What is Deep Brain Stimulation? Am I a candidate? Deep Brain A comprehensive evaluation will be performed to Deep brain stimulation (DBS) involves a ensure you are a good candidate. One of the most Stimulation at surgical procedure to place stimulation important criteria is to have had an adequate trial Enjoying Cleveland: electrodes into the deep structures of the of medications for the condition. Surgery is not The cultural, dining, and recommended if medications can adequately major league sports amenities Cleveland Clinic brain — the thalamus (for essential tremor) control the disease. A good candidate must be While visiting Cleveland, consider partaking in or subthalamic nucleus or globus pallidus healthy enough to undergo surgery and not Surgery in Cleveland. (for Parkinson’s disease or dystonia). The demonstrate significant cognitive impairment that the city’s diverse cultural, major league sports and dining amenities. Enjoy the influence of this electrodes are connected by wires to a could limit the benefits of the therapy. Talk to Ongoing care in Las Vegas. your Lou Ruvo Center for Brain Health movement multinational city through its diverse food scene, pacemaker device called an implantable disorders specialist to see if DBS is right for you. world-class museums (Cleveland Museum of Art; pulse generator (IPG), implanted under the Rock and Roll Hall of Fame and more), 2016 NBA skin of the chest just below the collarbone. What are the advantages? Champion Cleveland Cavaliers, or highly acclaimed Cleveland Orchestra. Enjoy the local markets, such Deep brain stimulation has many as the nationally-renowned West Side Market. Once activated, the device delivers advantages, notably: continuous electrical pulses to the target • DBS can greatly improve quality of areas to modify the dysfunctional brain life by reducing tremor and/or improving circuits that are responsible for motor motor function symptoms of the disease. • It does not damage brain tissue • DBS may be reversible: The stimulator can be turned off or the electrodes How effective is DBS surgery? potentially removed DBS surgery is FDA approved and is the most • Most individuals are able to significantly effective surgical treatment for essential tremor, reduce their medications following dystonia, and Parkinson’s disease (PD). In DBS surgery addition to controlling tremor and dystonia, DBS • The electrical stimulation can be easily can improve rigidity, slowness of movement, and adjusted if your symptoms or response to difficulty walking in PD. The vast majority of medication changes. This can be done at properly selected patients experience a marked the Lou Ruvo Center for Brain Health in improvement of their motor symptoms related to Las Vegas; no further surgery is necessary essential tremor, dystonia, and PD. Most people to make the adjustments are able to significantly reduce their medications.

rev May 2018 Why have your DBS surgery at The Practical Details: What should you expect immediately following Cleveland: Travel and tourism Cleveland Clinic? Sequence of events the surgery in Cleveland? After DBS implantation, as with any surgical Getting there Outcomes can vary after DBS, and it is extremely After your initial evaluation in Las Vegas, we will then procedure, your body will need time to heal. You We understand that contemplating brain surgery can important to have surgery at a center with set up a videoconference with our Cleveland-based may feel tired and sore, but pain medications can be overwhelming, and we want you to focus on care extensive expertise and frequency in performing neurosurgery team to ensure your eligibility and to be provided as needed to keep you comfortable. and recovery rather than the logistics of your travel. the procedure. Our neurology/ answer any questions you may have prior to your trip. You may feel up to leaving your hotel for short We are well equipped to make your travel to our main neurosurgery program is ranked Surgery is conducted on Mondays, Tuesdays, and periods to enjoy some of the leisure activities the campus in Cleveland, Ohio, as easy as possible, No. 6 nationally by U.S. News & Wednesdays, so those who are eligible for surgery city has to offer. Your safe, full recovery is our assisting with: World Report. In the past 10 years, and are traveling in from out of town will likely do number one priority. • Airline reservations: Cleveland, Ohio is a 3 ½ to 4 we have implanted DBS leads in so one or two days before, allowing time for require Activating the device via a short outpatient hour flight with multiple non-stops daily between more than 925 patients at the pre-surgical assessments (labs, EKG). procedure (in Las Vegas) and ongoing Cleveland Clinic main campus. McCarran Airport and Cleveland Hopkins Airport For patients with symptoms on only one side