Deep Brain Stimulation

The Chase Family Movement Disorders Center at the Hartford HealthCare Ayer Neuroscience Institute offers Deep Brain Stimulation (DBS) for the treatment of advanced Parkinson’s disease and Essential Tremor.  

DBS is a surgical procedure in which wires are connected from your brain to a pacemaker-like battery pack implanted in your chest. DBS is not a cure for your movement disorder, but it can dramatically decrease your symptoms, restore movement and improve your quality of life.

“It can be a life-saving procedure for patients,” says Dr. Patrick Senatus, medical director of the Deep Brain Stimulation Program at the Ayer Neuroscience Institute.

The multidisciplinary providers at our Chase Family Movement Disorders Center work closely with you to determine if DBS is the right treatment option. This comprehensive evaluation includes a functional assessment of your symptoms, neuropsychological testing and a neurosurgical evaluation. Our neurologists and neurosurgeon ensure the best care and proper follow-up so you achieve improvement in your symptoms and your quality of life is restored.


How Deep Brain Stimulation Works

Deep brain stimulation (DBS) uses electrical impulses to stimulate a targeted area in the brain. The stimulation affects movement by altering activity in that area of the brain. DBS is different from other surgical procedures to treat movement disorders in that it does not destroy any brain tissue, stimulation is adjustable, and the procedure is reversible.

Typically two separate procedures are required in order to start receiving DBS therapy. The first surgery (Stage I) is to implant a thin wire (lead) into a specific, predetermined brain target. Typically, the second surgery (Stage II) will take place a few weeks later. During the second surgery a small battery-powered device (pulse generator) similar to a pacemaker is implanted in the chest and connected to the electrodes in your brain by a wire.

Programming of the generator is initiated about four weeks after the initial surgery. The generator will be programmed in the office during an appointment with the neurologist. Often times multiple programming sessions may be needed in order to deliver the optimal level of stimulation to provide the greatest relief of symptoms.


Who Is A Candidate For DBS?

DBS is primarily used to help patients who have severely impaired functioning and movement and suffer from Parkinson’s disease, Essential Tremor, or Dystonia. Typically, your neurologist will recommend DBS as a treatment option if:

  • Your movement disorder has severely impaired functioning and movement.
  • Medication has been ineffective in controlling these symptoms.
  • You are significantly disabled but in good enough health for surgery.

DBS, though while not a cure, can have a life-changing impact on your mobility and quality of life.

Parkinson’s Disease

  • You have idiopathic Parkinson’s disease.
  • Your medication does not work as well as it used to, you experience on-off fluctuations and dyskinesia.
  • You require higher doses of medication, take your medications more frequently, or you require multiple medications to control your symptoms.
  • You have little or no cognitive dysfunction.

Essential Tremor

  • You have tried different medications or a combination of medications with little benefit.
  • The tremor prevents you from performing activities of daily living and negatively impacts your quality of life.
  • You experience negative medication side effects that prevent you from taking a therapeutic dose.

Dystonia

  • You have a diagnosis of primary dystonia
  • You have tried different medications or a combination of medications with little benefit.
  • Your symptoms prevent you from performing activities of daily living and negatively impacts your quality of life.

What To Expect

Evaluation: Before you have surgery you will meet with various members of the DBS team. A multidisciplinary approach is taken throughout the evaluation process. You can expect a neurological examination, neuropsychological testing, lab tests and an MRI as well as a neurosurgical evaluation. Together, you and the team will decide whether or not to go forward with the procedure.

Pre-operative Phase: The second step in the process is to schedule your surgery and to begin preparing and planning. You will receive pre-operative instructions and we will answer any additional questions that you may have.

Surgery, Stage I: Typically deep brain stimulation surgery is a two part procedure. The first surgery will be to implant the lead (for unilateral procedures) or leads (for bilateral procedures) into the brain. After the surgery is complete, you can expect to have a one-night stay in the hospital and you will be discharged the following day.

Surgery, Stage II: A couple of weeks later, the surgeon performs a second procedure to implant the stimulator device under the skin in the chest. The device is connected to the electrode(s) by a flexible wire. This is an outpatient procedure where you can expect to return home the same day as your operation. There are rechargeable and non-rechargeable generators on the market. You will be able to discuss the benefits of each generator with Dr. Senatus. Together you can decide which option would be best for you.

Programming: Typically, the programming process begins four weeks after Stage I of your surgery. You will have an appointment in the office to meet with your neurologist and begin the programming process. It may take multiple programming sessions in order to receive the maximum therapeutic effect from your DBS device. As your movement disorder progresses, you may need to come back to the office for additional programming sessions.

Follow-up Care: The non-rechargeable pulse generator has a 3- to 5-year battery life. Generally, the generator must be replaced when power is depleted. You will have check-ups at a minimum every three months to assess your symptoms and ensure that your generator is working properly. “The upper lengths of time that DBS can be effective hasn’t been determined,” says Dr. Senatus. “It can potentially last indefinitely.”


