Parkinson's Disease 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 team is your partner in caring for patients with DBS stimulators after surgery. We 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 DBS 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.

DBS clinical pathway for distance patients

  1. Consultation with fellowship-trained movement disorders neurologist – This provider will obtain a thorough history and perform a neurological exam. Initial determination of DBS candidacy will be conducted. If the patient is not a DBS candidate, the neurologist will recommend other options, such as a change in medications.
  2. Consultation with Kim Burchiel, M.D. – To discuss DBS, including risks and benefits. This includes our assessment of whether true Parkinson’s is present, as well as disease progression, response to medications and review of surgical risk/benefit considerations.
  3. Multidisciplinary risk-benefit assessment –
    1. Physical therapy conducts a two-day appointment to evaluate patient’s gait, balance and levodopa response. Day 1 is conducted with patient taking all PD medications. Day 2 is conducted with patient stopping all PD medications for 12 hours before evaluation.
    2. Neuropsychology conducts cognitive function testing. Patients should bring a caregiver to this appointment. If your practice is located outside the Portland, Oregon, area, OHSU offers provider education and training in evaluating patients for DBS.
    3. Speech therapy assesses speech function and counsels patient on DBS potential speech side effects. This evaluation is not required for assessing DBS candidacy.

Our team will evaluate information from these appointments and discuss DBS and other options with you and your patient. 

Some patients may be assessed by our neurosurgeon directly, without the initial neurologic evaluation, if it is clear after discussion with you and review of their medical history, they are DBS candidates.

  1. Neurosurgery – To review the procedure in detail, meet the neurosurgeon and 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, usually 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.

Programming of the neurostimulator can be accomplished at OHSU shortly after surgery, as detailed above. 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 adjustments as needed.
  3. 90 days and six months post lead-placement – Neurology appointments, ongoing programming adjustments as needed.

You may choose to complete the follow-up neurology appointments in your office, or some 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 Parkinson's Disease and Movement Disorders Program. 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 often need to be adjusted, typically every six months. Because DBS changes how the brain communicates with the body, patients may need post-DBS physical therapy, speech therapy or both.