Deep Brain Stimulation

Multidisciplinary care is the hallmark of Ochsner’s deep brain stimulation program. Collaboration among fellowship-trained neurologists, clinician programmers, neurosurgeons and neuropsychologists help review if a patient is a good candidate for deep brain stimulation. They strive to confirm diagnoses, educate patients on their options and identify patients who are both fit for surgery and have the best chance for an optimal outcome. Each type of specialist plays a key role:

• Neurologists evaluate patients’ candidacy for deep brain stimulation. They also provide medication management services and ongoing care, including device programming following surgery.

• Neuropsychologists perform an in-depth memory exam to help the team weigh the risks and benefits of treatment. In addition, neuropsychologists assist with identifying targets for treatment in the brain.

• Neurosurgeons educate patients about and perform the surgical procedures.

Patients meet with each specialist as part of the evaluation process. The specialists then meet in a conference to discuss each case and plan the treatment.

In addition to our multidisciplinary approach, other factors that distinguish deep brain stimulation at Ochsner include:

• Commitment to excellence. Deep brain stimulation is an option to treat certain patients with Parkinson’s disease. The Parkinson’s Foundation recognized the Ochsner Neuroscience Institute as a Comprehensive Care Center, symbolizing top-level care.

• Convenient care. From determining candidacy to performing the surgical procedures to programming the amount of electrical signaling after surgery, deep brain stimulation is a multistep process. To maximize convenience for patients, we offer virtual visits to allow patients to see members of our team from the comfort of home when possible.

• Precise lead placement. Leading-edge guidance software and neurophysiologists, neurosurgeons and neurologists who monitor the procedure in real time help ensure the team places the leads — the insulated wires that conduct electrical signals from the implanted device to the brain — precisely where they intended.

Ochsner Medical Center - New Orleans, Ochsner Lafayette General Medical Center and Ochsner LSU Health Shreveport offer deep brain stimulation. We work to reduce the need for travel to make care more convenient. We provide virtual pre- and post-treatment visits for patients in Louisiana and Mississippi when possible.

Our team uses deep brain stimulation to treat the following movement disorders:

• Dystonia. With this condition, muscles contract spontaneously, causing potentially painful stiff and slow movements. This can cause involuntary shaking (tremors), vocal abnormalities and gait problems.

• Essential tremor. Often an inherited disorder and more common than Parkinson’s, this condition typically causes tremors in the hands and arms. Many times, DBS therapy can help steady the hand tremor and allow people to manage utensils, typing, hand crafts and basic manual tasks once more.

• Parkinson’s disease. Trembling in the arms and legs is perhaps the most recognizable and treatable symptom of Parkinson’s disease with DBS. Other symptoms include balance problems, slow movements and stiffness in the arms and legs. Symptoms typically begin on one side of the body. Over time, however, they appear on both sides. Patients who require frequent medication doses often seek out DBS with a goal to reduce the number of daily doses required to feel their best.

Our team determines candidacy for deep brain stimulation based on a variety of factors. Our first step is confirming the diagnosis. Others include reviewing whether or not other treatments, such as medications, are providing adequate symptom relief.
 

If our team determines that you’re a good candidate for deep brain stimulation, they’ll schedule your surgery.

Deep brain stimulation typically involves two procedures. During the first procedure, you’ll receive local anesthesia, allowing you to stay awake during part of the surgery without feeling any discomfort. The surgeon will make a small hole in the skull to access the right or left side of the brain. The team places one or two electrodes into specific areas of the brain to record activity. This helps confirm whether the electrodes are in the correct place. As part of this confirmation process, the team stimulates the area to ensure the electrode produces the desired effects, such as tremor or stiffness reduction.

You’ll return to the medical center a few days later for surgery to implant a battery, or pacemaker-like device. This procedure takes place under general anesthesia. The surgeon makes an incision under your collarbone and places the device beneath the skin. Next, the surgeon connects the electrode in the brain to the battery using an extension wire and then closes the incision.

Several weeks later, you’ll meet with the neurologist in the clinic to activate the neurostimulator and program it to deliver electrical pulses to the brain. You can turn the device on and off using a patient programmer. Programming is noninvasive. Going forward, you and the neurologist can adjust the programming according to your needs.

No. This treatment can significantly improve symptoms, but it can’t prevent worsening of neurodegeneration, or disease progression.

Every case is different, but for specific symptoms, deep brain stimulation can produce significant improvement. We have had patients get back to work, their favorite hobbies, taking care of loved ones and other tasks otherwise limited by their disease.

Unlike other therapies, deep brain stimulation can evolve along with a disease. As the disease changes, the programming neurologist can change the therapy to meet your needs.

Referring providers can email referrals for DBS evaluation to Nancy Elliott, RN, at nancy.elliott@ochsner.org. Alternatively, referrals can be faxed to 504-703-9150, addressed to Nancy Elliott, RN.