Beyond the operation: life with adaptive Deep Brain Stimulation

So just like jumping back, Kevin, like you kind of got the green light to say you were going to be successful at going through because in our centre in Newcastle, once those patients have had a levodopa response test, they have had the neuropsychology assessment and they've had an MRI scan of their brain.

And we just do that MRI scan to sort of look for anything structural, like an abnormality that might stop the surgeons from placing the leads inside the target of the brain.

We're not looking for problems, but we're just making sure that the surgery is there's nothing in the way.

And once those three things have been done, we have a big conversation about the patients in our MDT.

And we all put our opinions forward about what we think is best in terms of where we're going to put the leads in the brain.

You know, do the pictures look good? What are the sort of the wish list of the patient? What are our end goals that we're looking for to try and help and treat in terms of the DBS? And then we're looking at the response to the levodopa.

And we like sort of to see a 30% improvement from the off to the on.

I'm not saying that that figure is, you have to be, it's like it's stuck.

Not all symptoms have to be suppressed by the levodopa.

It doesn't mean that just because the tremor wasn't completely gone or, you know, the slowness or the stiffness wasn't totally gone that you're not going to be a good candidate.

These are all things that we discuss in that meeting to try and get a bit of clarity and get those end points down.

And then obviously we speak to the neuropsychologist about that cognitive assessment that you have, which can be quite in-depth and quite intense, but it can reveal things that people like myself or even the neurologists, the surgeons can't see at face value on like just Our consultations in the clinic rooms together, I think the neuropsychologists, they delve a lot deeper, don't they? And they're looking at the higher function, the higher levels of function of your brain.

And we gather all that information together and we talk about it at that place.

And then we decide whether we're going to offer the patient the DBS.

I totally agree with you, Michel.

And actually, in our sense, it's pretty much aligned as you just described the process.

More and more, it's always very individualized decisions, as you pointed it out.

We have our thresholds, our guidelines to some extent, but also, as you mentioned, the 30% Lividopa threshold.

response to the Vodopa, it's not necessarily a cutoff that always has to be respected.

It always depends.

But it's very important that this is a multidisciplinary decision, that we try to look at it, all the different disciplines.

We also look at the movies of the patient, the recordings they did in the different conditions with and without medication.

We listen to the entire story, we look at the image, we hear the psychologist, we hear the psychiatrist, all of them.

And then there's the experience.

We decide what would be the targets if we would give potentially green light.