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Deep brain stimulation at Riverview helps patients with Parkinson's

Monday March 26, 2012
From left, are Rebecca Graboso, RN; Duane Leist, RN; and Lori Colineri, RN.
From left, are Rebecca Graboso, RN; Duane Leist, RN; and Lori Colineri, RN.
(Photo courtesy of Riverview Medical Center)
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When a new neurosurgeon joined the staff at Meridian Health's Riverview Medical Center and Meridian Neuroscience, the hospital and its nurses geared up to offer a new service — deep brain stimulation to treat Parkinson's disease. The stimulation blocks abnormal brain activity and relieves patients of symptoms such as tremors, rigidity, slowness of movement and stiffness.

"It was a great opportunity," said Lori Colineri, RN, MSN, NEA-BC, vice president and CNE at Riverview in Red Bank, N.J. "But from an administrative perspective, it was a challenge to ensure our nurses were competent, our OR staff specifically."

Deep brain stimulation requires multiple visits to the hospital for procedures: first, to prepare a halo-type apparatus; second, to place two electrodes in the brain that will deliver electrical stimulation to motor regions; and third, to thread wire extensions and implant a neurostimulator under the skin in the chest and connect the extensions to the stimulator. The stimulation blocks signals that cause Parkinson's motor symptoms. More than 80,000 patients worldwide have received deep brain stimulation.

Providers consider deep brain stimulation for patients who are taking the maximum dose of medications and still are experiencing symptoms or side effects that are worse than the benefits they receive from the drugs, said Rebecca Graboso, APRN, DNP, FNP-BC, a Riverview nurse practitioner.

"We're trying to improve the quality of life of these patients," Graboso said. "It's a great option for patients who cannot take medications anymore."

Medtronic, the device manufacturer, and neurosurgeon Peter Zahos, MD, provided training for Riverview's nursing team. The procedure required new equipment and instrumentation and different draping techniques. Duane Leist, RN, CNOR, a perioperative nurse at Riverview, familiarized himself with the equipment and went to another hospital to watch the surgery.

"It's terrific," Leist said. "It's nice when you have an opportunity to do a new procedure."

During a patient's second visit, the surgeon drills burr holes into the skull, uses an instrument attached to the apparatus to guide the electrodes into the brain and tests to ensure they are in the correct position. The patient receives a local anesthetic and remains awake to respond to questions.

Patients stay in the critical care unit overnight after placement of the electrodes.

"They need neurological assessments every hour while in the ICU [because] we need to identify if they have neurological deterioration," Graboso said. "Any time you are invasive in the brain, anything can happen. The nurses are educated in what might be the possible complications."

Complications include bleeding in the brain and misplacement of the electrode.

"They are looking for any kind of change in the person's neurological status: level of consciousness, decrease in strength, symmetry of the face, can they hold their arms out and maintain them there, do they know where they are and who they are, are their pupils equal and reactive to light," said MaryEllen Strozak, RN, BC, MS, CCRN, CNS, clinical nurse specialist for the critical care center and PACU at Riverview. She said sometimes with just the placement of the electrodes patients will experience a difference in their symptoms.

"They have hope that this is going to work," Strozak added.

The patients still must come back for placement and connection of the stimulator.

"Our first case went unbelievably well," Colineri said. "It was phenomenal to watch the transformation on the three different visits, and how a man could be so debilitated by such a horrible disease, [and] be able to walk out of here, be able to eat, tie his own tie and shoes, and button his shirt."

Anthony Farinella, Riverview's first DBS patient, was able to do things for himself for the first time in years, although he continues to experience some tremors.

"It was life-changing, and the coolest thing ever," Colineri said about the procedure.

Debra Anscombe Wood, RN, is a freelance writer. Send letters to editorNY@nurse.com or post a comment below.