Determining best stimulation settings after DBS surgery requires a structured process, careful exam and thoughtful appreciation for stimulation induced side effects and medication management. Arriving at optimal therapy can take up to 6 months of continuous stimulation if – the best electrode is selected. Below are the steps involved in achieving and maintaining optimal therapy:
- Assess and monitor symptoms that are responsive to stimulation
- Use settings that will improve symptoms
- Avoid too fast stimulation increases or medication decreases
- Maintain adequate expectations for the therapy
- Be patient with your body – takes time to reverse years of change
- High diligence in detection and avoidance of side effects
DBS side effects mimic the same symptoms seen with disease progression (worse speech, swallowing, walking and balance). If you just had surgery and are told you have disease progression as a cause for new or worse problems, seek out a DBS programming specialist soon as possible.
Once symptoms start to improve, stick with the stimulation settings that are working. Jumping around to different settings will not allow the brain to consolidate improvement and will lead to loss of benefit.
The high skill needed to adjust deep brain stimulation and medications is not commonly found in a general neurology office nor performed by a neurosurgeon. Search for medical professionals that focus on DBS and are trained in your medical condition. One question will set most true experts apart from those that dabble – Who was your mentor? Do your research. Most experts have the education and background that connects to others highly regarded in DBS. After accepting the risk of brain surgery, demand only the best possible care for your best possible future.
Caution to patients: stimulation is increasingly being managed by non-medical and unlicensed individuals and should be rejected by patients due to high risk of personal injury and disability; their actions are illegal whether performed in a neurologist’s office, during DBS surgery or over a phone call. Any and all medical services should be performed by medical professionals who are legally and morally responsible for your health and well-being and have the medical degree and licensure to practice medicine or surgery as granted by state medical boards.