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DBS

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I had DBS done in Aug. 2006. My problem was that I was falling a lot! My surgeon said I was a good candidate but he could not promise he could stop the falls. Since the surgery the number of falls has decreased. I may only fall 3 or 5 times a day as compared to maybe 20. I have several days in a row where I don't fall at all. I usually go down on my right knee I try to get up then I fall again. I was told by my programing nurse that I was sedated too much and he couldn't tell where to put the wire for sure because of no feedback. So can this be fixed by the programmer or should I go back to the surgeon. It is amazing how much better I am. I wasn't not awake, I don't remember anything. The surgeon said I was talking but I don't remember. I will always wonder if it would have made a difference if he would have waited for the sedative to wear off.

I do know that he went in and redid one side's placement of a friend of ours. Thank you

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The first thing you need to do is establish how much the gait and balance are responsive to medications. This is generally done pre-operatively, but can be repeated post-operatively. We do this by having patients come in off DBS overnight and off medications. We record a scale called the UPDRS. We then give a super high dose of medications often until the patient is dyskinetic or the patient feels their best on. We then reassess the scale. If walking balance are not improved or improved incompletely then that is the best you can hope for with surgery (DBS) of STN or GPi. If you get a spectacular improvement with meds but not DBS it may be worth looking at lead positioning with imaging.

 

One mistake in gait disorders following DBS is to cut back too much on the levodopa. Levodopa plus DBS often helps gait.

 

Remember if you have developed levodopa resistant gait and balance problems DBS usually is not helpful for this issue.

 

Finally there is a new brain target under investigation called PPN that may be a future DBS target for those with gait and balance problems unresponsive or poorly responsive to meds.

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