Treatment of Neurological Disorders
Damage in specialized clusters of brain cells responsible for movement control, or deficiencies in the production of neurotransmitters that facilitate this control, can lead to individuals losing their ability to move and control their actions. One of the most important surgical methods used in the treatment of neurological disorders caused by such damage is deep brain stimulation (DBS), also known as a brain pacemaker. DBS is an adjustable and controllable surgical procedure, particularly effective in patients with essential tremor (uncontrollable shaking during voluntary movements), Parkinson’s disease, and dystonia (involuntary muscle contractions).
Restoring Life with a Brain Pacemaker
With deep brain stimulation, electrodes implanted in the brain can be controlled remotely, and adjustments can be made to alleviate patients’ symptoms, helping to manage their condition. Compared to other brain and neurosurgery operations, DBS procedures involve fewer risks due to the advanced technology used. Patients undergoing deep brain stimulation, particularly those with Parkinson’s disease, experience improved quality of life and can resume their daily activities with greater ease.
Which Conditions Can Be Treated with Deep Brain Stimulation?
Deep brain stimulation is used to minimize the symptoms of certain diseases, including:
- Parkinson’s disease
- Epilepsy
- Tremor disorders affecting various parts of the body (Essential Tremor)
- Involuntary muscle contraction disorders (Dystonia)
- Tic disorders (Tourette Syndrome)
- Obsessive-compulsive disorders (OCD)
- Major depression
Research is also being conducted to explore the potential use of DBS in conditions such as Alzheimer’s disease and obesity.
Effects of Deep Brain Stimulation
Following a DBS procedure, patients can quickly return to their daily lives. The symptoms of Parkinson’s disease and involuntary muscle contractions significantly affect patients’ daily routines. Symptoms such as tremor episodes and excessive muscle contractions lead to loss of movement control.
With DBS, patients suffering from these symptoms return to an earlier stage of their disease. Many patients can reduce their medication dosage after the procedure, while some may even discontinue their medication entirely. Although DBS is highly effective in managing symptoms, it does not cure the disease itself. Most neurological disorders arise from damage to specific areas of the brain. While deep brain stimulation does not restore damaged brain regions to their original state, it helps alleviate symptoms such as tremors, lack of movement control, and slowed movements that result from the impairment of these areas.
In Parkinson’s patients, in particular, DBS helps minimize symptoms. Patients who have had the disease for over ten years and are in an advanced stage can return to an earlier phase of the disease after the procedure. Individuals who previously struggled with simple daily activities such as buttoning a shirt, preparing a meal, or tying their shoes can regain their independence and resume their normal social lives without assistance.
How Is Deep Brain Stimulation Surgery Performed?
The goal of DBS surgery is to deliver regular electrical stimulation to the damaged areas of the brain with impaired electrical activity. To achieve this, a brain map of the patient is first created using MRI and other imaging techniques. Based on this map, the target areas for electrode placement are determined. Thin wires that transmit electrical impulses are then implanted in these regions, while the pulse generator (battery) is placed under the collarbone or in the chest cavity.
Although this is the general procedure for DBS surgery, several steps are involved before, during, and after the operation.
Before the Surgery
Before surgery, various tests and examinations are performed to assess the patient’s condition. MRI and CT scans are used to create detailed brain maps. Additionally, several tests are conducted to determine the patient’s suitability for anesthesia. Blood tests and urinalysis are performed to evaluate general health status, including blood count, hormone levels, and kidney function.
These evaluations help determine whether the patient is ready for surgery. Other necessary tests may be performed based on the physician’s recommendations. Since DBS surgery affects patients not only physically but also psychologically, psychiatric consultations may be conducted for patients deemed necessary by their doctors to ensure their emotional well-being.
Once the patient's medical history is reviewed, medications are assessed, and the necessary tests and evaluations are completed, the patient is considered ready for surgery.
During the Surgery
DBS surgery can be performed while the patient is awake or under general anesthesia. The choice depends on the patient’s condition and the surgeon’s preference.
In procedures where the patient remains awake, local anesthesia is applied, and a small hole is drilled in the skull to insert the electrodes into the predetermined brain regions. During this process and while adjusting the electrodes, patients remain conscious but do not experience pain or discomfort.
The battery for the stimulator is placed under the skin, typically in the chest area. Since this part of the procedure requires making an incision, general anesthesia is used to ensure that the patient does not feel pain or discomfort.
For DBS surgeries performed under general anesthesia, the patient is first sedated. The electrodes are then implanted in the targeted brain regions, followed by the implantation of the battery in the same session.
Deep brain stimulation surgery is considered one of the safest neurosurgical procedures. While the duration varies from patient to patient, the procedure generally takes between 2 to 5 hours.
Hope for Neurological Patients with Deep Brain Stimulation!
Deep brain stimulation is a surgical method used to alleviate symptoms in patients with Parkinson’s disease and other movement disorders.
Prof. Dr. Enis Berberoğlu
Neurosurgery Specialist
