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Index
Table of Contents
Foreword
A Little History on Deep Brain Stimulation
DEEP BRAIN STIMULATION THERAPY
UNDERSTANDING THE MOTOR SYSTEM OF THE BRAIN
HISTORICAL UNDERSTANDING OF THE DISEASES TREATED WITH DBS
Parkinson’s Disease
Essential Tremor
Dystonia
EARLY BRAIN SURGERIES FOR MOVEMENT DISORDERS
ELECTRICAL THERAPIES IN THE BRAIN
DEEP BRAIN STIMULATION IN THE MODERN ERA
How Does DBS Work and What Can It Do for Me?
THE DBS SYSTEM
THE SKINNY ON HOW DBS WORKS AND WHAT IT CAN DO
For Parkinson’s Disease
For Essential Tremor
For Dystonia
Do I Qualify for Surgery?
PARKINSON’S DISEASE
When to Consider DBS
DBS Selection Criteria for Parkinson’s Disease
OTHER CONSIDERATIONS FOR PARKINSON’S DISEASE
Age
General Health
Support of Family and Friends
Expectations
ESSENTIAL TREMOR
When to Consider DBS
DBS Selection Criteria for Essential Tremor
Other Considerations for Essential Tremor
DYSTONIA
When to Consider DBS
DBS Selection Criteria for Dystonia
Other Considerations for Dystonia
THE DBS EVALUATION PROCESS
Choosing the Health Care Team that Is Right for You
THE DBS TEAM: CONSIDERATIONS
MEMBERS OF THE DBS TEAM
The Neurosurgeon
The Neurologist
The Neuropsychologist
Other Members of the Team
TALKING TO OTHERS
Your Social Support Network—Family and Friends
BEFORE SURGERY
DURING THE SURGERY
AFTER THE SURGERY
How to Prepare for the Big Day
PLANNING FOR THE BIG DAY
How Much Time Should I Take Off Work?
Insurance and Financial Concerns
Anxiety
General Health and Attitude
Surgical Clearance—A Clean Bill of Health
THE DAY BEFORE SURGERY
Medications
Other Concerns
What Should I Expect during the Surgery?
STAGE I: IMPLANTATION OF DBS LEADS
Frame Placement
Pre-operative MRI
Choosing the Target
Going to the Operating Room
Electrophysiological (Microelectrode) Recording
Placement and Testing of Leads
DBS Lead Placement Using Intraoperative MRI
Recovery and Post-operative Imaging
STAGE II: PLACEMENT OF THE STIMULATOR
I Had the Surgery. Now What?
THE HONEYMOON PERIOD
WHEN IS THE STIMULATOR TURNED ON?
PREPARING FOR P-DAY (THE DAY OF PROGRAMMING)
WHAT HAPPENS ON P-DAY?
Who Does the Programming?
PROGRAMMING BASICS
Monopolar vs. Bipolar Stimulation
Voltage, Frequency, and Pulse Width
Finding the Sweet Spot
FUTURE PROGRAMMING VISITS
ADJUSTMENT OF MEDICATIONS
Taking Care of Your DBS System and Other Precautions
WHAT IF I FALL OR GET INTO AN ACCIDENT?
WHAT ABOUT MAGNETS?
CAN I GET OTHER MEDICAL PROCEDURES DONE WITH THE DBS SYSTEM?
Diathermy
X-rays or Fluoroscopy
CT and PET (Positron Emission Tomography) Scans
Magnetic Resonance Imaging
Electrocautery
Cardiac Pacemakers
Emergency Cardio Pulmonary Resuscitation (CPR)
Electrocardiogram (EKG) or Electroencephalogram (EEG)
Ultrasound
Lithotripsy
Dental Work
Radiation Therapy
Mammogram (Breast X-ray)
Industrial Equipment
Household Appliances
Stimulator Battery Maintenance and Checkups
WHAT HAPPENS AT A DBS CHECKUP?
