DBS appointments

A complete evaluation by movement disorder specialists is an important part of successful DBS for Parkinson’s. At OHSU, we bring a team of experts together to make sure you are a good candidate for DBS. Our team reviews your symptoms and medications, and talks with you about your personal benefits and risks.

If you live outside the Portland area, we will 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.you may be able to have some appointments and tests by telemedicine, depending on your travel preferences and medical needs. After your doctor refers you to us, we will work closely with you to schedule these appointments.

The information on this page explains your evaluation for DBS, including testing. It also tells you about surgery and your hospital stay.

How long does the DBS process take?

At OHSU, the process of having DBS takes about three months. It may take less or more time depending on your situation. Here are some general guidelines:

  • Time from your first appointment to surgery: About three months.
  • Time from your doctor’s referral to your first OHSU appointment: Three to six weeks.
  • Timeframe for Stage 1 and Stage 2 of DBS surgery (electrode placement): Ten days to two weeks. If you live outside the Portland area and travel to OHSU, your surgery process may be shorter, about 10 to 12 days.

About your DBS appointments

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

  1. Meet with a neurologist, neurosurgeon or both – You meet with an OHSU specialist to determine if you could be a candidate for DBS. Your first appointment is with a neurologist who specializes in movement disorders, or 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.

  2. Meet with the DBS team – In this step, you have three appointments with different members of the Parkinson's Disease and Movement Disorders Program team. They are:
    • Physical therapy – This is a two-day appointment to evaluate your movement when you take medication and when you do not. The therapist will evaluate your walking (gait), balance and levodopa response. On the first day, you will take your Parkinson’s medications as usual. On the second day, you will stop taking all your Parkinson’s medications 12 hours before you see the therapist.
    • Neuropsychology – This appointment evaluates your memory and thinking. We recommend you bring a caregiver to this appointment.  
    • Speech therapy – A speech therapist will evaluate how you speak, and talk with you about possible DBS side effects on speaking.

    If you live outside the Portland area, we will work closely with you to make these appointments as convenient as possible.

  3. Pre-surgery appointments – These appointments take place if the results of your evaluations show you are a good candidate for DBS, and you choose to have the surgery. 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 or anesthesia. 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 in the local area, 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 talk about the details of surgery and ask any questions. We will talk 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.
  4. Surgery – On the day of your surgery, you come to OHSU Hospital. 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 placing the electrodes correctly.

    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 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, usually just below the collarbone. You leave OHSU before the end of the day.

  5. 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 stimulator, you do so with this programmer.

If you travel to OHSU – A sample surgery timeline

traveling PD patient journey for DBSMany of our patients travel to OHSU from outside the Portland 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

 

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