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Deep Brain Stimulation

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Deep Brain Stimulation (DBS) sends electronic signals to an area in the brain that controls movement and blocks some of the brain’s messages that cause annoying and disabling motor symptoms. It involves placing a pacemaker-like device under the skin in your chest (not in the brain). Very thin wires connect the device to your brain to enable the signals to reach the source of your symptoms.

DBS offers relief to many suffering from motor control difficulties, most commonly seen in patients with Parkinson’s disease. It may calm symptoms almost immediately and offers an increase in the quality of life for many patients. The procedure and treatment may also be used in epilepsy cases where the medication does not control seizures.

Why Choose UHealth?

Highly-trained specialists. The experienced neurosurgeons at UHealth have performed more than 600 of these procedures.

The latest in DBS technology. Our program was the first in the state of Florida to offer DBS systems that have Bluetooth generators and offer more precise stimulation.

Dedicated support groups. Your care doesn’t stop with just your medical procedure. Our team offers a support group for patients and their loved ones who have undergone DBS surgery or are planning to have the surgery.

Questions? We're here to help.

Our appointment specialists are ready to help you find what you need. Contact us today.

Who is a Candidate?


Patients with Parkinson’s disease whose medications don’t seem to work as well as they have in the past, and:

  • Experience periods when medication is not helping enough
  • Experience troubling dyskinesias (involuntary excessive movements)
  • Take frequent doses of dopaminergic drugs (Levodopa, Sinemet*, Stalevo*, Parcopa*) in a typical day
  • Despite having tried several drug combinations, experience any of the following troubling side effects: sleepiness, nausea, hallucinations, confusion/other thinking problems, lightheadedness upon standing, behavioral/personality changes

The procedure and treatment may also be used in epilepsy cases where the medication does not control seizures.


What to Expect


Until recently, the only option for treating many cerebrovascular conditions was brain surgery. The introduction of stent-assisted coiling has allowed patients to avoid surgical procedures, and recover much more quickly.

Implanting the device used in DBS is technically two procedures – one that implants the leads in your brain and the other that implants the neurostimulator under the skin of your chest right below the collarbone. These may be performed on the same day or on separate days.

Your hospital stay will usually be a few days so that all the planning and proper tests can be performed. These may include implant procedure and initial recovery before home care. Your surgical team will include:

  • A neurologist
  • A neurosurgeon specialized in DBS therapy
  • Other healthcare professionals

People who have had the procedure usually describe it as demanding and exhausting rather than painful. Afterwards, you may have some discomfort and soreness that can be managed with pain medication.

Healing

Recovery can take several weeks. Discomfort or pain at the incision sites can be managed with medication. Avoid strenuous activity, moving your arm above shoulder level, and excessively stretching your neck.

You may want to gradually attempt activities that were difficult before your surgery. Talk about this with your doctor first and follow all of your doctor’s instructions.

Programming sessions

You will see the best results after the system has been fine-tuned for your specific symptom control needs. These sessions allow your doctor to adjust the device so that it targets and controls your individual symptoms while minimizing side effects. You will return for follow-up sessions to further adjust the settings.

Periodic adjustments are a routine part of DBS therapy. After the initial programming, people with tremor may feel a brief tingling sensation, and usually experience relief from symptoms almost immediately.

It may take several months to reach maximum effect. Depending on the system and your therapy needs, you may have a controller that will allow you to turn the system on and off, adjust the stimulation, and check the battery.


FAQs


Would DBS keep me from using future treatments or cures that may come along?Page 1

No. DBS therapy will not reduce your future therapy options. DBS therapy is reversible and the system can be removed.

Is DBS just for tremor?Page 1

No, DBS also treats stiffness and slow or absent movement.

Is DBS something to consider as a last resort?Page 1

No. As soon as you realize that your medications don’t seem to work as well as they have in the past, talk to your doctor right away. The window of opportunity for DBS therapy opens when your body isn’t responding to medication as well as it used to – but before your medicine stops working completely.

If you wait too long, you will not benefit as much from the treatment.

How long will it take for the DBS therapy to work after the implant procedure?Page 1

Typically, the DBS device is not activated until you’ve healed from the surgery. Your symptoms may decrease at that time. Optimal results are usually achieved after the doctor or nurse who programs your device has gone through multiple programming sessions with you. This process may take several months.

What does the stimulation feel like?Page 1

Most people don’t feel the stimulation at all as it reduces their symptoms. However, some people may feel a brief tingling sensation when the stimulation is first turned on. Higher levels of stimulation have been described as uncomfortable, jolting or shocking. If the stimulation changes or becomes uncomfortable, contact your doctor immediately.

Will I be able to resume my normal daily activities?Page 1

For the first few weeks after surgery, you should avoid strenuous activity, arm movements over your shoulder, and excessive stretching of your neck. You may want to gradually attempt activities that were difficult before your surgery. Talk about this with your doctor first and follow all of your doctor’s instructions.

Will the neurostimulator show through my clothes?Page 1

Depending on your body build, the neurostimulator may be noticeable as a small bulge under the skin. Your doctor will try to place the neurostimulator in a place that is most comfortable and cosmetically acceptable.

Will I be able to increase or decrease the strength of stimulation?Page 1

In most cases, only your doctor can change the strength of stimulation. Depending on the type of neurostimulator you have, you may be able to choose from a range of stimulation settings that your doctor has programmed for you.

Will my insurance cover DBS therapy?Page 1

The current national policy provides coverage for Medicare beneficiaries who qualify as candidates for DBS; however, you will still pay deductibles, coinsurance, and copayments.

Typically, your doctor will work with private insurance companies to obtain prior approval. It is common for an insurance company to deny a request for prior approval if they are unfamiliar with the treatment.

Denied? If you receive a denial and wish to appeal, we’re here to guide you and your physician through the process.

Is it safe to have medical tests with the system implanted?Page 1

Consult your doctor before engaging in any medical treatment or diagnostic test (for example, MRI, mammograms, electrocautery, or heart defibrillation). Diathermy (deep heat treatment) should not be permitted under any circumstances.

Will I be able to have an MRI scan with a DBS system?Page 1

Many DBS systems are designed so that an MRI head scan is possible with proper safeguards. But, you should talk to your doctor if an MRI scan is prescribed for you.

Can stimulation be used during pregnancy?Page 1

The safety and effectiveness of this therapy have not been established for patients who are pregnant.

What are the risks associated with this type of treatment?Page 1

Since DBS therapy requires brain surgery, there are risks involved including bleeding inside the brain, seizures and infection. Also, the system may become infected, parts may wear through your skin, and the lead or lead/extension connector may move. Some patients receiving DBS therapy have reported depression and suicidal thoughts. Talk with your doctor about the risks that may be applicable to your specific situation.

Is this a permanent procedure?Page 1

No, it is actually completely reversible. It is also adjustable, which means that the stimulation can be adjusted to match changes in your symptoms. The system can also be deactivated or even surgically removed.

What happens if the neurostimulator stops working?Page 1

Your symptoms will return. If you can’t determine the possible cause and correct the problem, contact your doctor.

How long will the neurostimulator battery last?Page 1

On average (depending on programmed settings), the neurostimulator battery lasts 3 to 5 years. The rechargeable neurostimulator lasts for 9 years.

What happens when my neurostimulator is ready to be replaced?Page 1

Before your battery runs out, you’ll need to replace the neurostimulator through a surgical procedure. The lead and extension can typically stay in place and be reconnected to the new neurostimulator.

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • CompCare (Comprehensive Behavioral Care)
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry Vista Medicare HMO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Global Health Claims Services
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana HUMx
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care