HOW LONG DOES THE STIMULATOR BATTERY LAST?
DBS HANDHELD DEVICE
Soletra Handheld Device (Access Review Therapy Controller)
Kinetra Handheld Device (Access Therapy Controller)
Activa PC/RC Handheld Device (Patient Programmer)
REPLACING THE STIMULATOR
My Symptoms Are Not Under Control—Troubleshooting Your System
DBS NEVER HELPED SYMPTOMS IN THE FIRST PLACE
Poor DBS Candidate
Poor Electrode Placement
Programming Problem
Failure to Achieve Expectations
DBS WORKED AND SUDDENLY STOPPED WORKING
Infection
Stimulator Off or at End of Life
Other Hardware Malfunction
DBS SLOWLY STOPPED WORKING OVER TIME
Lead Migration
Disease Progression
Tolerance/Habituation
Health Risks and Possible Complications in Surgery
THINKING ABOUT THE RISKS OF SURGERY
RISKS OF DBS SURGERY AND WHAT IS DONE TO MINIMIZE THEM
Claustrophobia
Discomfort and Fatigue
Problems of Lead Location
Confusion
Seizure
Stroke
Circulation Problems
Infection
BALANCING THE RISKS AND BENEFITS
Long-Term Clinical and Side Effects
LONG-TERM CLINICAL EFFECTS OF DBS
Parkinson’s Disease
Essential Tremor
Dystonia
LONG-TERM SIDE EFFECTS OF DBS
Speech
Balance
Dyskinesias
Weight Gain
Apraxia of Eyelid Opening
Depression
Cognition
Frequently Asked Questions
DOES INSURANCE COVER THE COST OF THE PROCEDURE?
DOES THE DBS PROCEDURE NEED TO BE DONE WITH MRI? IHAVE A PACEMAKER AND CANNOT GET AN MRI
WHERE WOULD YOU PUT THE DBS STIMULATOR IF I ALREADY HAVE A PACEMAKER?
WHAT IF THE STIMULATOR BATTERY RUNS OUT? WHAT WILL HAPPEN?
WILL OTHERS BE ABLE TO SEE MY DBS STIMULATOR?
WHY WOULD YOU CHOOSE THE STN AS A SITE FOR PARKINSON’S DISEASE? IT SEEMS THAT IT IS ASSOCIATED WITH MORE PROBLEMS THAN GPI
I LIVE ALONE. CAN I HAVE DBS?
I NEED TREMOR CONTROL IN BOTH OF MY HANDS TO PERFORM MY JOB. CAN I HAVE DBS FOR BOTH HANDS?
HOW DO I KNOW WHEN TO USE MY DBS?
CAN I DO MY OWN PROGRAMMING?
I HAVE ESSENTIAL TREMOR THAT AFFECTS MY VOICE. WILL DBS HELP THE TREMOR IN MY VOICE?
WHAT IF SOMETHING LIKE STEM CELLS IS FOUND TO CURE PARKINSON’S DISEASE IN THE NEXT FEW YEARS? DOES UNDERGOING DBS NOW PREVENT ME FROM GETTING THATTREATMENT?
Glossary of Terms
Support Organizations
GENERAL MOVEMENT DISORDERS
FOR DEEP BRAIN STIMULATION
FOR PARKINSON’S DISEASE
FOR ESSENTIAL TREMOR
FOR DYSTONIA
List of Commonly Prescribed Medications
PARKINSON’S DISEASE
Levodopa Preparations
Dopamine Agonists
COMT Inhibitors
MAO-B Inhibitors
Amantadine
Anticholinergics
ESSENTIAL TREMOR
Propranolol
Primidone
Benzodiazepines
Topiramate
Gabapentin
DYSTONIA
Anticholinergics
Benzodiazepines
Baclofen
Levodopa Preparations
Tetrabenazine
Botulinum Toxin
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