Parkinson’s disease, which affects patients’ quality of life adversely through problems such as tremor in hands, slowness of movements, difficulty in walking and muscle stiffness, is initially taken under control with drug therapy. When drug therapy is insufficient or the drugs cause too many side effects, brain pacemakers become a viable option.
Parkinson’s, which is a degenerative disease of the central nervous system in the body, causes the brain cells that regulate fine motor skills to be destroyed. The reason behind the said destruction and its progress are not exactly known. Professor Murat Aksu, a neurologist at Acıbadem University Atakent Hospital, says, “Loss of brain cells manifests itself with varying symptoms.
The most common symptoms are mobility problems. Slowness in movement, tremors, disruption in muscle coordination and muscle stiffness are encountered” and continues as follows: “However, Parkinson’s is not a disease which only affects movement. It can also cause disruptions in the autonomic nervous system. For instance, there can be symptoms such as fainting, dizziness upon standing up and incontinence. There can also be certain psychotic symptoms. Parkinson’s disease patients, who can suffer from mood disorders, are more susceptible to depression.
The disease has important effects on daily life. Slowness in movement, reduction in facial gestures, inability to control facial muscles, mask-like expression, difficulty in standing, small handwriting, difficulty in holding a pen, low volume and slowness in speech, and speaking as if murmuring are among the symptoms that distress Parkinson’s disease patients. Tremor, which is one of the most common symptoms, is usually encountered during rest.
Since Parkinson’s is a disease which progresses with destruction of cells the first goal is to stop this effect. However, since there are no treatments that can eliminate it yet, the treatment is focused on elimination of the symptoms instead. Stating that that the treatment involves drugs, small pumps or an intestinal gel, Professor Aksu says, “The patient feels better with these applications but the cell destruction continues. After a while, the effects of the drug become insufficient and adjusting the dose becomes necessary. In some cases, there can be side effects arising from the drugs. This is where surgery comes to the forefront. The options are lesion surgery and DBS, which stands for deep brain stimulation. Since the focus has moved away from lesion surgery within the last 10 years, DBS, also known as a brain pacemaker, is currently on the agenda”.
Doctor Gülşah Öztürk, a neurosurgeon at Acıbadem University Atakent Hospital whom we have consulted on DBS, currently on the agenda and known among the public as a “brain pacemaker”, explains the procedure as follows: “The brain pacemaker stimulates the cores the size of lentils within the depths of the brain in order to regulate the electrical activity disrupted by Parkinson’s disease. Brain pacemakers consist of three main parts, namely two electrodes, a power supply the size of a matchbox and an extension cord which connects the two main parts. The electrodes are placed in the brain while the power supply in inserted under the collar.”
While it is stated that brain pacemakers are used for patients who do not respond to drug therapy or exposed to severe side effects, the method cannot be applied for all of these patients. The candidate patients are first evaluated neurologically and subjected to certain tests. If the cognitive functions, general health condition and the psychiatric condition of the patient is found suitable, then the brain pacemaker treatment is performed. Stating that a targeted plan is made in a computerized environment based on the pre-surgery MR images after patients who meet the ideal requirements are found, Doctor Öztürk shares with us the following information on the treatment: “A frame is placed on the patient’s head through use of local anesthetics and the coordinates of the target are determined on the brain tomography and MR images acquired on the morning of the procedure. While the patient is awake and under local anesthesia, electrodes are placed on the basis of the calculated coordinates; we take recordings with micro electrodes and follow up clinically on the patient by talking to them during the procedure. We place two permanent electrodes in the area of the brain where the best effect is observed. Then the frame on the patient’s head is removed and the electrodes placed in the brain are connected to the battery subcutaneously placed under the collar bone with a wire after the patient is put to sleep. The whole procedure takes 3 to 3.5 hours.”
The patient, who stays in the intensive care for one day and the department for three to four days after the operation, is monitored neurologically in order for the battery to be adjusted. Generally, the battery is activated on the second day and it is ensured for the drug and battery levels to be in compliance. During the early follow-up period, the neurology team adjusts the battery with a remote control. If the patient has received a rechargeable battery, then it is essential for them not to forget charging times. Other batteries do not require this. Doctor Öztürk also points out that patients who use brain pacemakers need to avoid martial arts and extreme sports, as well as not undergoing MRI without consulting their doctor first.
Professor Murat Aksu states that the recommendations on Parkinson’s disease vary per patients and says that any other accompanying diseases are very important in this respect.
There are certain genes which cause Parkinson’s disease. Genetic transition is particularly more common in young patients. However, Parkinson’s disease cases which arise as a result of disruption in genes only make up for 10% of the total Parkinson’s disease cases. Noting that there are no geographical or racial factors related to Parkinson’s while the rate of incidence increases with age despite the fact that the disease can occur at any age, Professor Murat Aksu says, “This disease can develop in all communities and socioeconomic groups. However, it is more common in men when compared to women”.