Frequently Asked Questions

How soon after surgery will my symptoms improve?

The generator is not usually activated until a few weeks after the procedure when all the wounds have healed. Nevertheless, just placing the electrode in the correct location can result in a temporary improvement in some of the symptoms.

Who turns on the generator?

Our movement disorder team will activate the generators and determine the correct settings to obtain the maximum clinical benefit with minimal side effects. Over the first few months, you may need a number of adjustments in order to determine the best settings. Once the optimal settings have been determined, the patients can turn stimulation on and off with a small magnet. For example, some patients turn the generator off at bedtime.

How long does the pulse generator battery last?

Battery longevity varies depending upon the parameter settings and number of hours the pulse generator is turned on each day. Estimated longevity is about five years at typical settings, 16 hours of use per day. When the pulse generator battery needs to be replaced, the old pulse generator is replaced by an entirely new pulse generator; the extension and lead are not replaced. The replacement procedure can by done under local anesthesia.

Is this surgery a cure for Parkinson's disease?

Currently, there is no cure for Parkinson's disease. The goal of this surgery is to improve your quality of life by ameliorating some of the disabling symptoms of the disease. The effects of STN stimulation are reversible when the stimulation is turned off, the symptoms will eventually re-appear. However, if the disease does progress, adjustments can be made to the stimulation parameters in order to maintain the beneficial effect of stimulation.

What is subthalamic nucleus stimulation?

The subthalamic nucleus (STN) is a structure located deep within the brain that controls many aspects of normal motor function. In Parkinson's Disease PD), the subthalamic nucleus is hyperactive, sending an excess of electrical signals to other parts of the brain.

Deep brain stimulation (DBS) of the subthalamic nucleus is a procedure in which tiny electrodes are placed via computer guidance and physiological mapping into the subthalamic nucleus on each side of the brain. These electrodes are connected to pacemaker-like devices implanted beneath the collarbone, much like a cardiac pacemaker. Electrical stimulation of the STN effectively jams or blocks the abnormal circuitry of the brain in Parkinson's disease, thus ameliorating many of the disabling symptoms and improving the overall quality of life of patients suffering from this degenerative disease.

How was surgery for Parkinson's disease developed?

Parkinson's disease is believed to be caused by the degeneration of nerve cells in a part of the brain known as the Substantia Nigra Pars Compacta. These nerve cells produce a substance known as dopamine. Dopamine is a neurotransmitter, a chemical signal sent from one nerve cell to another during normal brain activity such as movement. Reduction of the amount of dopamine in the brain interferes with the normal brain circuitry involved in movement; in particular, areas of the brain known as the basal ganglia, thalamus, subthalamic nucleus and motor cortex. An aberration in the circuitry is believed to result in the symptoms of Parkinson's disease. Approximately 40 years ago, neurologists and neurosurgeons found that making a destructive lesion in the basal ganglia or thalamus helped some of the symptoms of Parkinson's disease. Procedures such as thalamotomy and pallidotomy, which destroyed portions of the thalamus and globus pallidus (part of the basal ganglia), were noted to be rather effective in treating some of the symptoms of Parkinson's. These procedures were quite common in the 1950's and 1960's, until the advent of levodopa (L-Dopa), the first drug which demonstrated significant benefit for Parkinsons patients. Beginning in the late 1960's, the number of surgical procedures for Parkinson's declined significantly throughout the world.

However, despite the advent of pharmacological therapies for PD, there remains a population of patients who become less responsive over time to the medications, or who have disabling side effects. Thus, in the late 1970's/early 1980s, neurosurgical procedures (thalamotomy and pallidotomy) once again began increasing in number. As mentioned, these procedures involved making a permanent destructive lesion in a specified location of the brain. In the mid 1980's,a number of neurosurgeons began using electrical stimulation instead of lesioning procedures. Neurosurgeons had always used electrical stimulation during the course of lesioning surgery in order to guide lesion placement, and had found that stimulation using high frequency electrical signals could abolish tremor. Since deep brain stimulation is a reversible and adjustable technique, it has become increasingly popular as opposed to irreversible lesioning procedures.

Where was STN surgery developed?

STN Deep Brain Stimulation surgery for Parkinson's disease was first performed in Grenoble, France by Dr. A. Benabid, a pioneer in neurosurgery for Movement disorders. Other centers in Europe and Canada followed his lead. Patrick J. Kelly, M.D., F.A.C.S. Professor and Chairman, Department of Neurosurgery, New York University School of Medicine, and a pioneer in stereotactic neurosurgery, is internationally recognized as an authority on movement disorder surgery and a pioneer in stereotactic neurosurgery. Dr. Kelly is the recipient of the prestigious Scoville Achievement Award from the World Federation of Neurosurgical Societies. He is the former President of the American Society for Stereotactic and Functional Neurosurgery and is presently Vice President of the World Society of Stereotactic and Functional Neurosurgery.

For more information, please contact:

• Mark Gudesblatt M.D.
• Anne Dunne R.N.
  • South Shore Neurologic Associates
  • 280 Main Street
  • Bay Shore, New York 11706
  • 631-666-3939
  • FAX: 631-665-6844