Deep Brain Stimulation programming Sherrie Gould MSN, NP-C Scripps - - PowerPoint PPT Presentation

. . . b

• t

h a s c i e n c e a n d a n a r t

Deep Brain Stimulation programming

Sherrie Gould MSN, NP-C Scripps Clinic Center for Neurorestoration

Initial Programming

• Postpone programming until micro-lesion effect

subsides, about 3-4 weeks following surgery

• (although early programming can be performed)
• Schedule patient for morning visit if possible, with

medications withheld overnight

• Helpful tip: Have them bring their morning dose of

medications

Clinician and patient controls

Activa SC/PC/RC Patient Programmer

• 1. Explain to the patient that programming is

interactive process

• 2. Ask if was a lesion effect?

Verify device function (impedence)

• 3. Monopolar review
• 4. Set initial parameters

Efficient Programming: Initial Programming Visit

So What is Involved in Programming DBS??

• 1) Test all 4 electrodes on either side of

brain-which brings best result with no side effect?

• 2) Set pulse width (depending on tremor,

dystonia

• 3) Set frequency (depending on tremor, gait)
• 4) Set amplitude

1 2 3

Lead Electrodes

Bipolar Unipolar

1 2 3 1 2 3

• ff
• ff

(-)

• ff

(+) positive

• ff
• ff

(+) (-)

• ff

DBS Lead Electrode Selection

Interesting features of Activa SC/PC/RC

• Groups
• Interleaving
• Increased patient autonomy
• Fine pulse width adjustments
• Patient usage trends
• In the appropriate patient, this proves to be

invaluable when it comes to follow up visits

Follow-up Programming Visits

• Review interim changes: symptom response, medication changes, adverse

effects

• The goal is to slowly lower meds
• as the stimulation increases
• Review results of monopolar review for insight, patient likes
• and dislikes
• Formulate and implement management plan

– Adjust stimulation, adjust medication, make no adjustments

* Humanitarian Device: The effectiveness of this device for the treatment of dystonia has not been demonstrated.

Thank you for your time and attention