Brain Pace (Deep Brain Stimulation in Parkinson’s Disease)

Brain Pace (Deep Brain Stimulation in Parkinson’s Disease)

Parkinson’s disease occurs when a substance called dopamine is depleted in the brain. It usually occurs later in life 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.

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. When walking, they walk slowly and lean forward. Their voices are hoarse and they may develop difficulty in swallowing. The diagnosis of Parkinson’s disease is made by clinical examination findings.

Patients with the above-mentioned symptoms and whose quality of life is negatively affected should be examined by a neurologist. Neurologists apply the initial medical treatment of the disease, that is, 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 pace application?

Deep Brain Stimulation (DBS), known as a brain pace, 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 to the surgeon considering that they are 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.

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.

What are the surgical results like

Very successful results are obtained with surgery. Findings such as tremors, contractions, slowing of 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 (Deep Brain Stimulation) does not slow the progression of the disease, but provides significant relief from symptoms.

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