Deep Brain Stimulation Optimization Assessment Program
In caring for people living with deep brain stimulation, I am often asked whether stimulation can be changed to improve symptoms. Historically, once stimulation is set to the best possible setting after thorough and extensive testing, a change in stimulation can cause benefit loss and increase fall risk or swallowing problems. The concept that the best electrode should always yield maximal benefit over the years remains true, however in treating my patients as the disease progresses there are exceptions. Can stimulation be modified, even slightly, to improve symptoms over time? How can we know as programmers when stimulation settings are optimized without extensive testing?
- Rationale to re-test: The primary symptoms that typically initiate a request to change stimulation are walking, balance and speech. These motor (movement) symptoms are signs of progression and not likely very bothersome at the time of DBS surgery. Determining the best stimulation settings may have depended on very different symptoms or problems. Logically, changes in the disease also lead to changes in brain physiology and circuitry. The question remains, can we quickly assess whether stimulation could be changed safely without causing loss of therapy or risky declines in symptoms?
- A template for success: With years of troubleshooting self-referred patients from across the country and abroad, investigating and improving troublesome symptoms after years of living with DBS is possible. By implementing a rapid clinical assessment, the decision to change stimulation can be done thoughtfully and safely using the assessment tools we depend on when initially determining the optimal stimulation settings, but likely monitoring very different symptoms. Our rapid assessment has further been shortened for people living locally to our clinic in Colorado.
- What about non-motor symptoms: research has proven stimulation can cause negative mood and cognitive changes. Should we assess stimulation settings when these non-motor symptoms emerge or worsen? Would changing stimulation for mood or cognition worsen motor symptoms? The emotional and cognitive networks impacted by stimulation is less understood but we do know stimulation can cause mood and cognitive problems.
Rapid Assessment Program for DBS Optimization
Our DBS clinic offers a rapid assessment program to assess the impact of stimulation for motor, mood and mentation. These three M’s make the largest impact on quality of life in our patients and families. The assessment includes two half day visits and is open to our patients and others not under our care. Our goal is to offer our extensive expertise in performing rapid assessments to determine whether stimulation is optimized and give a detailed report and discussion about your DBS outcome. The first step is completing a three-day diary and DBS intake form. Once we receive your forms, admin specialist, Nicole Mootry will call to start the process. Nicole can review whether your insurance offers coverage at our clinic.