Care of DBS patients

Coordinate referrals to members of the team evaluating potential DBS surgical candidate: O Neurosurgeon. O Neuropsychologist. O Psychiatrist. O Radiologist.

Programme the DBS device (111): O At intervals designated as standard of care. O As needed.

PD patients should be programmed in the off medication state. They should be advised to discontinue their medications at 10 pm the night before the visit.

As patients present off medication, it may be best to schedule visits in the morning to reduce the time the individual is in the unmedicated state. Impedances and battery status should be checked at every office visit.

O If impedances are abnormal, and the clinician is concerned there may be a lead fracture, send the patient for plain films, including a shunt series and chest film. Reset the counters at each programming visit. O If there are numerous activations since the time of the last visit, inquire as to whether the device has been turned off for any reason. O If there have not been deliberate deactivations of the device, question whether the person has been exposed to a magnetic field, which can include freezers as well as security systems in retail stores. Monitor motor performance in at least two conditions to determine the ideal parameters: O Off medication/on stimulation. O On medication/on stimulation. May coordinate follow-up imaging studies for lead localization if needed.

111 DBS device programming. Finding the optimal settings requires patience and good communication.

CHAPTER 9

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