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  • Ned Neuhaus

Deep Brain Stimulation - Getting Ready (#4 in series)

Once through the qualification tests, it is time to sort out a few details and prepare mentally for the procedure. As you would expect, there are a seemingly endless number of tasks and things to think about before undertaking such a major procedure.


It is important to point out that this is the analysis I went through as it focused on the things most important to me in my DBS decision process. It is extremely unlikely anyone else would have exactly the same criteria, but I want to share my thoughts in the hopes it helps someone else determine their decision process.


What hardware did I choose?

The really great news is that there are several great options, the not so good news is there are several great options! While that may sound contradictory, remember that my baseline neuro/psych exam stated that people of my personality type "place a premium on avoiding mistakes". Not wanting to choose the "wrong" device seemed stressful. Once I got comfortable there wasn't really a "wrong" option, the decision cleared up for me.


It may sound odd, but I really have more consternation surrounding the device in my chest than the leads in my brain. For some reason, the chest implant sounds way more invasive to me! As a result, when I heard that rechargeable batteries were available a few years ago, the device choice seemed simple ... "I'll take the one that lasts 15 years vs 5 years, please!".


While I had my preliminary decision firmly in hand, I owed it to myself to do some due diligence to be sure there weren't other characteristics that may sway my decision. There were 3 main manufacturers and 4 choices on the table. To simplify the process, I will only highlight the major differences that differentiated the products in my analysis.


Remember, I had already determined any of the 4 were good decisions, I just needed to determine if there was one that rose to the top. Here are the differentiating features of each:

  • Boston Scientific: rechargeable

  • Abbot: remote programming (doctor can program without you being in the same room)

  • Medtronic Activa: rechargeable

  • Medtronic Percept: Sensing enabled lead

For me, the Abbott quickly fell off the list as it is not rechargeable and I really don't put a premium on remote programming as I will not be that far from my MDS.


Boston and the Medtronic Activa were basically the same to me, both really good rechargeable options.


Initially, Medtronic Percept seemed to fall below Boston and Medtronic Activa since it is not rechargeable. However, the sensing enabled lead really piqued my interest. The way I describe it is that up until this unit, the leads in your brain could only "talk" to your brain. The percept can also "listen" to your brain. At this time, you can only download the signals the unit "hears" from the brain. These can be helpful in documenting your symptoms throughout the day and potentially helping to better program your DBS. What is really intriguing to me is the future potential of this technology. In theory, the brain could "tell" the DBS what it needs to do to currently manage symptoms. The future DBS could be one that continuously reacts to my symptoms. It could even turn off when I don't need stimulation to control my symptoms. All of this is currently not available, and it may take years before it is commercially available, if ever. But, if I choose any other DBS, my leads won't be capable of "listening" to my symptoms and the unit in my chest could be updated for any new software when it becomes available to make better use of the sensing ability of the leads.


In the end, I determined I valued the ability to future-proof myself with the new lead technology was worth more than a rechargeable battery. I shocked myself that I chose a non rechargeable battery. It is also possible that the first time I need to replace my battery (3-5 years), a rechargeable battery will have received FDA approval.


As I mentioned earlier, your decision criteria will almost certainly differ, I really don't think there is a bad unit out there, so figure out what is important to you, don't just pick the one your friend or medical professional recommends without doing some research.


Other prep

Hopefully, this step won't be around forever, but 3 days before the surgery, I need to have a clean COVID PCR test. I had not worried much about this as I had been prudent for the past 2 years, am fully vaccinated and don't take a lot of risks with exposure. Well, the new variant of COVID decided to pay me a visit! Unfortunately, I scored a positive home test after showing symptoms 16 days before my surgery date.


The short version of the story is I no longer needed to worry about my PCR test ... the longer version is that my first surgery date has been delayed one month! To say this is a disappointment is a huge understatement. However, given that the primary reason for testing for COVID is to ensure my respiratory system is not impaired before going under anesthesia, I am ok with the delay.


The week before the surgery, there are meds you may need to stop taking (things like blood thinners). I also have a special antibacterial soap/shampoo to use. I also need to put some antibacterial ointment in my nostrils. There is blood work and pre-op meetings with the surgeon's office.


Then there is the seemingly endless stream of forms for insurance ... coming with bursts of "you aren't going to be covered", followed by that being a false alarm. Fun stuff, to say the least!





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