Deep brain stimulation: Approach to Care

Deep Brain Stimulation at the UF Center For Movement Disorders & NeurorestorationWhy the UF Health Center For Movement Disorders and Neurorestoration for DBS?

The UF Health Center for Movement Disorders and Neurorestoration is an international leader in the use of DBS implants for treating Parkinson disease and other movement disorders. The program is supported by the National Institutes of Health and several other funding agencies, and performs cutting edge research. The FDA has approved DBS for the treatment of Parkinson’s disease, Essential Tremor, and certain Dystonias. Use of DBS in other disorders is an active area of research here at UF (Tourette, OCD, Depression, others).

The UF Health Center for Movement Disorders and Neurorestoration (CMDNR) is the only center in North America that brings total care for movement disorders together in one location. The CMDNR was established at the Evelyn F. and William L. McKnight Brain Institute in July 2002, to bring together UF doctors and researchers with special expertise in Parkinson’s disease and other movement disorders. The mission of the center is “To provide the highest level of medical and surgical care to patients with Parkinson’s disease, tremor, dystonia and other movement disorders. To perform research that will lead to better treatments and ultimately cures for Parkinson’s disease and other movement disorders.”

The CMDNR offers the highest level of integrated, interdisciplinary care for patients with movement and neuropsychiatric disorders. The Center includes clinicians and researchers from the fields of neurology, neurosurgery, neuroscience, neuropsychology, speech and communication disorders, physical therapy/rehabilitation, psychiatry, neuropathology, and computer science.

The co-directors of the CMDNR are Michael S. Okun, M.D. (neurology), and Kelly D. Foote, M.D. (neurosurgery). The prominence of the Center is reflected by the multiple Centers of Excellence represented here. These include a National Parkinson Foundation Center of Excellence, Tyler’s Hope for a Dystonia Cure Center for Comprehensive Dystonia Care and an NIH designated headquarters of the nationwide Clinical Research Consortium for Spinocerebellar Ataxias.

Dr. Okun and Dr. Foote have specialized training in the surgical treatment of Parkinson’s disease and other movement disorders. In recent years, neurosurgical procedures for the treatment of Parkinson’s disease, essential tremor, dystonia, and other movement disorders have become important and exciting areas for both patient care and research.

What is Deep Brain Stimulation?

Deep brain stimulation, or DBS, a surgical therapy that involves the implantation of stimulating electrodes into select targets of the brain. These electrodes are used to interrupt faulty communication between brain regions that result in the disabling symptoms of Parkinson’s disease.

How does DBS work?

Understanding DBS for Parkinson’s disease requires a look at certain parts of the brain. Like electrical wiring in an appliance, if one or more circuits fails, the machine malfunctions or stops working. Research has shown that in Parkinson’s disease, there are faulty “circuits” that send abnormal signals to certain brain regions that result in disease symptoms. Interrupting these faulty signals using DBS improves symptoms in select cases. DBS is thus said to modulate neuronal circuits, but its exact mechanism of action remains unclear.

Am I a candidate?

At the CMDNR, DBS is performed by an experienced team including Dr. Michael Okun in Neurology and Dr. Kelly Foote in Neurosurgery. A preliminary evaluation in Neurology is the first step in becoming a patient. A potential candidate for DBS is typically scheduled for a Fast Track Evaluation. Fast Track involves a comprehensive two day evaluation usually scheduled on Monday and Tuesday. The Fast Track begins with an appointment with the neurosurgeon, Dr. Kelly Foote, followed by a 4 hour neuropsychological exam with a Neuropsychologist that measures your memory, thinking and cognition. The second day includes meeting with a Psychiatrist, physical therapist, occupational therapist, a Speech and Swallow evaluation and a data collection visit at the McKnight Brain Institute.

Following the Fast Track evaluation, the DBS team meets to discuss evaluations and make recommendations. These meetings occur monthly and surgery is typically scheduled 1-3 months following the Fast Track evaluation.

Things to consider

DBS is an elective surgery that you may choose as a treatment. Following your Fast Track evaluation, our team will contact you about your candidacy. If you are an appropriate candidate, you will need to be sure to discuss the risks/benefits with your doctors and your family. Like any surgery, DBS comes with the risk of complications. Although the risk of serious or permanent injury from DBS is low, it is important for you to understand that you could develop permanent side effects.

The DBS surgery and subsequent visits also require a commitment of time (once a month visits for the first six months and regular visits thereafter), energy, travel time and depending on your insurance, you may be required to cover some of the expenses.

Preparing for surgery

If you decide to pursue DBS surgery, your next step is to plan and prepare for the operative procedure and recovery. The CMDNR staff specializes in DBS therapy for the treatment of Parkinson’s disease, and will provide you with support throughout your recovery.

As your surgery date approaches, it is normal for you to experience nervousness or anxiety. The best recommendation is to plan ahead, stay organized, speak with other patients who have had the surgery and plan to bring a friend or family member to be with you before, during and for at least a month or two following your surgery.

The day prior to your surgery you will visit our Neurosurgery clinic for a pre-operative evaluation and if you are going to be under anesthesia for the procedure, you will have an appointment with anesthesiology. Your pre-operative MRI may be taken the day before surgery.

For more information about the surgical or medical treatment of movement disorders or to refer a patient, call the University of Florida Consultation Center at 352-294-5000. If you are a new patient you will be walked through the process of getting an appointment.

Contact us about Deep Brain Stimulation