Deep Brain Stimulation Troubleshooting and DBS Failures Clinic
History of the DBS Troubleshooting Clinic
Researchers from the United States published a seminal study on deep brain stimulation (DBS) failures in 2005. The study examined reasons why a DBS device could fail and determined and listed the potential causes of DBS failures and how to fix them. Causes identified include Patient selection, the DBS procedure itself (misplacement of DBS leads, sub-optimal placement of DBS leads), Programming, and/or medication modifications post-operation.
Doctors and scientists have been working to improve the quality of DBS. In response to patient demand, the concept of a Deep Brain Stimulation (DBS) troubleshooting clinic has been introduced. The clinic was established to provide a systematic approach to evaluating and treating DBS failures and other DBS-related issues.
How we help patients with sub-optimal Deep Brain Stimulation
The Deep Brain Stimulation Troubleshooting Clinic serves patients from around the India as well as internationally, and has assessed over 500 deep brain stimulation leads as well as re-operated and re-programmed dozens of patients to date. The clinic’s success is due to its systematic approach and the amount of time spent addressing all of the pertinent topics.
A patient is assessed for 1-2 hours in the morning and is given standardised rating scales for all drug and stimulation conditions (potentially four scales). The results of the MRI or imaging investigation are subsequently incorporated into a 3-D brain atlas. Finally, benefit and side effect thresholds are reviewed and documented for each lead and contact site, and drugs are changed as needed. All rehabilitation services (PT/OT/Speech) are available to see the patient if necessary.
Whether the lead is sub-optimally placed or not, we always try to reprogram the patient after the evaluation. The patient is then fully presented to the entire interdisciplinary DBS and clinical team (neurologist, neurosurgeon, neuropsychologist, psychiatrist, physical therapist, occupational therapist, speech/swallowing pathologist, social worker). Medications, programs, and behavioural treatments are reviewed, as well as follow-up. If surgery is required, the patient is immediately referred to the fast-track interdisciplinary evaluation for DBS surgery.