke and carbon monoxide detectors. Check the supplies of any emergency preparedness kits you may have, especially ones for the winter. See that your fire extinguishers are up to date.

What are your strategies for dealing with the time change? Share them in the comments!

***
allada_gopal

Gopal Allada, M.D. is a Clinical Associate Professor of Medicine who specializes in Critical Care, Sleep Medicine, Cystic Fibrosis and Pulmonary Medicine.

First annual Art of Neuroscience competition now accepting entries

The first annual ‘Art of Neuroscience’ competition is now accepting entries. All OHSU staff, faculty and students/trainees are invited to submit an original image that explores the aesthetics of brain and mind as a broad topic.

From molecules to psychiatry, all interpretations of the artistic aspects of neuroscience are welcome.

We are delighted to have a special category and prize designated just for high school students.

gettyimages-175538084-brain-paintingStudents should submit their art with the same information (including school) and format as detailed below.

Prizes will be awarded at the OHSU Brain Institute Annual Forum on Friday, November 18.

The winner from the high school category will be invited to attend the forum with his or her art teacher and family.

Submission Requirements

  • Format: JPEG
  • Information to include: Title of Image; Description of Image (<100 words); Artist’s Name and Department or School
  • Deadline: Monday, October 31

Submit images to: stoutk@ohsu.edu

Voting will be open to all OHSU staff, faculty and students/trainees from November 7 through November 16, and the winners will be announced at the OBI Annual Forum on Friday, November 18.

 

Oregon Poison Center experts discuss marijuana with educators from around the nation

nacct16-fb-banner-jpgThe Oregon Poison Center at OHSU recently presented on Oregon’s new marijuana laws from a poison prevention outlook at the North American Congress of Clinical Toxicology 2016 (NACCT).

Members of the Oregon Poison Center packed their bags and headed to Boston for this year’s annual toxicology conference. “Marijuana: The Poison Prevention Outlook” was one of the most anticipated sessions for the nation’s poison center educators.

In this session, Fiorella Carhuaz, the health educator for the Oregon Poison Center, explained the latest legalization laws and Oregon’s current marijuana use prevention campaigns. nacct-pic-fio-jpg

The Poison Center plays an important role in these efforts, along with their own educational programs, which include presentations to injury prevention groups and other interested groups, as well as making data reports easily accessible to the public. 

Carhuaz also spoke about the Oregon Health Authority’s (OHA) “Educate Before You Recreate” campaign, an educational campaign to increase awareness of what legalization means in Oregon. The OHA is also working on a teen marijuana use prevention campaign that is currently in its piloting phase.

The Oregon Poison Center has been collaborating with public health entities and has been releasing data reports to help better understand how legalization is affecting the calls made to the OPC. Carhuaz has also been giving presentations on marijuana to injury prevention groups and parent groups in both English and Spanish.

To make a request for a presentation please contact her directly at carhuaz@ohsu.edu.

The Oregon Poison Center reiterates that people of all ages should call them regarding marijuana exposures. They do not judge and are there to help. The Poison Help Hotline is 1-800-222-1222.

Alzheimer’s and the brain game challenge

iStock_62669108_cubeThe efficacy of brain games has come under scrutiny in the wake of a recent two million dollar settlement between the Federal Trade Commission (FTC) and Lumos Labs, parent company of the “Lumosity” program.

While the brain game industry makes billions in revenue, substantive evidence to validate these games’ effectiveness for preventing dementia remains to be seen. Lumos Labs’ heavily promoted claims that individuals who used its software could delay age-related cognitive decline and protect themselves against dementia, mild cognitive impairment, and Alzheimer’s disease was unfounded.

In a statement by Jessica Rich, Director of the FTC’s Bureau of Consumer Protection, “Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting its games could stave off memory loss, dementia, and even Alzheimer’s disease, but Lumosity simply did not have the science to back up its ads” (2016; FTC press release).

The question of whether or not brain-training games can, in fact, enhance cognition and prevent dementia is a contentious one.

There is current dissent among cognitive scientists.iStock_83865137_MEDIUM

A consensus statement, signed by 75 scientists and issued by the Berlin Max Planck Institute for Human Development and the Stanford Center on Longevity, concluded that claims of preventing cognitive decline by using brain games is not backed by any compelling scientific evidence.

But many cognitive training scientists argue that cognition can be strengthened by certain interventions, and further research is necessary.

John Harrison of Metis Cognition states, “Given the lack of clear evidence one way or the other, it seems to me that agnosticism is the appropriate position. However, the risk of rejecting the possibility that training works is that we might be throwing away one of the possible tools in our armamentarium for dealing with dementia” (see Jan 2016 Alzforum article).

Looking at two major studies with different conclusions, the challenges of determining the efficacy of brain games remains evident.

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, funded by the National Institutes of Health, concluded that computerized brain training can provide long-lasting cognitive benefits in healthy seniors in the areas of memory, reasoning, and processing speed.

