Deep brain stimulation means continuous stimulation (DBS) of millimeter-sized special areas in the depths of the brain. This procedure is a neurosurgical operation and is based on the stimulation of certain deeply located nuclei of the brain with electrodes that produce low-voltage electric current. This surgical treatment is used in movement disorders such as Parkinson’s disease, essential tremor, and dystonia, in the treatment of chronic pain and in the treatment of psychiatric diseases such as obsessive-compulsive and major depression. Thanks to DBS, the electrical activity of the brain can be changed in a controlled way in the special nuclei of the brain and treatment is provided; Even if undesirable effects develop, it is possible to remove the system without damaging the brain and without leaving a permanent effect. Studies in recent years have shown that when applied to appropriate patients, it increases the quality of life, decreases the side effects of drugs, reduces the financial burden significantly, and makes a significant contribution to the comfortable life of the patients. The VIM nucleus of the thalamus (Thalamus), the deep sensory and movement center of the brain, the subthalamic nucleus (STN), and the globus pallidus interna (Gpi), which is a part of the nucleus community called the basal ganglia, are still the main target points in treatment.
Parkinson’s disease It is a neuro-degenerative disease that is more common in men after the age of fifty, and it occurs with the death of brain cells that produce the hormone dopamine in the brain. Loss of these cells in the substantia nigra causes insufficient dopaminergic signal to reach the basal ganglia responsible for movement, which reduces the stimulating effect of the cerebral cortex and causes complaints such as tremor, slowing of movement (bradykinesia), impaired balance, and stiffness (rigidity) in the muscles. It is possible. Drug treatment in Parkinson’s disease is L-dopa and drugs that release it or have the same effect (agonist). DBS surgery, on the other hand, should be considered in patients who respond well to drug therapy but do not tolerate the side effects of drugs, and do not have severe psychiatric disease and dementia. DBS surgery provides a significant reduction in Parkinson’s findings and a significant improvement in quality of life in appropriately selected patients.
Patient selection and pre-surgical procedure Initial examination and evaluation by the neurologist, and then evaluation of Levodopa drug effect, complaints while the patient is under medication (ON time) and without medication (OFF time). Then, evaluation of the patients suitable for surgery together with the neurosurgeon and detailed brain MRI examination and neuropsychiatric evaluation. Evaluation of all findings and the patient by a neurosurgeon, neurology and psychiatry specialist and decision on surgical treatment.
DBS surgical procedure
Developments in MR technology and neuroguiding techniques, especially in the last ten years, can enable millimeter-sized intracranial nuclei to be aimed with less than 1 millimeter deviation and electrodes to be placed within the brain (electrode implantation) much more safely. Before the surgery, the patient is provided with detailed MR imaging and the images are uploaded to the machine that will guide, and the appropriate targets are determined in three dimensions on these MR images.
During the surgical procedure, the patient is usually put to sleep with local sedo-analgesia and in rarer cases with general anesthesia, and the depth of anesthesia is reduced from time to time in order to control the movements and to understand that the complaints such as tremor and stiffness have disappeared and to talk to the patient. A half-centimeter burr hole is drilled in the skull, and a 2-millimeter rod-shaped electrode is advanced in the appropriate trajectory, aiming at the appropriate brain nucleus, and it is checked that it is in the right place both by simultaneous MR images and neurophysiologically by looking at microelectrode recordings. Microelectrode recording is based on the principle that each brain nucleus produces electrical waves at specific frequencies and ensures that it is in the appropriate nucleus.
After the electrode is placed in the appropriate core, the other end is connected to the battery that produces energy, and a closed system is obtained by placing this battery under the skin in the chest area. Battery setting is done wirelessly from outside.
