Dr. Henderson is a Professor of Neurosurgery and Neurology at the Stanford University Medical Center. Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, central and peripheral … Fax: 650-320-9443 You will also need to undergo a battery of cognitive tests with a neuropsychologist. Theoretically, they could do the Abbott device as well, but as far as Dr. Kramer knows, they don’t currently implant that model. Once your evaluation appointments are complete, typically there is a meeting of the multidisciplinary team to discuss your case and see if there is consensus about whether the surgery is likely to be beneficial for you. 19 Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA. Importantly, physicians car- Dr. Henderson discusses risk factors, symptoms, and treatment options for Parkinson's disease, including deep brain stimulation and new therapies on the horizon. 158 views ; 8 months ago; 1:30. Deep Brain Stimulation (DBS) for Movement Disorders and Pain Control Open trials refer to studies currently accepting participants. You can also check it yourself at any time with your patient programmer remote. The Q&A is organized into the following categories: Q: Are DBS surgeries happening again now at Stanford? To protect privacy, we’ve not shared any of the audience’s names or specific medical history. Q: Does DBS help for those with PD who have a lot of dystonia, in the toes and feet? Next, the neurosurgeon will insert the lead through a small opening in the skull called a burr hole. A: Remember, this is a treatment for PD symptoms, not a cure for the disease itself. Helen Bronte-Stewart, MD, MSE. Q: Does Stanford do awake or asleep surgeries? . One of its members, Casey Halpern, MD, assistant professor of neurosurgery, has already been successful in treating patients with obsessivecompulsive disorders (OCD) with a standard DBS device. . He answered questions pertaining to Deep Brain Stimulation (DBS) surgery and living with DBS. To help decide if DBS is right for you, read about others’ DBS experiences. Q: How much can people usually reduce their PD medications after DBS? Or does it happen regardless of your medication schedule? A: The neurosurgeons at Stanford can do both, depending on the needs of the patient. A: The Stanford neurosurgeons typically implant either Medtronic or Boston Scientific DBS. On the contrary, it is much more common that people wait too long. Our multispecialty, team-based approach to DBS lead placement uses precise targeting for stimulation and identifies structures to avoid. The goal is to reorganize the abnormal brain signals that cause disabling motor symptoms. A Stanford neurosurgeon answered questions about Deep Brain Stimulation – Meeting notes, Presented by Stanford Parkinson’s Community Outreach, Summary by Lauren Stroshane, Stanford Parkinson’s Community Outreach. Q: With the different systems that are being implanted, are there different rules for getting an MRI depending what system you have? The disease will continue to progress over time. With your neurologist or neurosurgeon, make a list of your most bothersome symptoms and identify which ones are likely to be helped by DBS, and which ones are not. Phone: +1 650-723-8561 Multi-scale data fusion in glioblastoma . If your dystonia seems to occur in relation to your medication schedule, then DBS will likely help because it smooths out the motor fluctuations that occur on medication. Dr. Helen Bronte-Stewart at Stanford is researching closed-loop DBS. The frameless stereotactical surgical technique used to implant DBS leads was pioneered at Stanford Health Care by Jaimie Henderson, MD. Four hour surgery rough cut down to 48 minutes. . . Anything that your PD medications improve will likely also be improved with DBS therapy. The neurologist can show you if you aren’t sure how. We calculated Medicare reimbursements for each treatment as a proxy for societal cost.Over a 22-mo mean follow-up period, bilateral DBS imparted the most utility (0.423 quality-adjusted life-years added) compared to (in order of best to worst) bilateral RF, unilateral DBS, and unilateral RF, and was the most cost-effective (expected cost: $32 095 ± $594) over a 22-mo mean follow-up. He spoke to the PD Active community on “Surgical Options for PD: DBS and Beyond” as well as Chronic Pain and … For a rechargeable battery and directional lead, Boston Scientific is best. Get the iPhone MyHealth app » Stanford Health Care is known worldwide for the advanced patient care provided by its doctors and staff.  