Systems

First in the northeast to implant the Boston Scientific Vercise Gevia battery

First in the northeast to implant the Boston Scientific directional leads

Boston Scientific Vercise: The smallest battery on the market. (For more information, click here.)

Medtronic Activa System: Medtronic systems have been leading the way in DBS therapy since 1987. Medtronic systems are MRI-compatible. (For more information, click here.) 

Abbott Infinity System: We were the first in the state to implant the Infinity System, which has directional lead technology. (For more information, click here.)

DeepBrain.jpg


What Makes Our Program Unique?

State-of-the-Art Technology: We the only center in New England and the tri-state area with the O-arm 2 and Stealth 8 technology for DBS. The O-arm 2 allows us to preform intraoperative high resolution imaging. The Stealth 8 provides the most advanced navigation technology. These technological advances all aid in ensuring the most precise lead placement.

Frame based and frameless surgery: In traditional frame based DBS surgery a large metal frame is attached to the patient’s skull and attached to the surgical table, thereby immobilizing the patient’s upper body throughout the procedure. In an effort to provide more comfort to patients we have started using STarFix frameless technology which enables the patient to change position if needed during the procedure. The accuracy of frame based and frameless surgery is equivalent. Your surgeon will discuss with you whether frameless surgery is an option for you.

Chase Family Movement Disorders Center: We currently provide multidisciplinary services at our Vernon location where patients have access to our movement disorders specialists if needed, as well as fully integrated neurosurgery, physiatry, neuropsychiatry, neuropsychology, social work and behavioral therapy, personalized physical/occupational/speech therapy protocols, integrative medicine, diagnostic imaging, clinical research, and daily community wellness programs. We currently offer DBS for Parkinson’s disease and Essential Tremors. We have also received approval for Humanitarian Device Exemption for use of DBS in the treatment of Dystonia. The Chase Family Movement Disorders Center helps to make coordinated care more convenient for patients.

Neuropsychiatry: Dr. Joseph Trettel is the only clinical neuropsychiatrist practicing in Connecticut. Neuropsychiatry merges the specialties of psychiatry and neurology and treats behavioral difficulties associated with a wide range of neurological conditions. Patient access to neuropsychiatry allows for better care coordination within the Deep Brain Stimulation Program.


Meet The DBS Team

Neurosurgery

Patrick Badere Senatus, MD, PhD, FACS, FAANS: Medical Director of the Deep Brain Stimulation Program

Sharon Tokarz, PA-C

Michael Dawson, PA-C

Jennifer Quinn Mitchell, PA-C

Neurology

J. Antonelle de Marcaida, MD: Medical Director of the Chase Family Movement Disorders Center

Duarte Goncalves Machado, MD: Co-Medical Director of the Chase Family Movement Disorders Center

Michelle Lavallee-Dagostine, MD

Maria Luisa Moro-de-Casillas, MD

Neuropsychiatry

Joseph Trettel, MD, PhD: Medical Director of Neuropsychiatry

Neuropsychology

Jennifer Ann Caruso, PsyD

Social Work

Amanda Brill, MSW

DBS Program Coordinator

Sarah Johnson, RN, BSN


Meet our Deep Brain Stimulation Specialists:

Name Specialties Location
Bortan, Elena, MD 860.870.6385
  • Neurology
  • Vernon
Caruso, Jennifer Ann, PsyD 860.870.6385
  • Neuropsychology
  • Vernon
de Marcaida, J. Antonelle, MD
5.0 /5
69 surveys
860.870.6385
  • Neurology
  • Vernon
Khaled, Mohamad, MD 860.696.2290
  • Neurosurgery
  • Hartford
  • Enfield
Show Less
Lavallee-Dagostine, Michelle, MD
4.9 /5
131 surveys
860.870.6385
  • Neurology
  • Cheshire
Machado, Duarte Goncalves, MD
4.8 /5
140 surveys
860.870.6385
  • Neurology
  • Cheshire
  • Vernon
  • Willimantic
Show Less
Moro-de-Casillas, Maria Luisa, MD
4.9 /5
133 surveys
860.870.6385
  • Neurology
  • Plainfield
  • Vernon
Show Less
Senatus, Patrick Badere, MD, PhD, FACS, FAANS 860.870.6388
  • Neurosurgery
  • Vernon
Tokarz, Sharon, PA-C
4.8 /5
100 surveys
860.870.6388
  • Neurosurgery
  • Vernon
Trettel, Joseph D., MD, PhD 860.972.3621
  • Behavioral Neurology & Neuropsychiatry
  • Psychiatry
Show Less
  • Hartford
  • Vernon
Show Less

Chase Family Movement Disorders Center

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    Fax: 860.870.0625
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