Brain

Deep Brain Stimulation (DBS)

More than 150,000 patients have undergone DBS. The present day techniques make it a very safe procedure.

DBS Programming

Once the lead is effectively placed, programming must be optimized to maximize the clinical outcome. There is no single algorithm for DBS programming or reprogramming in movement disorders such as PD, but changing contact configuration and adjusting amplitude and pulse width are the most common parameters adjusted.

Most providers start by interrogating the system before proceeding with actual programming. Lead fractures or other damage to the system will generally manifest as abnormal impedance in one or more contacts. Intact contacts can then be tested sequentially or in combination to establish the efficacy and side effect thresholds and ranges. Once the optimal balance of efficacy and side effects are determined, additional programming may attempt to lower the current delivery.

DBS Reprogramming

Patients who have undergone DBS surgeries may sometimes not achieve good or desired relief.  There may be several causes for this:

  • Suboptimal programming of the DBS
  • Inaccurate lead placement
  • Difficult to treat symptoms, especially non-motor symptoms like sweating, sleep disturbance, numbness etc.
  • Unrealistic expectations
  • Improper management with drugs
Reprogramminig

We get several patients who have been operated at other centers but not obtained desired benefit. We accept to help them by using our skills and knowledge to provide them the best relief.

Mr. Karunakaran after DBS Reprogramming

The working of DBS system is very complex. There are symptoms that can exclusively respond to programming, where as there are symptoms that may respond with drug adjustments. For e.g.

  • Dyskinesia: will respond to reduction in drugs, but if this brings tremors, than we have to reprogram
  • “Not feeling strong”, “Lack of energy” will respond to drug management
  • Freezing : Will respond to programming

Uncontrolled tremors: Will respond to programming.

At our centre we have an experience of 19 years and more than 400 cases of DBS to help us understand these problems and resolve them. Dr. Doshi has been personally involved in programming all the PD patients and has yet to fail!!

Our reprogramming protocol

We usually ask the patient to be admitted for 4-5 days for this. We perform a CT scan and if available, review the previous records of the patient. If the patient is not given previous records by his doctors we can reprogram him using our algorithm from scratch. We have reprogrammed several patients from centres all across India and abroad. You can view their testimonials on: www.neurologicalsurgery.in/testimonial

To schedule a reprogramming appointment, write to: pdoshi@neurologicalsurgery.in