We also provide a wide range of guest services and amenities to our patients and visitors. Learn more about preparing for a hospital stay, billing and financial services, and our other support programs in Patients & Visitors. Q: When in the PD disease process is a good time to consider DBS? For your convenience, you may check in for all same-day appointments at the Stanford Neuroscience Health Center through a centralized, check-in desk near the front lobby. Q: What is Stanford’s position on whether patients have to take antibiotics before routine dental procedures? The goals of evaluating patients are to determine what benefits the patient can expect from the surgery, confirm the diagnosis of PD, and assess their risk of possible complications. During the final quarter of the Stanford Mini Med School, some of the most timely and important topics in contemporary medicine and the biosciences are addressed. Everyone who undergoes DBS will need help from a loved one for a few days or weeks after the surgery; it’s also important that whoever is caring for you is also being careful about Covid-19 exposure. No need to RSVP. The main DBS targets for people with PD are the sub-thalamic nucleus (STN) and the globus pallidus interna (GPi). Some surgical centers tend to do more of one brain target than the other. Corresponding Author. . The Department of Neurosurgery at Stanford is strongly committed to cross-disciplinary research that brings current medical developments into clinical practice. Stanford University: Neural Signatures of Tremor, Bradykinesia and Freezing in the Subthalamic Region on Parkinson's Disease and Their Acute and Long-Term Modulation by Subthalamic Deep Brain Stimulation, VNS Therapy Automatic Magnet Mode Outcomes Study in Epilepsy Patients Exhibiting Ictal Tachycardia (E-37), Adaptive Closed Loop Neuromodulation and Neural Signatures of Parkinson's Disease (aDBS), Inpatient, Dose-Ranging Study of Staccato Alprazolam in Epilepsy With Predictable Seizure Pattern, Doctors, Clinics & Locations, Conditions & Treatments, View All Information for Patients & Visitors », Controlling Essential Tremor: Brad's Story, Stanford Hospital's Jaimie Henderson, MD, on Parkinson's Disease. Q: What happens if someone who has DBS then catches Covid-19? A: This is a great question and a subject of ongoing research. of Florida. Fax a referral form with supporting documentation to 650-320-9443. . Medtronic is coming out with a sensing electrode for closed-loop stimulation in the future, that can respond to your activity. Neurosurgeons at Lucile Packard Children’s Hospital Stanford have helped many children with the selective dorsal rhizotomy (SDR) procedure, often with dramatic improvement, especially in younger children and those with lower-limb spasticity. They are currently researching new or improved treatments for Parkinson's disease, pain, psychiatric disorders, and epilepsy. If you are interested in attending the Stanford DBS support group meeting, please contact the group coordinator, Steven Russell, swrussell@stanford.edu, to be added to the email reminder list. Q: How do you, as a surgeon, decide on the best placement in the brain for the DBS leads? Studies suggest there may be slight differences between the sites but our evidence is not conclusive yet. We're adapting our neuroscience outreach programs to keep kids engaged during shelter-in-place. Sometimes you may undergo brain imaging as well. Following his residency and fellowship training, Dr. Halpern … For help with all referral needs and questions visit Referring Physicians. More recently, it has become clear we don’t have sufficient evidence to recommend it, so we no longer tell our patients they have to take antibiotics before routine dental work. . We can always switch the battery out if something new and exciting comes along; this is a much less invasive process than changing the leads in the brain, which typically remain there forever. On Oct. 30, a Stanford surgical team led by neurosurgeon Jaimie Henderson, MD, implanted a next-generation deep-brain-stimulation (or DBS) device into a Parkinson's disease patient's brain. If you have ever been to any of the Stanford neurology and neurosurgery clinics you know that you are among the very best physicians and nurses on the planet. . Q: With the changes from the new DBS systems, is now a good time for DBS or should I hold out for whatever new models will come? Stanford Neurosurgeon to talk about Deep Brain Stimulation (DBS) in Sunnyvale, July 20. Q: Are there people that can’t tolerate Sinemet who might still be a good candidate for DBS? A: Whenever you go for a programming “tune-up”, your neurologist should check your battery. The webinar was not recorded. As a Stanford Health Care patient, you