Reference no: EM133476975

A 53-year-old received deep-brain stimulation bilaterally for medically refractory Parkinson disease. The patient returned to the office for reprogramming of the devices. the system programming was checked to ensure proper functioning; the physician tested combinations of the implant parameters while assessing the degree of symptom and side effect improvement or worsening after each programming change. Electronic analysis and programming of an implanted permanent single-ray electrode system and subcutaneous generator/transmitter was performed. After each round of reprogramming the patient waited in the office for the new stimulation therapy to take effect. After a brief wait, the stimulator was again reprogrammed to try to achieve better results. After the patient's device was programmed to achieve maximal comfortable stimulation, the physician provided the patient and family members with detailed instructions regarding stimulator operation and precautions. The overall reprogramming session, including analysis, four reprogramming sessions, three waiting periods, and the final instructions took three hours. In addition, detailed history and physical examination and moderate-complexity medical decision making were provided concerning the patient's medication regime, to address concurrent medical problems, and to counsel the patient and family about psychosocial difficulties encountered in coping with moderately advanced Parkinson disease. (There is a visit and programming here)..