DBS Appointment Process for Essential Tremor

Being evaluated by movement disorders specialist is an important part of successful surgery for essential tremor. At OHSU, we bring a team of movement disorder experts together to review your symptoms, medications and individual risks and benefits.

If you live outside the local area, we do everything we can to make receiving care at OHSU as easy as possible. We try to schedule multiple appointments with our Parkinson's experts on the same day, and in some cases can offer telemedicine appointments. After your doctor refers you to us, we will work closely with you to schedule these appointments.

The information on this page explains the DBS evaluation process, including surgery and information for patients traveling from outside the Portland metro area.

About your appointments

You can think of having DBS in four steps. They are:

  1. Meet with a neurologist, neurosurgeon or both – You meet with a movement disorders specialist to determine if you could be a candidate for DBS, or with our neurosurgeon, Dr. Kim Burchiel, depending on your situation.

    If you see a neurologist first, the doctor will review your complete medical history and do a neurological examination. If you are not a DBS candidate, the doctor can recommend other treatment options, such as changing your medication.

    If you might be a DBS candidate, you will have a second appointment, with Dr. Burchiel. When you come in for your neurological surgery consultation, you will discuss DBS, including the risks and benefits for your situation. After your appointments are complete, all of the providers who performed your evaluations will meet to review your results and decide whether you are a good candidate for DBS surgery.

  2. Pre-surgery appointments – If the results of your evaluations show you are a good candidate for DBS, and you choose to have the surgery, these appointments are done at OHSU. They are:
    • MRI – This is a precise scan with OHSU’s powerful 3-Tesla MRI unit. The images allow Dr. Burchiel to begin planning where to place the electrodes during surgery. The MRI is usually the first of your pre-surgery appointments, so Dr. Burchiel has the results at your neurosurgery appointment.

      About your MRI

      Your pre-surgery MRI is usually done without sedation (medication to help you relax during the scan). If you need sedation for the MRI, or the MRI images are not clear (for example, if you move), you might need an extra day for this appointment.

      Please come for your MRI with an empty stomach in case you need to have sedation. Our team will tell you how long to avoid eating and drinking before the MRI. Also, please bring a caregiver with you.

      If you live locally, your MRI appointment happens about two weeks before surgery. If you travel to OHSU from out of state, it happens the day before.

    • Neurosurgery – You will meet with our neurosurgeon and physician assistant to go over the surgery in detail and ask any questions. We will talk with you about your medications and any allergies. You and your family will also receive instructions for coming to the hospital and for care after your surgery.
    • Perioperative medicine – This can be done the same day as your neurosurgery appointment, especially if you travel from outside the Portland area. You will have a general physical examination to make sure you are healthy enough for surgery and anesthesia.
  3. Surgery – On the day of your surgery, you come to OHSU Hospital Admissions. In the operating suite, you are placed under general anesthesia, so you are not aware of anything during the procedure. Your DBS team takes a high-resolution CT scan before surgery starts, to match up with your high-resolution MRI images from before surgery. This scan gives Dr. Burchiel additional information on accurate electrode placement.

    After reviewing your scans in the operating room, the doctor makes two small incisions, places the electrodes and takes one more CT scan to make sure they are in the right place. Then you go to intensive care to spend one night, and are discharged the next day.

    The second part of your surgery happens about two days to a week after the electrodes are placed. You come to the OHSU Day Surgery area and are placed under general anesthesia. Your surgeon puts the implanted pulse generator, also called the IPG or stimulator, under the skin just below the collarbone. You leave OHSU at the end of the day.

  4. Programming your stimulator – This is done in a doctor’s office a week after DBS surgery for out-of-town patients and a month after surgery for those in the Portland area. A trained physician assistant, neurologist or both will adjust the DBS settings. They do this with a small device called a programmer. You will probably need several programming sessions before you get the best symptom control from DBS.

    You will get a programmer that will allow you to check the status of your stimulator as well as its battery level. If your neurologist allows you to change the settings of your DBS, you will do so with this programmer.

OBI DBS essential tremor patient surgery journey map for traveling long-distance patients

Many of our patients travel to OHSU from outside the local area. If you live outside Portland, we arrange your surgery schedule to allow you to return home as soon as possible. A sample surgery timeline is:

Sample traveling patient surgery timeline