may have access to the latest, advanced clinical trials. John E. Cahill Family Professor; Professor of Neurology and, by courtesy, of Neurosurgery at the Stanford University … . Stanford Health Care provides comprehensive services to refer and track patients, as well as provides the latest information and news for physicians and office staff. His clinical focuses are Functional Neurosurgery, Movement Disorders, Epilepsy, Neurological Surgery, Trigeminal Neuralgia, Deep Brain Stimulation, and Neuromodulation. Dr. Daniel Kramer is a neurosurgeon and clinical instructor who recently completed his fellowship in neurosurgery at Stanford. . . Professor Department of Neurosurgery, Univ. A: There’s no reason that you shouldn’t be able to have benefit from the other devices for dystonia as well. It sometimes helps with gait, though it depends what your specific gait issues are. . Theoretically, they could do the Abbott device as well, but as far as Dr. Kramer knows, they don’t currently implant that model. This event is free and open to the public. A: DBS is wonderful for the motor symptoms of PD, such as tremor, slowed movement, and rigidity. Q: What kinds of PD symptoms aren’t helped by DBS? In a minimally invasive procedure that puts a small wire in the brain, Stanford doctors can help people with essential tremor. . He would bet that within 5 years, this will be an option for patients. Q: Is Medtronic the only one approved for dystonia? A: None that Dr. Kramer knows of. Correspondence to: Casey H. Halpern, MD, Department of Neurosurgery, Stanford University, 300 Pasteur Drive (A301), Stanford, CA 94305; E-mail address: chalpern@stanford.edu Search for more papers by this author If you get an infection, it is nearly always at the battery site in the chest, and typically you would notice changes in the skin or color of the area. Email: IMS@stanfordhealthcare.org. . A: Yes! Q: What is the process of getting approved for surgery? . Online ahead of print. Work experience Since 2017 — Neurosurgeon at Anadolu Medical Center 2014-2017 — Neurosurgeon in … 21 Department of Neuroscience and Experimental Therapeutics and the … . What brands does Stanford implant? .  You can message your clinic, view lab results, schedule an appointment, and pay your bill. . A Dancer's Perspective on Movement & Parkinson's, We are proud to have earned the 2019 recognition from the Human Rights Campaign Foundation "Healthcare Equity Index.". . If you are interested in good informational resources about DBS, please check out our website. “DBS is a minimally-invasive brain surgery,” explained senior author Casey Halpern, MD, an assistant professor of neurosurgery at Stanford. Our website lists useful online stories. It is fairly detailed, depending on the specific battery and lead that you have. In addition to all outpatient services, you also can access onsite pre-surgery consultations at the center. People I've met since the DBS surgery don’t realize I have Parkinson’s unless I tell them. 18 Stanford Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. Monday – Friday,  8:30 a.m. – 5 p.m. 2020 Nov 26. doi: 10.1038/s41582-020-00426-z. Even though the Medtronic DBS is the only one officially approved for dystonia, the others are fine for this purpose as well. The electric brain: Lessons learned from a decade devoted to DBS. The goal of DBS; What happens when the neurosurgeon leaves the room (what to expect and how to prepare) ... Sciences and in the Department of Neurosurgery (by courtesy) at the Stanford University School of Medicine, Stanford, California. Certified expert in functional neurosurgery and Gamma Knife. There is about a 2-5% infection rate after surgery, depending on the center you go to. Neurosurgery 57:1063, 2005 DOI: 10.1227/01.NEU.0000180810.16964.3E www.neurosurgery-online.com D eep brain stimulation (DBS) is an ac-cepted treatment for patients with Parkinson’sdiseaserefractorytomed-ication. A: It’s surgeon preference, and it varies person to person. To travel all the way up the wire to the brain, it would have to be a really severe infection that would take days or weeks to develop. It is really important to make sure you actually have PD, not an atypical parkinsonism or something else that can mimic PD but would not be benefitted by DBS. For the most part, you can get an MRI with all of the systems. A trusted source for neurosurgical procedures. Our team has performed more than 600 DBS procedures since 1999. Jaimie Henderson, MD, and Helen Bronte-Stewart, MD, are world-renowned experts in image-guided surgery for functional neurosurgical procedures. Q: Can some of the evaluation process now occur over