Deep Brain Stimulation Evaluation

The patient who elects to undergo deep brain stimulation surgery after carefully reviewing information about the surgery and an initial informational appointment will begin the evaluation process.

Individuals interested in learning more about DBS surgery should call (804)828-9165 to set up an informational appointment. At this appointment patients are given a packet of educational materials and if they have PD, are asked to complete a motor diary.

Clinical notes are obtained from the referring neurologist and primary care provider. If a patient has not been seen by a neurologist, an appointment with a movement disorders specialist will be scheduled to confirm that the patient is a good candidate for surgery.

Steps of the evaluation process:

• Evaluation of diagnosis, stage of disease, evaluation of the patient’s general health, and discussion of surgery
• For patients with PD, an off PD medication/on PD medication motor examination is performed.
• The degree of impairment that patients experience when their medicines are not working or “off” time can be assessed by performing an examination of the patient after s/he has been off all PD medications for approximately 8 hours (“off score”). This is compared to the benefit that the patient gets when his/her medications are working or “on score” assessed after taking the PD medications.
• Neuropsychological testing  This testing is used to look for signs of memory problems, depression or anxiety. It is important to identify these problems prior to surgery. Significant dementia rules out certain types of surgery. Depression and anxiety should be under treatment prior to surgery and may affect which nucleus is chosen for stimulation.
• MRI for intraoperative guidance
• Final decision on eligibility and desire for surgery

The DBS Team will help you through each step of the evaluation process. (left to right), Miriam Hirsch, RN; Kathryn Holloway, MD; Holley Stone, RN