Frequently Asked Questions
What is functional neurosurgery?
Functional neurosurgery is a specialty within neurosurgery that focuses on diseases and conditions that often do not correlate to any anatomical issue that can be identified through imaging studies. Rather, these disease processes occur as a result of an inherent neurochemical or electrophysiologic defect. Examples include movement disorders – such as Parkinson’s disease, tremor and dystonia – as well as epilepsy, spasticity and chronic pain.
While most surgeons operate to correct or remove anatomical abnormalities, functional neurosurgeons strive to modulate the chemical and electrical activity in the brain or spinal cord – thereby improving the patient’s symptoms.
What diseases and conditions can be treated through functional neurosurgery?
Functional neurosurgery is a relatively new and quickly advancing specialty. At present, there are three main types of treatment, each of which can address several different diseases and conditions.
The treatments available at the Functional Neurosurgery Center at Jefferson Hospital for Neuroscience include deep brain stimulation, spinal cord stimulation and epilepsy surgery. Our Center also offers access to surgical trials for innovative therapies and new indications, or uses, of existing therapies.
Why don't more people with Parkinson’s disease and other movement disorders undergo functional neurosurgery, such as deep brain stimulation (DBS)?
Because of the progressive nature of Parkinson’s disease and the inability to “see” the disorder on diagnostic scans, it can take years to be diagnosed with this condition. Following diagnosis, oral medication is one of the most common courses of action. For many patients, medications can be of help. However, newer surgical techniques – namely, deep brain stimulation – can also have a dramatic impact on individuals with Parkinson’s. Even so, primary care physicians and even some neurologists are often not familiar with the newest advancements in this area.
Could deep brain stimulation help me or someone I care about?
For patients with Parkinson’s disease, deep brain stimulation may be a viable treatment under the following circumstances:
- The patient has typical idiopathic Parkinson’s disease (in other words, the cause of the disease is unknown).
- The patient continues to respond to levodopa or other dopaminergic medications.
- The patient is disabled by medication-refractory response fluctuations, dyskinesias (involuntary, uncontrollable and often excessive movements), parkinsonian symptoms or medication-induced side effects.
Why is Jefferson Hospital for Neuroscience an excellent choice for functional neurosurgery?
Unlike other hospitals in the area, our Center offers a full complement of treatments – including deep brain stimulation, spinal cord stimulation, epilepsy surgery and access to surgical trials. We are also fully integrated and work with a large team of neurologists, each with expertise in a subspecialty of neurological science, such as movement disorders or epilepsy. We also have a team of dedicated neuropsychologists who help to screen and counsel our patients. And we collaborate closely with Thomas Jefferson University’s Parkinson’s Disease Research Unit, headed by one of the world’s leading researchers in this field.
Another reason we’re your best choice: our patient-centric approach to care. We’re highly responsive to our patients’ medical and psychological needs and work diligently to coordinate and advocate on our patients’ behalf from diagnosis through treatment and follow-up.
Will I gain weight from eating so much fat?
On this diet, the amount of food is carefully calculated so that you will eat all the calories you need for good health but you will not gain weight. The fat content of the food will not affect your weight because your total calories will be limited. If you desire to lose weight, that can be worked out with a nutritionist as you are working on the diet.
Do I need to finish all of my food?
You must finish all of your food, because the meal is put together in amounts that will give you the right balance of fat, protein, and carbohydrate. If that is not all eaten, the balance is lost and you may have a seizure.
Will taking prescriptions or other medicines affect the diet?
All medicines and pharmaceuticals from toothpaste to cough syrup to vitamins to prescription drugs must be free of sugar and other carbohydrates. You need to remind your physician to prescribe all needed medications in sugar-free and carbohydrate-free form. Read labels carefully and check with your pharmacist. While you are on the diet, you will be given supplements for a multivitamin, Nutraphos, calcium, and selenium.
Does the diet cause a problem with high cholesterol?
When adults are switched from a normal diet to an 80 percent fat diet, both cholesterol and triglyceride levels may increase. Your lipid levels will be checked on a regular basis while on the diet and if needed adjustments can be made to try to control your cholesterol and triglycerides levels.
What can I eat when I am away from home?
Your dietitian can help plan meals while traveling. Patients often pack their own meals in a cooler. Tuna, egg, or chicken salads are easy to carry in small containers.
What about special holidays like birthdays and Thanksgiving?
The dietitian will be able to give you special recipes to make festive foods while allowing you to stay on the diet.
Am I a candidate for RNS?
Determining a course of treatment is complex. It can only be done after a neurologist or neurosurgeon carefully evaluates your overall condition. RNS is generally for people who:
- Are age 18 or older
- Have tried and failed to respond to at least two different anti-epileptic medications
- Have seizures that start in one or two parts of the brain but are not candidates for epilepsy surgery
Is RNS covered by insurance?
RNS is an FDA-approved treatment for refractory epilepsy and is covered by insurance.
Isn't surgery for epilepsy a drastic step?
This is something you should discuss with your neurologist or neurosurgeon. Like all surgeries, RNS implantation carries some risks. However, it is also important to know that poorly controlled epilepsy is associated with negative sociological, psychological and medical outcomes and significant risks. RNS has the potential to reduce the number of seizures in many people, and might reduce the risks caused by uncontrolled seizures. Whenever considering surgery, we must consider the potential benefits and risks, and generally only offer surgery if the potential benefits outweigh the risks.
You, in conjunction with your loved ones and your physicians, are the only person that can decide what is right for you.
How do I get ready for the RNS procedure?
Your epilepsy doctors determine where to put the system’s leads, which are the wires that deliver the electrical pulses. To do that, we must determine your seizures begin in the brain. If this has not already been done, you will be admitted to our 8-bed, state-of-the-art Epilepsy Monitoring Unit. When you have seizures in the EMU, they are carefully monitored and recorded. This allows us to determine where in your brain from which the seizures are coming.
What happens after surgery?
Patients typically return home after a few days in the hospital. Once the RNS system is active, it delivers treatment automatically. The RNS System functions much like a cardiac pacemaker and constantly monitors brain activity. When it detects abnormal brain activity, it delivers an electrical pulse to either prevent a seizure from starting or stop it if already begun.
When you are discharged, you will be given a small, remote-like laptop with a special wand. This is used to download a log of the RNS activity to share with your neurologist. It will be uploaded to a secure website for review by your neurologist, who will tell you how often you must provide monitoring information.
Will I be seizure free?
RNS rarely stops seizures completely. Instead, it reduces the number of seizures that people experience and sometimes seizures may be less severe.
With RNS, patients still need to take anti-epileptic drugs. However, the dose may be lowered or medications may be switched for some.
Does the RNS system require ongoing maintenance?
The battery of the generator must be changed every three to five years. Changing the system's battery is done by your neurosurgeon during a short outpatient procedure.