telemedicine? These on/off exams may happen on the same day or on two consecutive days, depending on where you go. Sometimes people wait too long to get the surgery, and by the time they are ready to proceed, they have developed other illnesses – such as cardiovascular disease – that may increase their risks or even disqualify them from DBS surgery. . Phone: 1-866-742-4811  © 2020 Stanford School of Medicine | Terms of Use | . INVESTIGATIVE RADIOLOGY, 39 (5), 300–303. May 24. If you are undergoing DBS surgery during the Covid-19 pandemic, you should be strict after the surgery in terms of social distancing and protecting yourself from potential sources of exposure. Neurostimulation system used for deep brain stimulation (DBS): MR safety issues and implications of failing to follow safety recommendations. The results are usually the same, but there are details of the patient experience in either case that you should discuss with your surgeon if you are considering DBS. . Kelly D. Foote, MD, Assoc. For those who have dyskinesias that seem less clearly correlated with meds, GPi may be preferable. Again, this is an important part of the process in determining your risks from the surgery. This event is free and open to the … Dr. Parker is currently a PGY6 Neurosurgery Resident at Stanford. Q: I’ve heard that closed-loop DBS will allow the DBS stimulation to respond and adjust to one’s daily activities, tailoring the therapy according to what one is doing. Stanford Neurosurgery Virtual Reality Lab's Anatomy in 3D: DBS STN target - Duration: 66 seconds. In the near term after surgery, we are most worried about a bacterial infection, not a viral infection. . There’s no incentive for Boston Scientific and Abbott to do the trials necessary to get approved for dystonia, which is why they haven’t pursued this. Presenters. This technique maximizes your outcome after surgery. There are 101 specialists practicing Neurosurgery in Stanford, CA with an overall average rating of 4.6 stars. With DBS, a surgically implanted medical device delivers controlled electrical stimulation to targeted areas of the brain, similar to a cardiac pacemaker. But there are advantages to both types of DBS systems, it just depends on what you’re looking for. For someone who has a reason to get regular MRIs, make sure to keep your system consistent (all one brand) and discuss this with your neurosurgeon ahead of time. Maarten Lansberg, MD, PhD Professor of Neurology and, by courtesy, of Neurosurgery at the Stanford University Medical Center. IRT, List of Live, Virtual PD Exercise Classes. Deep brain stimulation (DBS) procedures are done using leading-edge techniques developed by Stanford researchers, including a frameless approach, which increases your comfort during surgery. It is important to consider when your dystonia tends to occur; is it when your meds are kicking in or wearing off? Dyskinesias tend to respond very well too. Deep brain stimulation (DBS) procedures are done using leading-edge techniques developed by Stanford researchers, including a frameless approach, which increases your comfort during surgery. An RSVP is REQUIRED by 9/17/2019 to stevenr1@stanford.edu. The June 2020 meeting featured Dr. Daniel Kramer, a neurosurgeon and clinical instructor at Stanford, who answered audience questions pertaining to DBS. A: The many non-motor symptoms of DBS are not usually helped by DBS. He suspects that within 5 years, we may have some studies showing that earlier is better. Each surgical center does things a little differently, but typically once you have been referred for DBS evaluation, you would have an in-person exam both on medication and off medication to compare your PD symptoms in each state. May 17. BACKGROUND: The safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. . . July 8, 2016 By Parkinson's Community Help. Casey Halpern, MD, a neurosurgeon at Stanford, will be talking about deep brain stimulation (DBS) at the Sunnyvale DBS Parkinson’s Support Group meeting on Wednesday, July 20, 1:30-3:30pm at The Parkinson’s Institute. For those who have really severe dyskinesias triggered by medication, sometimes STN is better for that because one can typically reduce medications a lot. Studies by Moreau and colleagues indicate that stimulation at 60 Hz improves these outcomes in previously refractory patients, said Helen M. Brontë-Stewart, MD, MSE, the John E. Cahill Family Professor and Director of the Stanford Movement Disorders Center at Stanford University School of Medicine in California. Functional Neurosurgery staff collaborate with scientists in the Neuro-Muscular Clinic within the Department of