Deep Brain Stimulation

For patients with Parkinson’s disease, tremors, rigidity and bradykinesia are often an expected part of life. Yet, it does not have to be that way. Technology, in the form of deep brain stimulation (DBS), a sort of pacemaker for the brain, can help with the motor symptoms of those with Parkinson’s and a few other movement disorders. Stanford Healthcare in Stanford, Calif. is one such facility that offers DBS.

Carlos Rodriguez, RN, CNRN, works as the deep brain stimulator program and Stanford balance center nurse coordinator. He brings a long-standing interest in neuroscience to the role, dating back to his days in nursing school at Washington State University.

 

Choosing Candidates

The DBS program at Stanford Healthcare is under the umbrella of the Stanford Movement Disorders Center, which sees patients with many diagnoses. However, Parkinson’s, essential tremor and a very specific type of dystonia with a genetic component are the primary diagnoses for the surgery.

Rodriguez is responsible to guide the patient through the pre-surgery phase, making sure they are evaluated by the neurologist and neuropsychologist. Evaluations take place over two days, one while the patient is on medication and one while they are not. “All the staff gets together and discusses the patient. We look at the different elements and decide if the patient is a candidate,” he explained.

The team considers the patient’s goals and assesses if they are cognitively stable, determining if the procedure could cause any cognitive deficits

 

Brain Waves

DBS consists of two phases. During surgeries, the leads are implanted in the subthalmic region of the brain. In a separate procedure, the neurostimulator, which delivers electronic signals to the brain, is implanted under the collarbone. The two components are connected via the extension, an insulated wire.

“We give patients time to heal and recover from the stress the surgery causes the body,” explained Rodriguez. This is especially important as stress can increase Parkinson’s symptoms. A few weeks after the operation, the device is turned on. DBS sends out electrical pulses that change how Parkinson’s impacts movement. Rodriguez is in charge of the methodical programming needed to find the most therapeutic settings.

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SYSTEM CHECK: Carlos Rodriguez, RN, CCRN, tests the equipment used in the Stanford Movement Disorders Center. Norbert von de Groeben/Stanford Health Care

He uses the United Parkinson’s Disease Rating Scale III to assess the patient’s motor control before the DBS, and then again after implantation, assessing the effectiveness of therapy, pre- and post-implantation. The essential tremor patients write and do other fine motor tasks with their hands.

If the tremor goes away without side effects, the procedure is considered a success. According to Stanford researchers, DBS allows for a 60-80% improvement in symptoms and a 50%-60% reduction in medication.

 

Nursing Knowledge

As a nurse, Rodriguez brings a specialized knowledge to the proceedings. He uses his past work experience at an inpatient neuroscience unit at as a point of reference. He explained, “I did not see the rest of the story with the inpatient neurological patients.”

He is able to connect everything together and have a broader view of what the patient goes through. He looks at the whole patient and helps them manage their entire disease.

The DBS patients will return to the clinic for adjustments, so Rodriguez can follow their progress more so than with other patients.

“That interaction with patients is what we nurses do all the time. We are the frontlines no matter where we are.”

 

Danielle Bullen is on staff at ADVANCE. Contact dbullen@advanceweb.com.

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