Neuromodulation surgery (Brain Pacemaker)
Thanks to the brain pacemaker, the electrodes placed on the patient can be controlled without touching the patient, and the disease can be controlled by making adjustments to correct the patient's complaints. Brain pacemaker operations using advanced technology carry less risk than other neurosurgery operations. The quality of life of patients who have undergone brain pacemaker operation, especially Parkinson's patients, can increase, and their daily lives can continue in their ordinary course.
In Which Diseases Is It Used?
The brain pacemaker is used to minimize the symptoms of some diseases:
- Parkinson's disease
- Epilepsy
- Tremor disorders in some parts of the body (Essential tremor)
- Involuntary contraction diseases are seen in some parts of the body (Dystonia)
- Tic disorder (Tourette)
- Obsessive-compulsive disorders
- Major depression
- In addition to these diseases, studies are being carried out on the use of brain pacemakers for Alzheimer's and obesity.
What are its effects?
After brain pacemaker operations, patients can return to their daily lives very quickly. Especially the daily lives of Parkinson's patients and patients who experience involuntary contractions change depending on these symptoms. Reasons such as trembling seizures and excessive contraction of the muscles cause patients to be unable to control their movements. Thanks to the brain pacemaker, patients suffering from these symptoms return to the initial stages of their disease. While the majority of patients who have undergone brain pacemaker operations reduce their drug doses, some of them stop the drugs they use entirely.
Although the brain pacemaker effectively treats symptoms, it does not eliminate the disease. Most neurological diseases are caused by damage to certain parts of the brain. The brain pacemaker does not restore these damaged areas to normal. Still, it is effective in relieving symptoms such as tremors, inability to control movement, and slow movements in the patient, which develop due to the dysfunction of this region.
Thanks to the brain pacemaker, these symptoms are minimized, especially in Parkinson's patients. After brain pacemaker operations, individuals in the 10th year of the disease and those with advanced Parkinson's can return to the first stage of the disease. Patients who cannot perform daily tasks such as buttoning a shirt, preparing food, or tying shoes and who are disconnected from social life can continue their daily lives without needing help.
How is Brain Pacemaker Surgery Performed?
The purpose of brain pacemaker applications is to give electrical stimulation to the areas of the brain with damaged and impaired electrical activity at regular intervals. For this purpose, it is necessary first to make a brain map of the patients. MRI and other imaging methods are used for the map. Then, considering this map, the regions where the electrodes should be placed are determined, and thin cables that will provide electrical activity are placed in these areas. The battery that will give the electrical stimulus is placed under the collarbone or in the thoracic cage cavity.
Although the general process of the brain pacemaker surgery is like this, a series of procedures are applied before, during, and after the surgery.
Preoperative Period
Before the operation, various tests and examinations are performed on the patients to determine their condition. MRI and brain tomography are imaging methods used to make brain maps of patients. In addition, some tests are performed to determine the patient's suitability for anesthesia.
Blood and urine tests are performed to assess the patient's general condition. Tests indicating the patient's current health status, such as blood count, hormone status, and kidney functions, are carried out to determine whether the patient is ready for surgery. In addition to these tests, other tests deemed appropriate by the physicians are also applied.
Brain pacemaker surgeries affect patients physically and psychologically. For this reason, psychiatry interviews are conducted for patients deemed appropriate by physicians to provide relief.
After listening to the patient's medical history, learning the drugs used, and these examinations and tests, the patient is ready for surgery.
Operation
Brain pacemaker surgeries can be performed while the patient is awake or under anesthesia. This is determined by the patient's disease and physician preference. In surgeries performed while the patient is awake, a small hole is drilled where the surgeons and electrodes apply local anesthesia in the areas determined on the brain map. Although the patients are conscious during this procedure and the adjustment of the electrodes, they do not feel any pain. The batteries are placed under the patient's skin, usually in the rib cage. Therefore, general anesthesia is applied to patients so that they do not feel pain during the operation.
In the surgery performed under anesthesia, the patient is first put to sleep. Then, the electrodes are placed on the targeted area, and the battery placement is performed in the same session.
Brain pacemaker surgeries are to be among the most risk-free brain operations. The duration of the operation varies from patient to patient, but it is, on average, between 2 and 5 hours.
Postoperative Period
Patients should be in the hospital on the first day after the pacemaker surgery due to the possibility of some complications. It is expected to have pain in the head after the surgery. Along with the pain, dizziness is one of the common side effects. Medical intervention is required if this temporary pain and dizziness is abnormally severe.
Although brain pacemaker surgeries are one of the most risk-free surgeries, it is possible to have some complications and side effects, as in any surgery. Vascular occlusions, infections, bleeding, visual disturbances, loss of balance, and nerve damage are some of the complications that may occur.
What Are the Risks of Brain Pacemaker Surgery?
Brain pacemaker operations carry less risk than other surgeries performed in the field of neurosurgery. However, it has some risk factors likely to be seen in every surgery. Studies show that the severe complications seen in brain pacemaker operations are around 2%-3% on average. Compared to these severe complications, minor complications occur in approximately 10% of patients.
Some complications that can be seen during and after brain pacemaker surgery are:
- Brain hemorrhage
- Wound problems
- Loss of vision
- Shifts in brain electrodes
- Infection problems
- Contact disorders
Frequently Asked Questions
Does the brain pacemaker affect daily life?
The brain pacemaker used to eliminate the symptoms of some diseases does not affect daily life. Those with a brain pacemaker can maintain their everyday life like healthy individuals.
How long can a brain pacemaker be used?
The brain pacemaker, which functions similarly to a battery, has a specific lifecycle, too. The lifespan of the brain pacemakers used for different diseases also varies. Brain pacemakers applied to Parkinson's patients are generally used for 3-5 years. In patients with dystonia, the battery life is shorter due to differences in application. Rechargeable brain pacemakers can be used for more than five years. The projected life of these batteries is approximately 15 years.
Can patients with a brain pacemaker engage in physical activity?
Yes. Patients with a brain pacemaker can do all kinds of physical activities like healthy individuals. They can exercise regularly, swim, and play sports such as football and tennis. However, extreme sports and driving should be avoided to prevent head injuries from accidents.
Who cannot have a brain pacemaker?
Patients who will undergo a brain pacemaker surgery must meet some criteria. In early-stage Parkinson's patients who respond to drug treatment, using a brain pacemaker is not a preferred method, especially in the first five years. Brain pacemaker is not applied in patients with moderate and severe dementia, in patients with severe depressive episodes, and in patients with a condition that prevents taking anesthesia.
Is infection seen after brain pacemaker application?
Most researchers point out that 3% of infection cases are seen after brain pacemaker applications. Most of these infections are seen in the chest area, where the power supply is placed.
Can patients with a brain pacemaker benefit from radiological imaging?
MRI, tomography, brain imaging methods, and X-ray devices do not affect patients with brain pacemakers. However, body imaging with an MRI device is not recommended for these patients.
Can non-rechargeable brain pacemakers be reused later?
Although this situation varies depending on the model of the rechargeable brain pacemakers, it is possible to recharge most rechargeable models after shutdown.
How long does it take for patients to recover after brain pacemaker surgery?
The average recovery time for patients after surgery is one month. This month includes the first few days when the patient is observed and the 10-14 days until the dressing and stitches are removed. This period may be longer in case of complications such as persistent side effects.
Do brain pacemaker surgeries completely cure the related disease?
No. A brain pacemaker is used to minimize the symptoms of diseases such as Parkinson's and dystonia. The absence of symptoms such as tremors is due to using a brain pacemaker. In this sense, patients show the same symptoms when the pacemaker is not used.
