Essential Tremor Patient Flow for DBS

We focus on the unique needs of each patient, family and referring provider. You remain the primary neurologic provider, and continue seeing your patient as needed.

Your partner for patients from any area

The OHSU movements disorder team is your partner in caring for patients with DBS stimulators after surgery. Dr. Burchiel pioneered the use of DBS in the United States and are one of the few centers offering “asleep” deep brain stimulation. Learn more about OHSU’s DBS expertise.

We work with you and your patients to determine the best care for each patient’s convenience, safety and comfort. We also prioritize your ease of management and confidence in your patients’ deep brain stimulation evaluation and programming follow-up visits.

Once preoperative appointments are completed, surgery for lead placement can be accomplished in approximately ten days to two weeks. The implanted pulse generator is typically placed approximately two to seven days after lead placement.

Follow-up appointments at one, two, three, six and twelve months after surgery. In some cases, me might be able to use telemedicine for some follow-up visits.

Your patient will get a programmer, allowing them to check the status of their stimulator as well as its battery level. You can decide whether to allow your patient to use the programmer to change the stimulator's settings. Our team can assist with optimizing the programming. You continue to manage your patient’s Parkinson’s care. Learn about training and education opportunities for providers

Appointments

We carefully assess your patients for deep brain stimulation candidacy and potential benefits and risks, to ensure each patient the best chance of optimal benefit.

The general stages of the DBS process are shown below. Evaluation and preoperative appointments may be conducted via telemedicine, when appropriate or more convenient for the patient.

We will see your patient to discuss the DBS procedure, outlining the risks and benefits. This includes assessment of the tremor, disease progression and response to medications. Following this evaluation, we will send medical chart notes and discuss our recommendations with you.

  1. Neurosurgery – To review the procedure in detail, meet the physician assistant who follows patients in the hospital, review current medications and allergies and provide admission and post-operative care information.
  2. Perioperative medicine – General examination to clear patient for surgery.
  3. MRI – To allow neurosurgeon to begin mapping electrode placement.

Patients are admitted to OHSU Hospital, taken to surgery and placed under general anesthesia, with five cranial fiducials placed for surgical planning. After a final preoperative CT scan, the surgeon makes two incisions, places the electrodes and confirms correct placement with an additional CT. Patients go to intensive care after surgery for one night.

Pulse generator placement

The internal pulse generator is placed in the patient’s chest between two and seven days after lead placement. This is also done under general anesthesia.

Options for patients from outside the Portland area

We accommodate many DBS patients from outside the local area. Below is a sample timeline of surgery, recovery and travel. Our aim is allow patients to return to your community as soon as possible.

Sample patient timelines for distance patients with essential tremor

Programming can be accomplished at OHSU shortly after surgery. For patients both in and outside the Portland, Oregon, area, it can also be done later to allow more healing time and return to a satisfactory baseline.

Patients have follow-up appointments at OHSU or via telemedicine at the following intervals.

  1. 30 days post-lead placement – Wound check and neurology optimization appointment.
  2. 60 days post lead-placement – Neurology appointment, ongoing programming if needed. 
  3. 90 days and six months post lead-placement – Neurology appointments, ongoing programming if needed.

You may choose to complete the follow-up neurology appointments in your office, or patients may have these via telemedicine. Programming may be done as early as one week after DBS surgery, or later, as detailed above, to allow you to program the stimulator with training via telemedicine, allow patients to heal more fully, or both.

For programming after the initial stimulator activation, the patient is welcome to continue in our Movement Disorders clinic. For patients who have neurologists outside of OHSU who are comfortable programming the IPG, it is often most convenient to return to the regular neurologist. We are happy to advise you on programming strategies and help you develop the most convenient plan for you and your patient.

Unlike medications, DBS does not lose effectiveness. However, the stimulator settings may need to be adjusted as the disease progresses. Because DBS changes how the brain communicates with the body, patients may need post-DBS physical therapy, speech therapy or both.