Pre-surgical Evaluation for DBS
If you are a candidate for DBS surgery you will have a careful pre-operative evaluation. The evaluation is to make sure that DBS surgery is safe for you. The first step is a consultation with a movement disorders neurologist. They will confirm your diagnosis and make sure that all the reasonable medicines have been tried. For some patients a neuropsychological evaluation will be done. A doctor will test how well you remember things and follow instructions. You may be asked to perform simple math. These tests are NOT designed to see how smart you are. They help decide if DBS treatment would cause harm. Your neurologist and surgeon will decide if you need these tests. Most patients with Parkinson’s disease do need them. Neuropsychological tests help predict whether you may develop thinking problems after DBS surgery. We will inform you of this chance before you make your decision.
You will undergo a special MRI scan of the brain. This scan must be done at Cedars-Sinai and cannot be done at any other hospital. The MRI gives a detailed picture of your brain. It will be used during the surgery to guide exact placement of the DBS electrodes.
Your neurosurgeon and neurologist will review the MRI scan and the neuropsychological testing results to make sure that surgery will be safe for you.
Preparing for Surgery:
You will see the nurse in the neurosurgery office before the scheduled surgery date. The purpose of this visit is to prepare you for the surgery, hospitalization, and recovery at home. It is important for you or your caretakers to bring ALL medicine and their exact dosages to that appointment. This includes vitamins, minerals, or other supplements you might be taking. Medicine that might thin your blood such as aspirin, plavix, indomethacin, coumadin, and many herbal supplements, must be stopped two weeks prior to the surgery.
You will be asked to take nothing by mouth (no liquids, no food) starting at midnight the night before the surgery. This allows time for the stomach to empty. If you take regular medicines for the disease you are having DBS surgery for, do not take them after midnight. If you are taking medicines for diabetes or heart problems, you will receive special instructions about when and how to take them. The nurse will discuss the time to arrive at the hospital on the day of surgery, where to go, and what to expect. Patients are asked to come to the hospital at 0630 the morning of the surgery and are admitted to the hospital at that time. Upon arrival to the hospital, patients are prepared for surgery in the preoperative area on the surgery floor. In the next chapter, we will describe the steps before surgery in more detail. Family members can wait in the surgical waiting room. This is where the doctor will talk to them when the surgery is finished.
The nurses will also discuss how much assistance the patient will need at home following the surgery. In general, patients will be able to care for themselves but may need help with some household chores. Patients should avoid strenuous activities. Exercise should be limited to walking for the first two weeks after surgery. Driving is allowed if the patient has adequate vision and pain medicines are not needed. Patients can resume social activities as they feel able. Some patients may benefit from physical therapy and occupational therapy after DBS surgery. IF your doctor orders this, it should start as soon as possible after the surgery.
You can return to work when you and your surgeon decide. Patients with less physically active jobs sometimes return to work as early as 1-2 weeks after surgery. Those with more physical jobs do not usually return to work for 4-8 weeks after surgery.