of the maintenance of the device • Transportation to and from the airport via The DBS procedure utilizes the full resources body, the stimulation electrodes only need to be Two to four weeks later, the IPG is turned on and complimentary limousine service of our multi-disciplinary team of experts at implanted on one side (the side of the brain opposite adjusted by your neurologist at the Lou Ruvo our Cleveland and Las Vegas campuses: Our the symptoms). Center for Brain Health and symptom relief begins. • Lodging at a variety of price points and proximity to campus, including one hotel, neurologists, neurosurgeons and neuropsychologists However, most surgical candidates will need to Your Lou Ruvo Center for Brain Health neurology the Intercontinental, that is on campus and have expertise and specialized training in DBS, and have stimulation electrodes implanted into both provider will continue to provide your ongoing care will provide ongoing assessments and modifications sides of the brain, which is considered a bilateral through routine appointments, which will now accessible to the hospital via indoor walkways to assure you receive optimal continuity of care. procedure. Under some circumstances, the surgery include adjustments as needed to your implanted • Transportation from your hotel to Cleveland “Virtual visits” utilize videoconference technology, is completed all at once, but more frequently, device. These non-invasive adjustments can be Clinic should you elect to stay off campus allowing you to see the Cleveland-based DBS surgery is done via a staged approach in two made during a normal office visit and require no special preparation on your part. neurosurgery team and your Las Vegas-based operations within a week of each other. In some There is no charge to you to have your travel cases, additional time is required for recovery and movement disorders specialist at the same time coordinated by our dedicated travel agency, evaluation, and the second procedure may require to ensure you receive comprehensive care. Coming soon: The Lou Ruvo Center for Brain American Express. Your Cleveland Clinic Care a return visit to Cleveland. Health in Las Vegas will offer a support group Coordinator will facilitate an introduction to For ongoing communication, your care team uses Here is an overview of what to expect with the most for patients and families who have experienced this service. Should the pace of your recovery DBS surgery. Ask us for more details. a centralized electronic medical record across common multi-step, five to seven day approach. require adjustments to your lodging or flight home, Cleveland Clinic. Via our online tool, MyChart, The first surgery (in Cleveland) American Express is available 24/7 to you and any family caregivers you authorize can Post-surgical care: accommodate your changing travel needs. message your Las Vegas-based care team or The electrodes are implanted into the brain. How should you care for the surgical area at home? Cleveland-based surgical team at any time with In some cases, it may be necessary to briefly • Your stitches or staples will be removed 10-14 Getting around campus questions or concerns about your condition. awaken you during the procedure to test the effects of the stimulation. Local anesthetic days after surgery. Once on our main campus, you’ll quickly notice the Will the surgery be covered by insurance? (pain-relieving medication) is given to the • You may wash your head with a damp cloth, enormity and breadth of Cleveland Clinic’s services. To sensitive areas. Most people report mild ease your navigation, we offer easy online guidance via This FDA approved procedure is covered by avoiding the surgical area. discomfort related to the incisions needed your smart phone: clevelandclinic.yourdirectroute.com Medicare in most states for the treatment of for the surgery and only stay one night in the In the weeks following the surgery Parkinson’s disease, dystonia, and essential tremor. hospital after the surgery. • Do not engage in housework or other activities Many commercial insurance companies also cover that would require you to lift more than five The second surgery (in Cleveland) the costs of deep brain stimulation surgery. pounds) for 2 weeks after surgery. Light aerobic Five to seven days later, you will be readmitted activity, especially walking is encouraged. To determine if your insurance policy covers all to the hospital to insert the IPG. While under or a portion of the costs, please contact your general anesthesia, an extension wire is inserted • Do not engage in heavy activities (jogging, insurance provider directly. to connect one end of the brain electrodes to the swimming) for 4 to 6 weeks after surgery. battery/generator. • Depending on the type of work you do, you may return to work within 4 to 6 weeks.