Deep brain stimulation for the treatment of Parkinson’s patients in Türkiye

Deep stimulation and Parkinson’s disease (DBS) is a surgical procedure based on implanting electrodes in certain areas of the brain that generate electrical impulses that control abnormal brain activity. The impulses can be modified according to chemical differences within the brain that cause different disease states and controlled through the internal pulse generator programmable and placed under the skin in the upper chest.

What is Parkinson’s disease:

It is a disorder of the nervous system that affects movement, and the disease develops gradually, and symptoms begin with a tremor that is difficult to notice in only one hand, and the disease can only be treated by using medications, as it significantly reduces symptoms, and deep brain stimulation treatment may also help in that.

Symptoms of Parkinson’s disease

Signs and symptoms of Parkinson’s disease vary from person to person. They may be unnoticed and it is common for symptoms to start on one side of the body. It remains worse on this side as the disease progresses even after symptoms begin to affect both sides.

Signs and symptoms of Parkinson’s disease include:

Tremor: A tremor occurs in one of the extremities of the hand or fingers.
Slow movement: Parkinson’s disease leads to slow movement as the disease progresses, making it difficult to perform simple tasks.
Muscle stiffness: Muscle stiffness occurs in any part of the body.
Balance problems: The patient may have balance problems.
Decreased ability to perform unconscious movements, such as smiling or swinging arms while walking.
Speech changes: speaking softly, or quickly and stumbling.
Difficulty writing: Difficulty writing and letters may appear small.

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 impulses 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 prevent tremors or reduce their frequency.

How useful is deep brain stimulation for Parkinson’s patients?

The treatment is aimed at people with obstructive tremors. Seizures and dyskinesia caused by medication, but it is not considered a cure. It does not slow the progression of the disease and is not thought to improve problems with speech, swallowing, thinking problems, or frozen walking. It is also not suitable for everyone with Parkinson’s disease and most people need to take medication after deep brain stimulation, but in much smaller doses.

Who Candidate Deep Stimulation and Parkinson’s?

He resorts to treatment after trying pharmacological treatments on patients, such as anti-seizure drugs, depression drugs, and drugs for Parkinson’s disease and multiple sclerosis. Then the doctor is consulted about the success rates of deep brain stimulation.

Preoperative tests:

The extent of benefit from treatment is determined by conducting a number of diagnostic tests and all surgical options are taken into account. 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 deep stimulation surgery for Parkinson’s disease:

The patient gives his medical history including allergies, medications, anesthesia reactions, and previous surgeries.
Stop taking all nonsteroidal anti-inflammatory drugs (IBUPROFEN, NAPROXEN) as well as blood thinners (COUMADIN, ASPIRIN, PLAVIX) seven days before surgery.
Not drinking alcohol and using nicotine one week before and two weeks after surgery, in order to avoid bleeding and problems with the healing process.
It is required to wash skin and hair with Hibiclens or a special soap prior to surgery.
No food or drink is allowed 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 a stimulator, the scalp incision is finally closed with sutures and a bandage is placed on it.

After deep stimulation surgery for Parkinson’s disease:

The patient stays in the hospital for monitoring and observation, then returns home the next day, then returns to the hospital after about a week 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 implant surgery:

Part of the scalp incision is reopened to access the electrical leads, then a small incision is made near the collarbone, the neurostimulator device is implanted under the skin, and 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 and the drug dose is adjusted accordingly. It 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 sensation. Tingling when you turn on the catalyst for the first time

Other diseases treated by deep brain stimulation:

Deep brain stimulation is used to treat people with uncontrolled focal seizures (drug-resistant seizures) and is an option for people whose seizures can’t be treated with other types of epilepsy surgery. It is also used for some people with depression. And also for people who have had Parkinson’s for at least four years and have movement symptoms that are not adequately controlled with medication.

Deep stimulation and Parkinson’s 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 medical technologies and methods.

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