Deep Brain Stimulation

Can you describe the surgical procedure?

• You will be admitted to the hospital the morning of the procedure or the night before the procedure. Initially, a halo-like frame known as a stereotactic headframe will be placed on your head using local and intravenous anesthesia. You then will obtain an MRI scan with the frame on, and return to the operating room. There, under local anesthesia, a hole the size of a quarter will be made in your skull, and an electrode will be placed using computer guidance through the hole directed at the subthalamic nucleus. The NYU team of neurophysiologists including Drs. Beric and Sterio will begin electrophysiologic mapping using sophisticated monitoring devices, they will listen to the activity of the neurons, or nerve cells, in your brain, in order to determine precisely where to place the electrode. This is done while you are awake and involves cooperation between the patient and the operative team. Specifically, the physicians may ask you if you feel a tingling in a part of your body, and if so, in what part of the body. Since the brain contains a map of your body, based on your responses, the exact location of the electrode can be determined. Once the correct location has been determined, a permanent electrode is placed in the subthalamic nucleus. The procedure is then repeated on the other side. Once both electrodes have been placed , the anesthesiologist will administer general anesthesia, and the generator (pacemaker) devices will be placed . You will then be woken up from the procedure and taken to the recovery room. The average hospital stay is 2-3 days post-operatively. We routinely obtain a CT scan of your brain the day of surgery or the following day to verify correct placement of the electrode.

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. The NYU 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. The movement disorder team at South Shore Neurologic Associates will work with the NYU movement disorder team to ensure that the generator settings and medication regimen are adjusted in coordinated manner to optimize the functional outcome and patient satisfaction.