Neuromodulation surgery (Brain Pacemaker - Deep Brain Stimulation in Parkinson's Disease)

Another symptom is slowness in movements. The patient has difficulty in doing their daily chores. There is a slowdown while eating or when turning to one side from the other and this is done with difficulty. The patient has muscle stiffness. Patients write in lowercases and illegibly. When walking, they walk slowly and lean forward. Their voice is hoarse and difficulty in swallowing may develop.
The diagnosis of Parkinson's disease is made by clinical examination findings.
Patients with the above-mentioned symptoms and whose quality of life is adversely affected should be examined by a neurologist. Neurology specialists apply an initial medical treatment for the disease. Since the main problem in this disease is the deficiency of a substance in the brain, patients respond well to drug treatment and it is possible to treat many patients with drug therapy, especially at the beginning of the disease. When the disease progresses and there is no response to the drugs, or when the side effects of the drugs that negatively affect the daily life of the patient occur, surgical treatment comes into play.

What is the purpose of the brain pacemaker application?

Deep Brain Stimulation (DBS), known as a brain pacemaker, is the most commonly used surgical method for the motor symptoms of Parkinson's disease. In the DBS procedure, microelectrodes are placed in one of the two regions of the brain (subthalamic nucleus or globus pallidus region) in order to give high-frequency electrical stimulation. This stimulation regulates the signal that is missing in Parkinson's patients. DBS surgery is the most preferred surgery because it is safe, effective, fully reversible if desired, and adaptable to the patient. This treatment is applied to patients who are resistant to drugs or adversely affected by the side effects of drugs.

How are these patients evaluated before surgery?

Patients who are referred with the thought of being suitable for surgical treatment are evaluated together with Neurology and Psychiatry specialists. The patient's preoperative disease status is scored with various scales and recorded with video footage.

Which patients are selected as suitable candidates?

Patients with definitive diagnosis, 5-7 years after the onset of the disease, and no significant disabling psychiatric problem are selected for surgery in Parkinson's disease. If patients do not respond to medical treatment or if motor or psychiatric side effects occur at therapeutic doses, these patients are candidates for surgery. For surgery, it is necessary to pay attention to the general condition of the patient and whether there are any accompanying diseases.

How is Parkinson's surgery done?

Before the surgery, detailed brain magnetic resonance imaging is performed. On the morning of the surgery, a special frame is placed on the patient's head and brain tomography images are taken with this frame. These images are then combined on the computer with the brain images we have taken before. Three-dimensional spatial coordinates of the points determined as target points in the brain on the combined images are obtained. While the patient is awake in the operating room, the target points in the brain are determined with the help of special electrodes under local anesthesia, and then permanent electrodes are placed. In the last phase of the surgery, the patient receives general anesthesia and a high-tech pacemaker gets inserted under the skin on the chest and it gets connected to the electrodes previously placed into the brain. Total processing time is 5-6 hours.

What are the surgical results like?

Very successful results are obtained with surgery. Findings such as tremors, contractions, slowing down in movements, and involuntary movements, which disturb the patients, are taken under control to a great extent. The intensity and order of the electric current applied in accordance with the patient's examination findings can be adjusted on the skin with special devices.
Patients continue to take their medications after the surgery, but in many patients, the drug doses are reduced and thus a significant decrease is observed in side effects such as dystonia (twitching of the muscles). DBS does not slow the progression of the disease, but provides significant relief from symptoms.