Deep brain stimulation for the treatment of depression in Türkiye

Deep brain stimulation (DBS) is a surgical procedure based on implanting electrodes in specific areas of the brain that generate electrical impulses that control abnormal brain activity. The programmable procedure is placed under the skin in the upper chest.

What is depression:

Depression is a mood disorder that causes persistent feelings of sadness and loss of interest and leads to a variety of emotional and physical problems as a person has difficulties carrying out normal daily activities and feels as if life is not worth living. Treatment of depression takes a long time, but most people with depression feel better with medication, psychotherapy, or deep brain stimulation.

Symptoms of depression:

People have multiple episodes that occur most of the day, nearly every day, and include:

• Feeling of sadness, crying, emptiness and despair.
• Outbursts of anger, irritability, or frustration.
• Loss of interest or enjoyment in most or all normal activities, such as sex, hobbies, or sports.
• Insomnia or prolonged sleep disturbances.
• Fatigue or decreased activity.
• Loss of appetite, weight loss or, conversely, increased cravings for food and weight gain.
• Anxiety, excitement, or anxiety.
• slowed body movements.
• Feelings of worthlessness or guilt, focusing on past failures or self-blame.
• Difficulty thinking, concentrating, making decisions, and remembering things.
• Frequent thoughts of death, suicidal thoughts or suicide attempts.
• Unexplained physical problems such as back pain or headaches.

How useful is deep brain stimulation for depressed patients?

Implantation of electrodes into a region of the brain called the subthalamic cingulate cortex (Area 25) can have a treatment-resistant antidepressant effect that lasts for a long time.

The deep brain stimulation system has three components:

Electrode: A thin, insulated wire is inserted through a small hole in the skull and implanted in a specific area of the brain.

Extension cord: connects the electrode to the internal pulse generator and is passed in isolation under the skin of the head, neck and shoulder.

IPG Internal Pulse Generator: These are implanted under the skin in the upper chest.

How does deep brain stimulation therapy work?

The device is placed by a neurosurgeon during an operation. Thin electrodes carry electrical pulses from the neurostimulator directly to the brain to stop the brain signals that are causing the problem.

The neurostimulator is battery operated and programmable like a minicomputer (like a pacemaker).

The doctor programs the device based on previous analyzes and not a direct response.

These electrical currents affect the excitability of certain circuits in the brain and help to prevent tremors or reduce their frequency.

Who is a Candidate for Deep Brain Stimulation?

The doctor resorts to deep brain stimulation (DBS) after trying pharmacological treatments on patients, such as anti-seizure drugs, depression drugs, and drugs for Parkinson’s disease and multiple sclerosis. The doctor then consults with the patient about the success rates of DBS.

Preoperative exam:

The extent of benefit from treatment is determined by conducting a number of diagnostic tests and taking into account all surgical options, such as vagus nerve stimulation (VNS) or deep brain stimulation (DBS).

Consider these factors when choosing deep brain stimulation treatment:

• The type of person’s symptoms.
• The best way to reduce the risks of surgery and get the most out of deep brain stimulation.

Before surgery:

The patient gives their medical history, including allergies, medications, anesthesia reactions, and previous surgeries.

Stop taking all nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, as well as blood thinners, such as warfarin, aspirin, and Plavix, seven days before surgery.

Do not drink alcohol or use nicotine one week before and two weeks after surgery to avoid bleeding and problems with the healing process.

You must wash your skin and hair with Hibiclens or a special soap prior to surgery.

Do not eat or drink anything the night before the surgery.

During surgery:

The whole process takes 5 to 7 hours. The surgery takes 3 to 4 hours, and the first step begins with placing a stereotaxic frame on the patient’s head temporarily using Velcro Straps. The four pin sites are injected with local anesthesia, then a mild sedative is administered. One inch wide hair is shaved along the incision line. A skin incision is made across the top of the head, and two holes are opened on the left and right sides of the skull using a drill, through which an electrode enters the brain to a specific and planned location inside the brain.

After that, a number of tests are conducted, such as raising the arms or legs, or counting numbers, and the brain cell activity is displayed on the computer and the exact location of the neurons is determined. Then a plastic cover is placed over the hole to fix the electrode in place, and a file of wire is left under the scalp to tie it. Later with an extension cord and stimulator, and finally the scalp incision is closed with sutures and a bandage is applied.

after surgery

The patient stays in the hospital for monitoring and observation before returning home the next day. After about a week, the patient returns to the hospital to undergo surgery to implant the stimulator in the chest. The surgery is performed under general anesthesia and takes about an hour. Patients return home on the same day.

Stimulator implantation surgery

Part of the scalp incision is reopened to access the electrical leads. A small incision is made near the collarbone, where the neurostimulator device is implanted under the skin. The neurostimulator is then connected to an extension cord that is passed under the skin of the scalp down the neck and then to the stimulator in the chest.

Catalyst programming:

The stimulator is programmed about 10 days after surgery. The drug dose is then adjusted accordingly. The stimulator is reprogrammed through 3 to 4 sessions every 3 weeks to achieve maximum symptom control while minimizing side effects. Most people do not feel the stimulus because it reduces their symptoms, but some people may feel a short tingling sensation when the stimulator is first turned on.

Risks

The treatment has potential but minor and reversible risks and side effects. Deep brain stimulation is safe and effective in properly selected patients.

Risks include:

• The risk of cerebral hemorrhage, including stroke, is 1%.
• infection.
• A malfunction in the machine.
• No benefit for certain symptoms.
• headache.
• Deterioration of mental or emotional condition.

Side effects during stimulation include:

• Temporary tingling in the face or extremities.
• A feeling of tightness in the muscles.
• Speech or vision problems.
• Loss of balance.

Deep brain stimulation and depression in Türkiye

The medical staff of surgical teams, doctors and consultants in REHABTÜRK can provide the best treatment options and free consultations – by striving to keep abreast of the latest technologies and medical methods.

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