DBS (Deep Brain Stimulation) Evaluation and Management

In 1995 when Deep Brain Stimulation (DBS) was in its infancy in the United States, neurologist Dr. David Greeley had a large percentage of patients with Parkinson's disease, tremor, and dystonia who wanted to learn about the procedure. He contacted Spokane neurosurgeon Dr. Jeff Hirschauer, who had stereotactic training and also had an interest. Dr. Hirschauer went on to perform the first DBS surgery in Spokane in 1997, assisted by Dr. Greeley in the operating room. Jamie Mark, ARNP, joined the team in 2000, and collectively, they have completed over 400 surgeries for patients with tremor and Parkinson's disease. More recent additions to our team include neurosurgeon Dr. Jonathan Carlson in 2009 and neurologist Dr. Jason Aldred in 2014. This center of excellence in Spokane is one of the oldest, largest and most successful programs for DBS in the United States.

Parkinson’s Treatment OptionsWatch the Explore DBS Therapy for Parkinson’s video series to gain a broad understanding of the procedure, its benefits and its risks.

 

 

DBS consists of a lead (a wire) with four electrodes that is implanted into the brain and a battery (pulse generator) that is placed in the chest under the collarbone. It is important to remember that DBS is not a cure nor does it slow the progression of disease, but by producing a small electrical current, DBS is able to improve the symptoms of the above-mentioned disease states.

DBS surgery entails two separate operations. In the first surgery we implant the lead(s) into the brain. For patients with Essential Tremor (ET) we often will implant the side of the brain that is predominately affected by the disease. For Parkinson’s disease or dystonia we most often implant both sides of the brain.

In this first surgery you are awake for portions of the procedure so that the surgical team can speak to you during the surgery to ensure we get the leads exactly where they need to be placed. Typically, patients feel minimal or no discomfort while awake.

One to two weeks later, an extension wire is tunneled down the back of the head and neck and the battery is placed in the chest. This surgery is done under general anesthesia.

For each surgery you will most likely stay at least one night in the hospital. We perform our surgeries at Providence Sacred Heart Medical Center in Spokane.

All components of the device are under the skin and no actual portion of the device can be seen, although in some patients it might be possible to see the outline of the battery in the chest or the lead on the scalp.

Speak to your healthcare provider about DBS to see if you might be a candidate. The pamphlet Identifying Candidates for Deep Brain Stimulation in Parkinson’s Disease and the Role of the Primary Care Physician addresses many issues that should be taken into account when considering DBS.