“However, standard tests of function conducted by the researchers showed no difference in functional abilities among the [experimental and control] groups” (2014; NIH press release). The Brain Test Britain study, sponsored by the British Broadcasting Company, found that computer-based brain training games do not benefit people of a wide variety of ages beyond improved skill at playing said games and that these benefits do not translate to other brain functions.

Brain-training games appear to have the potential to give us short-term benefits in some specific areas. Unfortunately, evidence that these games can prevent cognitive decline and provide lasting, significant improvements in how we function in our everyday lives remains inconclusive.

***
KateMincks-2015

 

 

Kate Mincks, B.A. is a Research Assistant at the Layton Aging & Alzheimer’s Disease Center

 

 

 

This article originally appeared in the The Layton Center’s newsletter, the Update, a biannual publication that features stories on Layton Center and national research, experiences of volunteers in some of our studies, and cognitive health. Subscribe here.

Teaching the next generation of doctors about community care for people with dementia

senior-woman-happyDelivering quality medical care for persons with Alzheimer’s disease is, and will increasingly be, one of the most challenging responsibilities for physicians. An estimated 5.3 million Americans currently suffer from Alzheimer’s disease. By the year 2050, this number is estimated to be 13.8 million (2016 Alzheimer’s Disease Facts & Figures, published by the Alzheimer’s Association).

In communities across the U.S., services available to persons with dementia and their families may include a confusing array of options such as assisted living, foster care, retirement homes, home care, care management services, respite care, day care as well as educational and support programs for families. Yet, doctors in training generally spend little or no time learning about these options.

Medical educators are now recognizing how important it is for doctors to know not only how to diagnose and medically treat illness but also to understand the larger social world that patients live in. In recognition of this broader role, OHSU has embarked on a transformation of its Undergraduate Medical Education curriculum.

The goals of the new curriculum are, as reported by Mark Richardson, M.D., M.B.A., dean of the OHSU School of Medicine, “to prepare healthcare professionals for the changing health care delivery and discovery environments, and to do so in ways that continue placing emphasis on self-directed and also include life-long and inter-professional education.”

The new curriculum has provided the opportunity for the Layton Aging & Alzheimer’s Disease Center to educate future doctors about community health and social care. During four two-week “intersessions” sandwiched between academic terms, 2nd year students will receive intensive experiences learning about four topics: cognitive impairment, cancer, infectious disease and pain.

During the cognitive impairment intersession, students will learn about a range of conditions that may affect brain function and memory including Alzheimer’s disease and other variants of dementia, and they will have the opportunity to learn about community resources available to serve them.

During the first intersession held in March 2016, students visited the Alzheimer’s Association and gained a perspective on Alzheimer’s disease as a global and public health concern and an appreciation for the key role of the Association in serving patients and families.

Following this session, the students divided into four groups visiting different types of care facilities:

  • Providence ElderPlace
  • Laurelhurst Day Center
  • Glendoveer Residential Care and Day Center
  • Emerson House Memory Care Residential Center
  • Cedar Sinai Park Adult Day Services Center

The students also were introduced to the Aging & Disability Resource Center (ADRC) a one-stop resource center that is available throughout the country and that can help families find services tailored to their particular needs.  Doctors cannot know about all the community services available for their patients but seeing a sampling of service options  and knowing that there are ADRCs to help families in need will go a long way towards their ability to provide support needed by persons with dementia and their families.

***

Linda-Boise

 

Linda Boise, Ph.D., M.P.H. is Director of Outreach, Recruitment and Education Core at the Layton Aging & Alzheimer’s Disease Center.

 

 

 

This article originally appeared in the The Layton Center’s newsletter, the Update, a biannual publication that features stories on Layton Center and national research, experiences of volunteers in some of our studies, and cognitive health. Subscribe here.

Ask these 3 questions to quickly identify inflammatory neuropathy

Patients with peripheral neuropathy present with weakness, numbness and/or tingling and pain in the upper or lower extremities or both. There are many causes for peripheral neuropathy. The most common causes for peripheral neuropathy are genetic mutations and diabetes.

For those types of neuropathies which are non-inflammatory, treatment is usually symptomatic, meaning focusing on the symptoms and removing the offending agent if possible. For example if a drug is causing the neuropathy, stop the drug or if diabetes is causing the neuropathy, control the diabetes.foot pain

However, peripheral neuropathy can also be caused by an underlying autoimmune disease. Up to 20 percent of patients with peripheral neuropathy actually have an autoimmune or inflammatory cause.

Quick identification and adequate immunosuppressive treatment of these patients helps prevent patient disability and sometimes death.

Therefore, when evaluating patients with neuropathies, the physician faces an important challenge of categorizing the disease as caused by an inflammatory neuropathy or a non-inflammatory neuropathy. Ascertaining whether the neuropathy is due to inflammatory vs non-inflammatory cause can sometimes lead to excessive testing, waste of health care dollars and, occasionally, harm to patients.

To solve this dilemma, our new research provides a simple strategy to quickly screen for inflammatory neuropathies.

Asking the following three questions, which highlight key characteristics of inflammatory neuropathies, prior to any blood work or other testing, can rapidly screen for potential inflammatory neuropathies:

1. Onset: how quickly did the condition present itself; did the symptoms of the neuropathy have a rapid onset and progress to reach their peak in less than eight weeks?

