Deep Brain Stimulation (DBS) surgery offers a treatment pathway for individuals managing certain neurological conditions, such as Parkinson’s disease, essential tremor, and dystonia. This procedure involves implanting electrodes in specific brain areas, connected to a small device placed under the skin, which delivers electrical impulses to help regulate abnormal brain activity.
Immediate Post-Surgery Period
Immediately after DBS surgery, patients typically spend one to two days recovering in the hospital for monitoring. During this initial phase, it is common to experience temporary side effects, including headaches, fatigue, and mild nausea. Bruising, swelling around the eyes, and tenderness at the incision sites on the scalp and chest are also common and usually subside within a few days or weeks.
Medical staff monitor vital signs and conduct neurological checks to ensure the device is functioning and to watch for any immediate complications. Pain during this period is generally mild and can be managed with oral medication. Wound care for the surgical incisions is initiated, with dressings typically removed within two days, after which gentle washing can begin. The DBS device is not activated during this hospital stay.
The Recovery Journey at Home
Upon discharge from the hospital, the recovery process continues at home, preceding device activation. During the first four to six weeks, patients should avoid strenuous activities, heavy lifting exceeding 15 pounds, and movements that strain the chest or upper arm muscles, such as swimming or golf. Continued wound care involves keeping incision sites clean and dry; stitches on the scalp are typically removed within 7-14 days.
Patients may experience residual discomfort or swelling, and fatigue is common, necessitating adequate rest. Monitoring for signs of infection, such as expanding redness, unusual drainage, or fever above 101.5 °F, is important; report any such signs to the healthcare provider. Symptoms will not yet be controlled by the DBS system during this phase, as the device remains inactive. Some patients may experience a temporary improvement in symptoms, known as a “honeymoon effect,” but this effect is transient, and symptoms typically return to pre-surgery levels before activation.
Device Activation and Programming
DBS device activation typically occurs several weeks to a few months after surgery, allowing the brain to heal. This step usually takes place in an outpatient clinic, often with a neurologist or specialized programmer. Programming involves adjusting various stimulation parameters, including amplitude, pulse width, frequency, and electrode configuration.
Patients might experience immediate sensations, such as tingling, during these programming sessions as parameters are adjusted. Programming is an iterative process, often requiring multiple visits over several months to fine-tune settings. Patient feedback during these sessions guides the healthcare team in finding the most effective and comfortable settings to minimize symptoms and side effects.
Living with DBS and Long-Term Care
Living with an activated DBS system involves ongoing management and routine follow-up appointments with the neurology team. These visits monitor symptom control, assess device performance, and make necessary adjustments to programming settings as the condition progresses. The medical team may also adjust medication dosages to work effectively with the electrical stimulation.
The implantable pulse generator (IPG), which houses the battery, has a finite lifespan. Non-rechargeable batteries last between 3 to 5 years, while rechargeable batteries can last up to 15 years or more with consistent charging. Replacement of the IPG requires a minor surgical procedure, usually leaving the leads in the brain intact. Patients can use a handheld remote control to turn the device on or off, check battery status, and make minor adjustments to stimulation within parameters set by their doctor.
Most DBS systems are MR Conditional, meaning magnetic resonance imaging (MRI) scans are safe under specific conditions, which must be discussed with the managing physician prior to the scan. Patients should carry their device identification card, especially when traveling, as strong electromagnetic fields, such as those at airport security or theft detectors, can temporarily affect the device. Daily activities are minimally impacted, and the device works continuously to manage symptoms.