Deep Brain Stimulation (DBS) is a very important neurosurgical procedure that has changed your life and helped you control the symptoms of your Parkinson's disease, essential tremor, or dystonia. The surgery went well, and now they can move around freely. But you quickly learn that the device needs to be constantly and specifically adjusted to keep it working well on the trip. It can be scary to think about having to go back to the university hospital or specialty center often, for long periods of time, and at a high cost. This is where Direct Primary Care (DPC) can act as your modern medical home, helping you coordinate your care and making it easier and more accessible to manage your health in the long term.
DBS is a well-known treatment in which a neurosurgeon puts one or more thin electrodes into certain parts of the brain. A wire connects these electrodes to a neurostimulator, which is like a pacemaker and is put under the skin in the chest. This device sends constant electrical signals to the brain to change the broken circuits that cause movement problems.
Who It Helps: For many people with movement disorders that medicine can no longer control well, this therapy changes their lives. Some of these people are:
Parkinson's Disease: DBS can greatly lessen tremors, stiffness, and the involuntary movements (dyskinesias) that some medications cause. It can also lengthen "on" time, which is when symptoms are well-controlled.
Tremor that is essential
Dystonia
The Challenge of Managing for Life: DBS is not a therapy that you can just set and forget. A specialized neurologist or DBS nurse needs to keep programming the device and making sure its electrical settings are just right. In the past, this meant that patients had to go to a specialty center a lot, which was hard for them.
Warning: DPC doctors don't do DBS surgery or set up the device. Only a very specialized team of neurologists and neurosurgeons can do this. DPC is an important part of your health care because it helps you coordinate your care, manage your health on a daily basis, and get modern, remote-capable care. This is why DPC is the best choice for a DBS patient:
A "Home Base" for Care That Is Well-Coordinated: Your DPC doctor is in charge of your whole health.
They make sure that you, your family, your caregiver, and the distant DBS specialty center can all talk to each other without any problems.
They take care of all of your other health issues, such as diabetes, high blood pressure, or bone health, while always being aware of your neurological condition and the device you have implanted.
Making modern, home-based, and telehealth care easier: This is a game-changing job for DPC that directly solves the biggest problem with DBS management.
DPC practices are the best place for your DBS specialist to do telehealth visits in your area.
They can help set up remote DBS programming sessions, where the university hospital specialist can change the settings on your device over a secure internet connection while you sit comfortably in your local DPC office or even at home.
This partnership makes it much easier for you and your family to travel, both financially and logistically.
A partner who is quick to respond to urgent needs and provides ongoing support: DPC's quick access is a very important safety net.
If you fall, worry about an infection near the implant site, or have a question about a new medication, you can see a doctor who knows your complicated history right away and get a full evaluation.
They give you and your caregivers the psychosocial support you need to deal with the many problems that come with having a chronic neurological disease.
Case 1: David, 72, lives in a small town four hours away from the specialty center where he had DBS surgery for Parkinson's disease. His DPC doctor works with the DBS center. David goes to his local DPC office to make changes to his programming on a regular basis. His DPC doctor helps him set up a telehealth video call with his neurologist, who then fine-tunes his DBS settings from afar. David and his wife don't have to travel for a whole day just to make a 30-minute change.
Case 2: Linda, 68, has a DBS device in case 2. She trips and sees some new redness and tenderness around the place in her chest where her neurostimulator is. She sends her DPC doctor a picture. That afternoon, the doctor sees her, finds a mild skin infection (cellulitis), starts her on the right oral antibiotic, and tells her neurosurgery team about the plan right away to keep a more serious problem from happening.
Q: Is it possible for my DPC doctor to change my DBS settings? A: No. A neurologist or a trained DBS nurse at a specialty center does DBS programming, which is a very specialized skill. But your DPC doctor can be the most important local partner who sets up a remote programming session with your specialist. This way, you can get world-class expert care without having to travel far.
Q: What is DPC's most important job after I have DBS surgery? A: One of the most important things they do is be your medical home and care coordinator. They take care of your overall health, are the first people you call for any new medical problem (other than a programming need), and work with your specialist team to help you get the most out of modern telehealth and remote care technologies that make your life easier.
Q: Is it common for DBS to be programmed from a distance? A: It is a field that is growing quickly and is becoming the new standard of care at many big centers. It was made specifically to get rid of the biggest problems patients have with getting to and from appointments. A proactive DPC practice is the best partner to help you get this new type of care.
DPC has a clear advantage for patients who are getting this advanced therapy because:
Getting rid of the travel and access barrier: DPC is a local "hub" that lets you take advantage of the remote programming and telehealth follow-up that are part of modern DBS care.
Providing Masterful Care Coordination: Being the most important link between you, your family, and your highly specialized DBS center.
Providing holistic, person-centered care means taking care of all of your health and giving you the important psychosocial support you need to live with a chronic neurological condition.
Deep Brain Stimulation is an amazing treatment that can help you get your life back after a movement disorder that makes it hard to move. But you shouldn't have to be on the road all the time to take care of this advanced device. You need a local partner to help you with your care and connect you with your specialty team. Direct Primary Care is the modern medical home that can help you with DBS by giving you the support, coordination, and access to technology you need to do well.
