Deep Brain Stimulation (Neuromodulation) Center

It is often used in Parkinson’s disease and other movement disorders such as tremor and dystonia. In addition, its use is becoming widespread in psychiatric diseases such as Tourette’s syndrome, severe depression and OCD, and epilepsy. Apart from these, in appropriate cases; There are case examples in the literature in diseases such as alcohol and substance addiction, anorexia nervosa, obesity, autism.

With the diagnosis of the disease, drug treatment is started. Patients can return to their pre-sick lives for the first few years as if they had never been sick. This period is called the honeymoon period. However, in the following years, it can be said that it is time to consider brain pacemaker surgery with the inability to control complaints such as tremor, freezing, stiffness, slowness of movement despite drug treatment, the increase in the duration of closed periods during the day, and the emergence of involuntary movements such as dancing with the increase in drug doses. Pacemaker surgery is not recommended for the first 4-5 years from the moment of diagnosis. The most important reason for this is that Parkinson’s disease can be confused with other diseases. Unfortunately, in such diseases called Parkinson’s plus, brain pacemaker surgeries do not give as successful results as in Parkinson’s disease. An exception to this situation is Parkinson’s patients, who cannot be controlled with medications and complain of tremors in the hands predominate. A s in diagnosis

For brain pacemaker surgery, the onset of the disease must be at least 4-5 years ago. This is because Parkinson’s disease can be clinically confused with some other neurological diseases. Brain pacemaker surgery is not recommended in patients who have frequent falls and the drugs they use provide almost no benefit even for a short period of time. Moreover; Especially in patients with advanced fall and balance problems, even an increase in postoperative complaints can be observed. Again, brain pacemaker surgery should not be performed in patients with severe psychiatric depression or in patients with serious mental disorders called psychosis. Since patients with Parkinson’s disease may experience sadness and anxiety due to a decrease in the quality of life of patients and their limited life, such mild clinical psychiatric conditions do not constitute an obstacle for surgery. However, in the more severe psychiatric problems we have just mentioned, drug treatment should be started first and this surgery should be performed after the psychiatric treatment of the patients is completed. Patients who have had such complaints in the past and have recovered with psychiatric drug treatment should be followed closely after brain pacemaker surgeries. This information should be shared in detail with the patient and their relatives before the surgery.

Another obstacle to surgery is patients whose cognitive status is behind compared to their age. Brain pacemaker surgeries should not be performed in patients with dementia findings. In addition, pacemaker surgeries are not suitable for patients with other chronic diseases that are severe and uncontrolled. However, diseases such as hypertension, heart disease or diabetes, which are under control, do not prevent the surgery from being performed.

Brain pacemaker surgeries are not applications to be decided by a single physician. In order to understand whether Parkinson’s patients are suitable for surgery, we hospitalize our patients for a few days in our movement disorders and brain pacemaker center. During this period, we first check whether the patient receives the most appropriate drug treatment by our experienced movement disorder neurologists working in our center. If necessary, we add new drugs. Afterwards, detailed tests are applied by our neurologists to our patients in the medicated and non-medicated periods, that is, in the periods when it is closed and open, to measure the degree of Parkinson’s disease. According to the results of these tests, we decide whether it is neurologically suitable for surgery. If we find our patients suitable for surgery, they are then subjected to a detailed examination by our psychiatrist. Again, in order to evaluate the dementia or cognitive status of our patients, detailed neuropsychological tests are applied to our patients by our neuropsychologist.

Brain pacemaker surgeries are a surgical method that is usually performed while patients are awake. There are a couple of important reasons for this. Although neurosurgeons make fine calculations by looking at the brain MRIs of the patients before the surgery, we still prefer the patients to be awake so that the electrodes to be placed in the brain can be sent to the right point. Because the areas we target are points that are located in deep regions of the brain and are a few millimeters in size. If we place the electrodes in a different place by a millimeter or two, it is unlikely that we will get the good result we expect from the brain pacemaker treatment. For this reason, we use the microelectrode recording method, in which we electrophysiologically record a single cell in the brain, in pacemaker surgeries.  Thanks to this technique, we can listen to and record the sound of each cell in the brain and find the brain region where there is abnormal activity in diseases such as Parkinson’s without any margin of error. Afterwards, we give low-voltage electrical stimulation to the patients during the surgery. In the meantime, we examine the patient by our neurologist and observe the healing effects and possible side effects of the stimulus we give. Our patients also feel the extent to which their complaints improve during the surgery. In fact, we do the surgery together with our patients. However, some of our patients may be uneasy about having surgery while awake and do not want to. In this case, we can perform brain pacemaker applications by putting our patients to sleep, but still using microelectrode recording during surgery.

After brain pacemaker surgery, patients tend to gain weight, especially in the first months, due to both the decrease in joint stiffness and the increase in appetite. We try to prevent this problem by providing nutrition education by our dietitian before the surgery and when they come for control. Another problem can be wound inflammation. In order to prevent this situation, we provide meticulous and detailed information to our patients during discharge by our Parkinson’s nurse. After surgery, some patients may experience some temporary psychiatric complaints. In this case, we recommend that they contact our center. We definitely do not recommend injurious sports such as football, judo, wrestling and boxing. But we also recommend that they do all the sports they want that are not injurious. Again, we tell them not to pass through x-ray machines at airports and similar places and give them a document stating that they carry a brain pacemaker.

The first thing patients with such tremor complaints should do is to consult an experienced movement disorder neurologist. Although the primary treatment is drug therapy, the brain pacemaker method gives very satisfactory results in patients whose tremor cannot be controlled with the treatment applied.