When deciding to have deep brain stimulation for Parkinson’s, dystonia, essential tremor or epilepsy, you want to be confident it will work. But results vary widely between centers. Patients considering deep brain stimulation (DBS) should be sure to know the revision rate and infection rate of the surgeon they are considering.
DBS is highly effective for an overwhelming majority of patients. In fact, essential tremor patients can expect to see a reduction in motor symptoms of 70% to 95%. Patients with early-stage Parkinson’s also can expect dramatic results. But revision rates—the percent of DBS surgeries that need to redone—vary greatly across neurosurgery practices.
A study published in Parkinsonism and Related Disorders, estimated the national deep brain stimulation revision rate to be more than 15%. That’s extremely high, according to David VanSickle, M.D., Ph.D., who says the DBS revision rate for the Denver DBS Center is closer to 1%.
There are several factors that play a role in the need for revision surgery, including infection, lead placement and type of DBS system used.
Reducing Infection from DBS
One of the ways Dr. VanSickle and the other deep brain stimulation neurosurgeons at Denver DBS Center keep infection rates low is by performing asleep DBS surgery. He was the first neurosurgeon in North America to combine robotics and asleep DBS and remains the only one in Denver to do it.
Using the Mazor Robotics Renaissance Guidance System, Dr. VanSickle can complete DBS surgery in a shorter amount of time than with traditional awake DBS surgery. Shorter surgeries have lower infection rates.
“It’s not uncommon to see infection rates of 3% to 3.5%,” Dr. VanSickle says. “Our infection rate with asleep DBS is less than 0.3%”
DBS Lead Placement
Another reason for DBS revision surgery is inaccurate lead placement. Millimeters count when it comes to DBS. With the Mazor system, Dr. VanSickle can place the electrode leads within a millimeter of accuracy. And that can mean the difference between providing relief the first time and requiring revision.
Type of DBS
Dr. VanSickle is also able to keep revision rates low by using newer DBS systems from Abbott and Boston Scientific. These innovative systems have a feature called steerable current, which allows the surgeon to effectively move the electrical current virtually post-surgery.
“You can’t move it very much—only about a half of a millimeter—but it’s enough to make a difference,” he says.
Questions to Ask about DBS
If you’re considering DBS surgery for the treatment of Parkinson’s disease or essential tremor, you’ll want to consider revision rates before choosing a practice. Here are some questions to help you select the right neurosurgeon for DBS:
- What is your revision rate?
- What is your infection rate?
- How many DBS surgeries do you perform each year?
- Do you use DBS systems with steerable current?
- How do you perform the surgery? Do you use a robotic system?
- Can I speak with some of your patients about their experiences?
Dr. VanSickle also recommends joining a support group so you can meet others with your same condition. Ask them about their experiences with DBS to get a better idea of what to expect.
Learn more about deep brain stimulation center and asleep deep brain stimulation in our Learning Library.