Brain Battery (Deep Brain Stimulation in Parkinson's Disease)
Parkinson's disease occurs when a substance called dopamine is depleted in the brain.
It usually occurs in older ages and the initial symptom is tremor in the hand or one half of the body. Leaning forward or not swinging his arm while walking can be seen as a concomitant posture disorder in the patient. In DBS, it is aimed to place microelectrodes in one of the two regions of the brain (subthalamic nucleus, globbuspallidus) that play a role in the pathogenesis of Parkinson's Disease in surgery. The activity of the regions is regulated by giving electrical impulses to these regions through the placed electrodes. In this way, a significant improvement is observed in the patient's clinic even during the operation.
DBS therapy is an effective and safe treatment option.
Another symptom is slowness in movements. The patient has difficulty in doing his daily work. While eating, there is a slowdown when turning to one side and this is done with difficulty. The patient has muscle stiffness. Patients write in lowercase and illegible. They walk slowly and lean forward while walking. Their voices are 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 the initial medical treatment of the disease, namely drug therapy. 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 battery application?
Deep Brain Stimulation (DBS), known as a brain battery, 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?
The patients who are referred with the thought that the surgeon is suitable for 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 a 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.
For surgical treatment (DBS), patients are evaluated in detail by various scales and tests by neurology, psychiatry and neurosurgery specialists to determine whether they are suitable for the operation and whether they can benefit from the treatment. The benefits and risks are explained to eligible patients. Video footage is taken before the operation.
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. Total processing time is 5-6 hours.
As it can be understood from this brief information, a strong team of doctors with more than one specialty and hospitals with a well-equipped technical infrastructure are needed in order to perform these surgeries. For this reason, these surgeries can be performed in a very limited number of centers all over the world.
What are the surgical results like?
Very successful results are obtained with surgery. Findings such as tremors, contractions, slowing of movements, involuntary movements, which disturb the patients, are taken under control to a great extent. The intensity and pattern 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 (contraction in the muscles, twisting). DBS does not slow the progression of the disease, but provides significant relief from symptoms.