DBS is an ongoing therapy and not a single surgical event. The process of the therapy occurs in four basic phases:
1. Candidacy Assessment
There are usually a couple of meetings between the prospective candidate, the neurosurgeon, referring neurologist, and clinical neurophysiologist before the formal team assessment.
2. Surgical Procedures
The surgeries are carried out in the next few months and occur in two stages separated by a week.
During the first stage, the neurosurgeon implants the stimulating leads, guided by the neurophysiologist, and taking up to 7 hours. In this surgery, the patient is sedated and lightly anesthetized, but awake enough to assist in guiding the placement, through their responses to test stimulation.
During the second stage, the surgery is much shorter and carried out under full anesthesia, like most standard surgeries. At this stage, the IPG is implanted and the cables are connected to the stimulating leads.
3. Initial Programming
Within two weeks of recovery, the initial screening of contacts and programming occurs. For the next half year, the patient will continue to meet with the clinical programmer and neurologist, who together will optimize the stimulation settings of the IPG and the patient's medication.
4. Long-Term Maintenance
From then on the patient will meet with the programmer semi-annually or annually to ensure that the IPG is working well and to make any fine adjustments coincident with changes in the disease or patien's medications.