Frequently asked questions

DBS

When is it too late for DBS?


One of the questions posed to me recently has been, ' When is the best time to have DBS? And when is it too late?" Well, the FDA recently changed their approval for DBS, now making it available for those who have been diagnosed (or had symptoms) for at least 4 years. Previous to this, I think it used to be 6-8 years. But it is now be recognized that having DBS earlier may actually be better; because the earlier DBS is introduced – the greater the benefits . Anyway, according to the doctors, in order to even consider DBS:

  • You must have had symptoms for at least 4 years;
  • Have responded well to the medication levodopa;
  • Still benefit from medication, but it’s becoming less effective or causing intolerable side effects;
  • Require multiple medications, higher dosages, or more frequent doses to manage your symptoms.
  • Ability to remain calm and cooperative during an awake neurosurgical procedure lasting 1-3 hours per brain side.
It's generally considered 'too late' when the following has occurred:
  • Your symptoms no longer respond to medication;
  • Your mobility has deteriorated. Good mobility, with the ability to walk, in the best "on-medication" state is important for a good outcome. In general, surgery makes the "off" medication state more like the "on" state but rarely does better than the best "on" state, so a patient with poor function in best "on" (for example, unable to walk at any time) is a poor surgical candidate.
  • You develop medical conditions that prevent surgery such as cognitive impairment, gait and balance problems. Dementia (significantly impaired memory or thinking) is a major contraindication to surgery, since such patients have great difficulty tolerating the surgery, may have further loss of intellectual function due to the surgery, deal poorly with the complexity of DBS therapy, and realize little overall functional benefit;
  • You become severely disabled. DBS is a poor procedure to rescue someone with end stage Parkinson's disease who is wheelchair bound or in a nursing home, although these are the most desperate patients. It is an excellent procedure for Parkinson's patients who are still employed but may be just at the point where disability would stop them from working;
  • Serious cardiac disease, uncontrolled hypertension, or any major other chronic systemic illness increases the risk and decreases the benefit of surgery. Also, an MRI of the brain should be free of severe vascular disease, extensive atrophy, or signs of atypical parkinsonism.
  • Patient age. The benefits of DBS for PD decline with advancing age, and the risks go up. Rarely is surgery offered to a person over 80 and would only be considered if they are in otherwise excellent health, are cognitively intact, and have good function in the on state. For patients over 75, the benefits are likely to be modest.
Generally DBS will not work when the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. This is the reason why one has to go through all the 'pre-op' requirements first, such as speech therapy, cognitive evaluation, mental (psych) evaluation, and of course evaluation by the entire neurological team. Only then can one be 'approved' for DBS surgery. For more info on this pre-op requirements, see the second part of my DBS blog series.





Web Site

Why is the Deep Brain Thoughts web page not displaying properly?


If you are experiencing any problems with the website (such as old items showing up or sections not showing up properly) try reloaded/refreshing the web page. This can usually be done by using the reload button (usually looks like a circular line with an arrow on the end) on your browser's address bar. If that does not work, then try flushing your browser's cache memory area. This can fix a lot of these issues. Below are links for flushing cache on the various major browsers available: Internet Explorer Microsoft Edge Google Chrome Opera Safari (Mac) Vivaldi




What's the difference between signing up for your mailing list vs. sign up in the blog page?


Very good question! The 'Sign up for mailing list' simply adds your email to my list of folks who get emails from me - mostly letting them know that a new blog entry is available. This is a very good option if you DON'T use Facebook, since every new blog posting I will announce via Facebook. (And I will NEVER sell your ID nor spam any of my users!) The second 'Sign up' signs you up to the internal blog system so that you can post comments about a blog posting, rate a posting, have your own 'profile', and so forth. This, unlike the old Discus system I used before, is entirely based within my Wix blog website, so this is not some kind of sign-up where you don't know what is going on with your logon info - it is used just by my website. So don't be afraid to sign-up for posting comments - share your experiences and thoughts with others on Deep Brain Thoughts!





About Me

Hi, I'm Tom, from whose brain these Deep Brain Thoughts flow! Thank you for visiting my blog, and keep coming back to enjoy future ramblings!

See my full profile >

© 2020 by Deep Brain Thoughts. Proudly created with Wix.com

Last Updated: 2019-09-11

Connect With Me

  • Facebook
  • Twitter
  • RSS