2. Distribution: how widespread throughout the body is the neuropathy; does the neuropathy affect one limb more than the other? Does it affect both the area near the body’s center and parts of the body located away from the center?

3. Systemic features: is the nerve pain accompanied by systemic features; in addition to the neuropathy, is the patient experiencing weight loss or skin changes?

If the answer to any of those questions is yes, then the patient has a high likelihood of inflammatory neuropathy and should be investigated and treated as soon as possible.

***

Karam-Chafic_16-sm
Chafic Karam, M.D., is the lead author of the paper “Rapid screening for inflammatory neuropathies by standardized clinical criteria,” published in the June 29, 2016 issue of Neurology® Clinical Practice.

 

In the interest of ensuring the integrity of our research and as part of our commitment to public transparency, OHSU actively regulates, tracks and  manages relationships that our researchers may hold with entities outside of OHSU. Dr. Karam serves as Neurology® WriteClick® Deputy Editor and received speaker honoraria from Nufactor and consulting honoraria from Lundbeck. L.A. Tramontozzi III receives publishing royalties for Deja Review Psychiatry (McGraw Hill, 2007, 2011).

Considering deep brain stimulation? OHSU maps treatment step by step

Colin Halstead of Eugene had DBS surgery at OHSU. “I don’t understand why anybody wouldn’t have this that could,” he said.

Colin Halstead of Eugene had DBS surgery at OHSU. “I don’t understand why anybody wouldn’t have this that could,” he said.

Many people with Parkinson’s disease or essential tremor reach a day when medication just doesn’t cut it anymore.

Sometimes the medication doesn’t provide the relief it once did. Or patients have to take such high doses that side effects spiral beyond what they can tolerate.

That’s when some turn to deep brain stimulation surgery, or DBS.

At OHSU, patients who have Parkinson’s or essential tremor and are considering DBS receive a step-by-step treatment plan. The steps include a thorough evaluation to make sure that only patients with a strong chance of success become candidates for surgery.

Here’s a guide to how the process works ─ for patients living inside and outside the Portland region ─ plus information on where to learn more.

Timeline

The DBS process typically takes about three months from the first appointment to surgery.

Out-of-town patients can conduct many of the appointments in their home communities through OHSU’s Telemedicine Network, which offers a secure video link to OHSU specialists. Some patients come to Portland only for surgery.

Evaluation

The first step is to establish that the patient has a clear diagnosis. DBS helps idiopathic or classic Parkinson’s, for example, but not other types. In addition, the patient should be at a point where medication no longer effectively controls symptoms.

You can find checklists on our DBS website to help indicate who is a good candidate. The site includes a checklist for Parkinson’s patients and for essential tremor patients.

OHSU's deep brain stimulation website includes guides to the DBS process for patients with Parkinson’s disease or essential tremor, including those who live near OHSU or far away.

OHSU’s deep brain stimulation website includes guides to the DBS process for patients with Parkinson’s disease or essential tremor, including those who live near OHSU or far away.

Parkinson’s patients: Next, Parkinson’s patients have a series of appointments over one or two days with movement-disorders experts. Specially trained psychologists test thinking abilities and memory. Physical therapists test movement abilities on and off medication. Patients may also meet with a speech therapist.

Essential tremor patients: Patients with essential tremor meet with a neurologist, neurosurgeon or both to go over medical history, risks and benefits.

Before surgery

Those found to be good candidates for DBS and who choose to go ahead have an MRI and a final appointment to make sure they’re healthy enough for surgery.

Surgery

Patients come to OHSU Hospital on the day of surgery and are put under general anesthesia. They have a CT scan that’s matched with the pre-surgery MRI, giving the surgeon a down-to-the-millimeter roadmap for placing the electrodes. The surgeon makes two small incisions, places the electrodes, and takes another CT scan to make sure they’re in the right places.

The surgeon also places thin wires under the skin of the head, neck and shoulders for connection to the pacemaker-like device, called a stimulator or an implanted pulse generator. Patients typically spend one night in the hospital and are released the next day.

Two to seven days later, the patient comes to OHSU to have the stimulator implanted. The device is about the size of a tea bag and is placed under the skin, usually below the collarbone. The person is put under general anesthesia for the procedure and goes home that day.

Programming and follow-up

Out-of-town patients have an appointment a week after DBS surgery to have their incisions checked and to receive initial programming of their stimulator. After that, they have appointments at one, two and three months – at OHSU or in their home communities – to adjust their DBS settings.

Patients in the Portland area receive incision checks and initial programming one month after DBS surgery. Then they have appointments for DBS adjustments at two and three months.

Patients may require several programming sessions to achieve the best symptom control.

After that, both sets of patients see their neurologist every six months for routine care and any needed DBS adjustments. The stimulator battery is replaced in a minor outpatient procedure every three to five years.

Visit OHSU’s DBS website to learn more. The site includes guides to the process for Parkinson’s patients and for essential tremor patients, including those who live in the Portland area and those who don’t.

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