CW’s DBS SURGERY - A Little Background

These Blogs about CW's DBS SURGERY are from my notes and diary written as CW (my husband) went through his DBS (Deep Brain Stimulation) procedure.  Hopefully some of this information will help others going through or considering DBS surgery.

Note:  As of July 17, 2010 CW has had his three surgeries and both of his pacemakers have had their first tuning.  He is still recovering from the surgeries.  – Dottie –

The Start Of It All

For several years CW’s Parkinson’s was progressing slowly and his medications were managing his symptoms fairly well until the fall of 2007, when CW was diagnosed with Pheochromocytoma (a nasty type of cancer of the adrenal gland), and he had to have surgery to remove an adrenal gland. After this surgery, CW’s PD medications (meds) didn’t appear to be managing his symptoms very well and the disease seemed be progressing somewhat faster.  His doctors said that this sometimes (changes in the progression of PD) happens when a patient has severe illness or stress.

At the beginning of this year, 2010, CW made the difficult decision to have Deep Brain Stimulation surgery (commonly known as DBS), to be performed at the Medical College of Georgia (MCG) in Augusta. All of CW’s doctors (neurology, family, etc.) agreed that it was time for him to have the procedure.

DBS consists of 3 separate surgeries

• 1st surgery is implanting an electrode connected with a wire on one side of the brain

• 2nd surgery is implanting an electrode connected with a wire on opposite side of the brain

• 3rd surgery is where the wires are connected to a type of pacemaker device (called an impulse generator, or IPG) implanted under the skin of the chest, below the collarbone

Later the impulse generator /neurostimulators will be turned on and programmed to a starter level. There may be several months of return appointments to fine tune the programming of the stimulators and PD medication adjustments.

DBS is not a cure for Parkinson's disease nor will it stop the progression of the disease. It is another way of managing Parkinson’s symptoms by reduction of PD symptoms and also being able to greatly reduce PD medications.

In spite of the fact that a patient initiates having DBS; and in spite of the fact that their doctors indicate that it is time to have DBS, you still must go through an evaluation process before you are approved to actually have the surgery (at least at the majority of hospitals this is the protocol). It certainly isn’t a decision to be made lightly; and a decision like this affects the whole family not just the patient.

January 2010 we went through the DBS evaluation process to see if CW is a good candidate. CW had MRI scans, CT scans, neurology evaluation and testing, neuropsychological evaluation, evaluation by the brain surgeon, anesthesia evaluation, risk assessment, lab tests, and other stuff that I can’t remember.

I’d like to note that as part of the evaluation I also had to participate in the neuropsychological evaluation. They want to make sure that everyone, patient and primary caregiver is on the same page and understands the ramifications of having DBS and the risks of surgery.

After all the testing and evaluation, you wait to hear the results. Then if you are approved, you wait to get a date for the first surgery and the date for the 1st pre-operation testing (yep, more testing to be done). Fortunately MCG has been really nice about scheduling the CW’s 1st surgery pre-op for the day before his surgery – which means that we won’t have to make two separate trips to Augusta.

The scheduled dates for all three surgeries –

• May 26th – Inserting 1st electrode & wire on one side of brain – local anesthesia with normally an overnight hospital stay

• June 8th – Inserting 2nd electrode & wire on opposite side of brain – local anesthesia with normally an overnight hospital stay

• June 22nd – Inserting a type of pacemaker device (called an impulse generator, or IPG) implanted under the skin of the chest, below the collarbone (general anesthesia) and connecting the wires from the two electrodes – but not turning on the pacemakers yet because they want the surgical incisions to have healed – general anesthesia with normally outpatient if all goes well

So that’s where we are right now, waiting to go to Augusta for the 1st surgery. I told CW that when they drill the hole in his brain for his first surgery, that he should be careful not to tilt his head and let everything fall out – he just looked at me, shook his head, and then he laughed.

To be continued…