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TOPIC: When is enough really enough

Moderators: mholland

1 year 3 weeks ago

Knowing when DBS is optimized can be confusing when there are so many variables to consider- such as medication changes, stimulation changes and changes in your symptoms. During the first few months after DBS surgery, stimulation settings are optimized, symptoms improve and medications are reduced. We expect DBS to be successful for all patients that have had a proper evaluation by a specialist, proper electrode placement and appropriate adjustment of the stimulation. There are some situations when stimulation is turned up too high and side effects occur that can impact swallowing, speech and walking. Even gait freezing can be worsened with inappropriate stimulation settings. If DBS is causing problems or symptoms did not improve as you expected, seeking a second opinion is advised as stimulation side effects are reversible in just minutes.
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1 year 3 weeks ago

  • Anonymous
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I am just curious if DBS is going to be a good treatment option for people who are in the newer stages of their diagnosis? Is it heading that way, rather than getting to a maximum medication point?

Thank you.
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1 year 3 weeks ago

Hi, the right time for DBS varies. From a patient's perspective, the earlier the better especially if complications of PD are not yet bothersome but are inevitable. From a clinician's perspective, the risk of brain surgery must not outweigh the expected benefit. This is a subjective decision but usually based on experience with patients who have had DBS. From the insurance perspective, paying over a hundred thousand for an elective surgical procedure should provide noted benefit or the surgery is considered un-necessary. The FDA has approved DBS for patients with disabling tremor and/or motor fluctuations/complications and this is what typically determines when surgery is offered to patients. Until we have long-term outcomes to show earlier is better(usually 5 years), DBS will continue to be offered well beyond when the patient would benefit the most.
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