1. How long will the benefits of surgery last?
Because these operations in their current forms have been done for less than ten years, it is difficult to make definitive statements about the long term benefits of the procedures. In a series of patients reported from France with what is probably the longest duration of follow-up of STN-DBS, patients' improvement was shown to be stable for at least five years. Furthermore, from our own experience symptom reduction from pallidotomy has been maintained for more than ten years. It is important to realize, however, that this surgery probably does nothing to affect the progression of the disease process itself, so long term deterioration is expected.

2. Should I wait for cell transplants to become available?
It is possible that some type of (stem or differentiated) cell stereotactic transplantation into subcortical brain centers may ultimately prove to be the helpful therapies for many types of neurological problems including movement disorders. Despite a large amount of publicity, however, these techniques are in very early stages of development. Many complex medical and ethical issues will need to be resolved before they can be made available for general use. Thus, it is likely to be several years before we will have any treatments of this type to offer patients.

3. Will having an operation now affect my chances of having other forms of treatment that might become available in the future?
Although it is difficult to predict the effects of movement disorder surgery on an unknown form of therapy, it seems unlikely that the types of procedures currently being done would significantly interfere with any foreseeable types of management. Patients with implanted stimulators, however, present special difficulties for current MRI scanning procedures (see below) so this would have to be kept in mind in planning your evaluation for any future type of treatment. Furthermore, it is possible that having had this type of surgery might make you ineligible for some types of experimental clinical trials in the future.

4. Can I have an MRI scan with a DBS in place?
Current guidelines do permit MRI scans of the brain only in patients with DBS in place. These have to be done in accordance with certain very specific guidelines which have been developed by the manufacturer to avoid the chance of harm to the patient and to minimize the likelihood of damage to the implanted elements of the DBS system. It is strongly recommended, therefore that MRI scans in DBS patients be performed only if there are no reasonable diagnostic alternatives (e.g. CT scans) and that they be performed only at implanting facilities which are familiar with the appropriate safety procedures.

5. Are there other types of physical energy I should avoid, e.g. microwaves?
Microwave oven exposure is safe. Radiofrequency energy in the form of DIATHERMY TREATMENTS IS EXTREMELY DANGEROUS AND IS TO BE AVOIDED ABSOLUTELY. This type of energy is used by physical therapists for "deep heat therapy" and apparently sometimes by dentists to speed healing after extraction. All of these practitioners should have received notification of these facts from the manufacturer of the DBS system. However, it is recommended that you inform any medical, dental, or allied health practitioners that you have a DBS system implanted before undergoing treatment.
Some metal-detection devices such as those in airports or department stores may result in the stimulator being turned off. Also they can transiently increase the amplitude (strength) of the stimulation resulting in transient harmless (though perhaps unpleasant) neurological symptoms such as extremity tingling. It is recommended that patients display there registration cards (supplied when the device is implanted) and request a hand search. If this is not possible, patients could temporarily switch the generators off until they were safely past the screening devices.

6. Do I have to do anything to operate the stimulator?
No. The stimulator is designed to cycle on and off without any input from the patient. Patients are provided with a magnet with which they can turn the stimulator on and off. There is no reason to do so however except to save battery life (see below). Patients are also furnished a device with which they can tell if the stimulator is turned on or not.

7. What powers the stimulator? Do the batteries have to be changed?
The generator portion of the stimulator is powered by batteries which do have to be changed periodically. Current battery life is 3 - 5 years depending upon the degree of use. Changing the battery involves replacing the generator which does require an operation. This is a minor procedure, however, which is done under general anesthesia and can be done as an outpatient.

8. If I have bilateral stimulators, do I have two separate generators?
No. Since approval of the dual-channel Kinetra™ generator in 2004, we have been using it for patients with bilateral stimulators. Thus, patients have only a single generator typically placed on the right side of the chest below the clavicle. Patients with double generators could easily be "retrofitted", but this will probably not be recommended since it appears that the single, dual-channel unit will not offer significant enough advantages to make such a change worthwhile for the patient.

9. Is the cost of the procedure covered by insurance?
Yes. Most insurance companies now cover DBS for PD and ET. FDA approval for DBS in dystonia is in a different category since this is a more recent application of the technology. Thus, insurance approval for DBS in dystonia is on a "case-by-case" basis. Insurance companies are generally cooperative, however, when provided with evidence of the effectiveness of the procedure.

10. Must I have the stimulator programming done at the same medical facility where the implantation is done?
In general, yes. Because proper programming is vitally important for achieving the best possible results from the procedures, and because communication between the implanting surgeons and the programming neurologists is so important, virtually all implanting centers strongly encourage patients to return for programming to the center where the implantation was done. On very rare occasions, exceptions have been made but you should assume that you will need to return to the implanting center for regular clinic visits after the implantation has been done.

11. I have a DBS and my doctor/dentist has recommended a surgical procedure. What precautions need to be taken?
In general, surgery and anesthesia do not require any special considerations. However, if the procedure will require the use of electrocautery or the application of some other type of physical energy to your body, it is strongly recommended that your doctor contact the manufacturer of the DBS system to obtain recommendations that will maximize your safety and minimize the chances of damage to the device. Medtronic Neurological can be reached at (888)638-7627 or through this link. Furthermore if the surgery will involve manipulation of infected tissue, e.g. extraction of an abscessed tooth, your doctor may want to consider covering you with antibiotics as he would patients with artificial joints or heart valves.