Brain batteries are highly complex electronic devices that have been increasingly used in the surgical treatment of many movement disorders, especially Parkinson’s Disease, in recent years.
As it is known, the initial treatment of all movement disorders is tried to be done with medical treatment. However, in patients with advanced stages of Parkinson’s disease who no longer respond to drug therapy or in whom severe drug side effects such as involuntary movements are observed, neck contractions called spasmotic torticollis, and dystonia diseases with severe body contractions, medical treatment is often not helpful or sufficient. Functional and Stereotactic Neurosurgery interventions, which are a sub-branch of neurosurgery, can provide significant benefits to patients as an alternative treatment in such patients.
The aim of these surgical interventions is to accurately locate anatomical and physiological targets with a diameter of a few millimeters in the brain and to change the physiological activity at these points without affecting the vital tissues around them. This change can be achieved either by burning the target area with a laser-like method, in other words “destructive interference”, or by influencing this region by giving a kind of electric current, in other words “modulative interference”.
Brain batteries are electronic devices that are placed inside the human brain and consist of an electrode with four polarity-changeable platinum-iridium poles, an extension connecting this electrode to the main battery device, and the battery’s own body. The electrode part is placed inside the brain, and this electrode is connected to the battery placed under the skin on the upper part of the thorax with the help of an extension. The battery device is a very complex electronic module that can be programmed telemetrically from the outside via a computer. By programming this device, the four poles at the end of the electrode in the brain can be changed to positive/negative/neutral and many different combinations can be created. In addition, the intensity, that is, the amplitude, the frequency, the number of electric waves given per second and the wave width of the given current can be adjusted, so the location and size of the affected area in the brain can be changed.
Brain pacemaker implantation operation is performed completely under local anesthesia and patients are awake. Only in the last stage of the operation, patients are put to sleep so that they do not feel pain while the body of the battery is placed under the skin in the chest in the last hour. Although it varies from patient to patient after the batteries are inserted, the batteries are fine-tuned with frequent and frequent checks every few weeks, and the parameters that the patients can get the most efficiency from are adjusted.
Patients with a battery are given a magnet and if they wish, patients can bring this magnet close to the battery body on their chest and hold it on for a few seconds, and they can turn the battery on and off. The purpose of this procedure is to extend the battery life of the batteries by keeping the batteries turned off at night in suitable patients. Although the life of the batteries varies according to the brain region and patients, it varies between 7-8 years on average. When the battery of the battery runs out, there is no need for another brain operation, and only the part of the batteries placed under the skin in the chest area is replaced with an operation of about half an hour. It is also possible to apply externally rechargeable brain batteries with a lifespan of up to 9 years in patients with dystonia who require higher electrical current.
There is no change in the normal daily lives of patients who have batteries inserted. Patients can continue all kinds of sports activities and swim. Patients who are fitted with a battery are given a document stating that they are carrying an electronic device, and they show this document at the security checks when necessary. Patients with a battery are not allowed to have MRIs as they may change the battery settings. However, when necessary, it is also possible to have an MRI with adjustments to be made.
Due to the features described above, brain batteries provide great convenience in the treatment of movement disorders when they are inserted into people, as a controllable, adjustable and reversible treatment method if side effects are observed. Brain cells, which started to be implemented with the first versions with a single pole at the end of the 1970s, have been increasingly used with the newly developed versions with four poles at the beginning of the 90s.
In Parkinson’s patients, brain batteries are placed in three different brain regions according to the leading findings of the patients today. In patients with tremor called tremor, the brain region called the thalamus where the cells responsible for tremor are more concentrated, and in patients with symptoms such as stiffness, slowness and involuntary movements, the brain region called the globus pallidus, the findings are bilateral and severe, and gait disturbance is observed. In patients in which the patient is in the foreground, brain batteries are placed in the brain regions called the subthalamic nucleus, one in each hemisphere of the brain, and bilaterally. In which brain region the batteries will be placed is decided according to the leading clinical findings of the patients. Although the distance between these brain nuclei is not more than a few millimeters, significant differences are observed between the clinical results of the applications. Since the brain batteries implanted in the subthalamic nucleus have a similar effect in Parkinson’s patients, they improve almost all the symptoms of the disease, and due to these features, they are being used more and more frequently.
In the treatment of movement disorders, it is of great importance to locate the target cells and the vital formations around them without any margin of error. Microelectrode recording and stimulation technique, which has been developed in recent years, is the ability to detect and listen to the electrical activity of a single cell in the brain, by placing an electrode with a tip of 2 microns in the human brain and advancing this electrode through a computer and connecting it to very complex and expensive electronic devices, or to this region. It is a method that enables the physiological map of the brain to be obtained by examining the response of patients who were operated while awake by giving a very low electric current. Thanks to this method, the locations of target cells that differ at least two to three millimeters from patient to patient can be found with an error margin of less than 100 microns. More than 750 operations have been successfully performed by Dr. Ali ZIRH since the beginning of March 1997, using the microelectrode recording and stimulation technique, and 195 brain batteries have been inserted. Thanks to the Microelectrode recording and stimulation technique used at the single cell level, extremely successful results were obtained in the patients and no complications and side effects were observed.
In surgical interventions in Parkinson’s patients, it is possible to control the excessive activity in the cells in these regions by making lesions (burning) with a method called Radiofrequency (RF) similar to a laser in the relevant brain regions. In countries like our country, where economic conditions are not very good or where health insurance does not cover such surgical procedures, if the economic conditions of the patients are not suitable for battery insertion at the beginning, the first surgical intervention is generally in the form of lesion. In this case, making a lesion (burning) in unilateral surgical interventions gives very successful results. In these conditions, brain batteries are usually applied in bilateral surgical procedures where the risk of side effects is high, with the aim of controlling the effects of the second operation. In addition, in recent years, it has been observed that the operation of placing a bilateral brain battery in the area of the brain called the Subthalamic Nucleus provides a remarkable improvement in Parkinson’s patients in the advanced stages, and that the patients can recover almost to a point where they do not even need to take medication. The difficulty in this treatment is that the mentioned area is very small and it is very difficult to determine the location correctly. However, using the microelectrode recording and stimulation technique, it is possible to detect these regions without errors. Similarly, by placing batteries on different targets, it is possible to treat hand tremors, severe neck contractions, neck curvatures and uncontrollable pains with this method, apart from Parkinson’s disease.
Today, the Social Security System covers the entire cost of the battery, which is the most expensive part of the operation, for patients who are properly selected and operated with the right indication. Thus, in recent months, it has been possible for much more patients to benefit from Brain Battery implantation operations, which is a more reliable and controllable method instead of lesion surgery. Using microelectrode recording and stimulation technique, Dr. Ali ZIRH performed a brain pacemaker implantation operation in 195 patients, 118 of these operations were performed in Medikalpark Bahçelievler Hospital, which provided the patients to have surgery within the scope of the Social Security Institution in the last two years.
It may not be possible to perform surgery on every patient with movement disorder. It is only decided after detailed clinical evaluation and tests whether patients will benefit from surgery or whether they are candidates for such an intervention.