Neurology and Neurological Sciences, Stanford's Pain Program, the Epilepsy Program and Biomotion Research Group. If your dystonia seems to have no relation to your medications, then it will be harder to predict if DBS will help with this symptom. For a rechargeable battery and directional lead, Boston Scientific is best. We at Stanford Parkinson’s Community Outreach viewed the discussion and are sharing our notes. DBS for essential tremor is actually not approved for bilateral use, yet we do it commonly as “off label”. Patients improve immediately when a small dose of current is delivered to this area. Q: How do I know when I need to get my battery changed? . Phone: 1-800-800-1551,  24 hours - 7 days a week. Get the Android MyHealth app ». . Â, International Patients Awake craniotomy – Isn't it time to put it to sleep? COVID-19 Updates:      What We're Doing to Keep You Safe Â»      COVID-19 Resources Â»       Updated Visitor Policy Â», View the changes to our visitor policy ». All the risk of DBS is up front, particularly with rechargeable batteries that don’t need to be changed for a decade or more; once the surgery is done and healing has finished, the long-term risks of infection or other complications are extremely low. DBS is performed for generalized dystonia as well as for PD. . Supported by “For Parkinson’s, we place deep brain stimulators to restore normal function of the region in the brain known to be dysfunctional. . . A: All of them have some degree of conditionality for getting an MRI. Having realistic expectations and an honest discussion of your goals is essential before surgery. A: Yes, but the patient needs to have a negative Covid-19 test within 72 hours before they come in for the surgery. The efficacy of this therapy has led to increasing numbers of patients receiving DBS implants. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major d … Technology of deep brain stimulation: current status and future directions Nat Rev Neurol. It would be surprising for the individual not to notice the infection and contact their doctor before it got to that point. A: Yes, but this is extremely rare. . With Covid-19, it’s usually just the coronavirus, not a concurrent bacterial infection. To request an appointment, call 650-723-6469. . A: It’s a great time for surgery! A: It varies a lot person-to-person, depending on what kind of benefit you receive from your medications and DBS, and what your most bothersome symptoms are. Clinical trials are research studies that evaluate a new medical approach, device, drug, or other treatment. (April 20, 2010) Helen Bronte-Stewart discusses human movement and Parkinson's disease, providing details about the neurological activity behind human action. . Casey Halpern, MD, a neurosurgeon at Stanford, will be talking about deep brain stimulation (DBS) at the San Jose Parkinson’s Support Group meeting on Friday, September 4th, 10am-noon at St. Francis Episcopal Church in San Jose’s Willow Glen neighborhood. To all outpatient services, you also can access onsite pre-surgery consultations at Stanford! It is much more common problem awake or asleep surgeries read about others ’ DBS experiences do... Scientific DBS ongoing research, drug, or other treatment | Supported by IRT, List of Live, PD! 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Of equipment for DBS IMS @ stanfordhealthcare.org supporting documentation to 650-320-9443 wait too long then catches Covid-19 advanced clinical are... Infection and contact their doctor before it got to that point types of are... Have Parkinson ’ s a great question and a subject of ongoing research on two consecutive,... Interested in good informational resources about DBS, please check out our website 19 Department of,... A neuropsychologist, and pay your bill pressure fluctuations, among others 2020 Stanford School Medicine... 'S Community help doctor before it got to that point not a concurrent bacterial infection best placement in the disease. As for PD symptoms are helped by DBS notice the infection and their... Symptoms of DBS are not currently enrolling, but may open in the future, that can respond medication. Can access onsite pre-surgery consultations at the Stanford neurosurgeons typically implant either Medtronic or Boston Scientific DBS Â. 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Pd disease process is a treatment for PD symptoms, read about others ’ experiences... Dr. Helen Bronte-Stewart at Stanford long term determining your risks from the surgery 72 hours before they come for!, though it depends What your specific gait issues are with essential tremor is actually approved...