Neurostimulator Programming Note (DBS/VNS)

Date/Time: [Encounter date and time]

Location: [Care setting]

Clinician: [Name, credentials]

Participants: [Patient; caregiver if present; interpreter if present; device representative if present] (Specify each participant's role.)

Primary Indication: [Covered condition for device therapy] (If treatment-resistant depression, document CED pathway participation.)

Reason for Visit

[Purpose of visit: routine programming / titration / troubleshooting / urgent concern] (Prioritize any safety concerns. Limit to 1–3 sentences.)

Interval History

• [Therapy response and durability since last visit]
• [Adverse effects temporally linked to stimulation] (DBS: speech, gait, mood, paresthesias. VNS: voice change, cough, throat discomfort, dyspnea.)
• [Significant events: ER visits, seizures, falls, infections near hardware, MRI/diathermy exposures, device alerts]
• [Adherence and operational issues: charging routine, magnet/remote use, controller difficulties]
• [Relevant medication changes affecting target condition or stimulation tolerance]

Baseline Clinical Status

(Document clinical status immediately before any programming changes.)

• [Medication state at assessment] (e.g., dopaminergic ON/OFF timing for movement disorders; antiseizure regimen adherence for epilepsy)
• [Key findings relevant to device target] (DBS: tremor, rigidity, bradykinesia, dyskinesia, gait, speech. VNS: seizure frequency, types, rescue therapy and magnet use.)
• [Scale scores if obtained] (Optional.)

Implanted System Summary

• Device Type: [DBS / VNS]
• Manufacturer: [Device manufacturer]
• Model (IPG/Generator): [Model name and number]
• Serial Number (IPG/Generator): [Serial number]
• Lead(s)/Electrodes: [Model and serial numbers if available]
• Implant Date(s): [Dates for lead(s) and IPG/generator]
• Targets and Laterality: [Target(s) and side(s)] (DBS only.)
• Generator and Lead Location: [Generator side; lead side/route] (VNS only.)
• MRI-Conditional Status: [MRI status and verification source: interrogation screen / manufacturer card]

(If any information is unavailable, document "Not available today—will obtain from implant records.")

Device Interrogation

• Power Status: [Battery voltage (V) or percentage (%); ERI/EOS flags; estimated longevity if displayed]
• Therapy Status: [On / Off]; [Active program(s)]; [Last programmed timestamp if available]
• Lead Integrity: [DBS: impedances by contact in ohms. VNS: system diagnostics and lead/generator integrity.] (Flag out-of-range values with interpretation.)
• Event Logs: [Device-recorded faults, shutoffs, magnet activations, sensing logs if applicable]
• Hardware Exam: [Skin over IPG pocket and lead tract: erythema, tenderness, swelling, erosion, fluctuance]

(If interrogation could not be completed, document failure mode, troubleshooting performed, and contingency plan.)

Programming

Programmer/Method: [Programmer platform]; [Who performed programming]; [Face-to-face programming time in minutes]

Settings BEFORE (Include units for all parameters.)

• DBS:
  • [Side and program label]
  • [Contact configuration and polarity]
  • [Amplitude (mA or V)]; [Pulse width (µs)]; [Frequency (Hz)]
  • [Advanced features if active: interleaving, cycling, directional steering, sensing/adaptive parameters]
  • [Patient control range if enabled]
• VNS:
  • Normal Mode: [Output current (mA)]; [Frequency (Hz)]; [Pulse width (µs)]; [On time (sec)]; [Off time (min)]
  • Magnet Mode: [Output current (mA)]; [On time (sec)]
  • AutoStim: [Parameters if active]

Programming Trials

• [Settings tested: amplitude titration, contact changes, pulse width adjustments, frequency changes]
• [Side-effect thresholds identified] (DBS: contact-specific thresholds. VNS: titration step tolerability.)

Rationale

[Clinical reasoning linking chosen settings to therapeutic goals or side-effect mitigation]

Settings AFTER (Include units for all parameters. If no changes, state "No changes made" with brief rationale.)

• DBS:
  • [Final active program(s) by side]
  • [Contact configuration and polarity]
  • [Amplitude (mA or V)]; [Pulse width (µs)]; [Frequency (Hz)]
  • [Advanced features if active]
  • [Stored additional programs with intended use]
  • [Patient control parameters and allowed range]
• VNS:
  • Normal Mode: [Output current (mA)]; [Frequency (Hz)]; [Pulse width (µs)]; [On time (sec)]; [Off time (min)]
  • Magnet Mode: [Output current (mA)]; [On time (sec)]; [Magnet use instructions]
  • AutoStim: [Parameters if active]
  • [Patient control parameters if enabled]

Observed Response

• [Immediate clinical changes observed: improvements, no change, or worsening]
• [Immediate adverse effects and mitigation steps taken]
• [VNS: voice/cough/throat sensation at new dose; whether test stimulation delivered]

Assessment

(Problem-oriented format, ordered by clinical priority.)

[Problem 1]: [Primary neurologic condition and current control]

[Assessment of symptom control and functional impact]

[Problem 2]: [Neurostimulator status]

[Device function, integrity concerns, battery status with anticipated replacement timeline]

[Problem 3]: [Stimulation-related side effects]

[Suspected mechanism and mitigation approach] (Only include if applicable.)

[Problem 4]: [Relevant comorbidities affecting therapy]

[Factors influencing safety, programming tolerance, or outcomes] (Only include if applicable.)

(If hardware issue suspected, label as "Concern for…" and cite supporting evidence.)

Plan

• Programming Plan: [Maintain settings / continue titration / patient self-adjustment instructions; when to revert to prior program; rescue options]
• Medications: [Changes and rationale] (Only include if changes made.)
• Battery Management: [Expected replacement window; neurosurgery referral if indicated; charging education]
• Diagnostics/Orders: [Imaging, labs, EEG, device vendor troubleshooting, consults] (Only include if applicable.)
• Safety Counseling: [Falls, swallowing/aspiration risk, driving/seizure precautions, MRI/diathermy restrictions, emergency contact instructions]
• Follow-Up: [Next programming visit]; [Remote check schedule if applicable]; [Criteria for earlier return]

Education and Counseling

• [Device operation and patient controller use]
• [Magnet/remote use instructions]
• [Charging routine and best practices] (If rechargeable device.)
• [Symptom or seizure diary guidance]
• [Key safety restrictions reviewed and understanding confirmed]

(Note whether instructions provided to patient, caregiver, or both.)