Parkinson’s; It is a chronic neurological disease that occurs with the deficiency of the substance we call ‘dopamine’ in the brain. The disease, which occurs when the dopamine-secreting cells in the brain are reduced or damaged with age, causes movement disorders and involuntary movements. The disease usually presents with tremors in the hands and feet, slowing down in movements, dullness in facial features, stiffness in the muscles and difficulty in walking with small steps, especially in the foreground on one side of the body.
Even though Parkinson’s is a chronic and progressive disease, it is not a disease to be feared. In this disease, initially with drug treatment; In cases where drug treatment is not sufficient, it is possible to restore patients to near-normal living standards with surgical interventions.
The diagnosis of Parkinson’s disease is made by clinical findings. Especially in older patients, trembling in the hands “counting money” style, slowing down in movements, not participating in the body sway, and walking sticking to the body, especially on one side of the body; Facial condition that can be expressed as “mask face” with dulling of gaze and decrease in facial expressions, walking with small steps and leaning forward should make us think that this disease may be in the beginning stage and patients should consult a neurologist.
Initial treatment in Parkinson’s disease is drug therapy, and a significant proportion of Parkinson’s patients respond well to medical treatment. If 80-85 percent of the patients in Parkinson’s respond well to the treatment at the beginning, they can continue their lives for a long time without any problems with drug treatment. In these patients, if the patient cannot wake up and relax despite more doses and more frequent medication, if the hours of well-being provided by the drug therapy gradually decrease, if the patients spend a significant part of the day sluggish, or if the side effects of the drugs that cause involuntary movements such as restlessness, convulsions and dancing increase, in other words, if the drug treatment is blocked in one place, then we consider the option of surgery and perform the surgery for implantation of a brain pacemaker.
Brain pacing surgery is a treatment method that we call “neuromodulation” in the medical language, and we try to correct the symptoms of the disease by applying electrical current to the areas responsible for the disease with thin electrodes that we place in the brain. With this method, we can suppress or stimulate the activities of cells in target regions of the brain. Since we can control and program the current we give with a computer, it is a completely recyclable, controllable and adjustable treatment method.
We can define the contribution of brain batteries to patients as “turning back the clock of the disease”. When we operate on a Parkinson’s patient who is about 10 years old, we can bring the patient back to the first and second year of the disease. This change means that most patients who cannot tie their shoes, hold their fork, button their shirts, disconnect from social life, cannot do their job anymore, and have to continue their lives with the help of others, can return to their daily lives and live on their own; means that a significant portion of them can return to their profession and practice it again.
Brain battery surgery can benefit almost all of the patients’ complaints such as tremor, difficulty walking, stiffness, stiffness and slowness. Contrary to popular belief, patients who do not have tremors but only have stiffness and slowing of movement also benefit from brain battery treatment. In Parkinson’s patients who do not respond adequately to drug treatment, who have severe tremors, or who cannot benefit from the drug as before due to severe drug side effects, the brain pacemaker gives successful results. The benefit that the treatment can provide generally parallels the benefit that patients can gain from high-dose drug therapy without drug side effects.
We perform these surgeries while the patient is awake, talking and helping each other. We pierce a small hole on both sides with local anesthesia on the patient’s head on the operating table, and with the method called “Microelectrode Recording and Stimulation Technique” through the electrodes we advance from there, we find our targets in the brain without any margin of error, and we place a two-sided thin brain pacing electrode on these points. We pass these electrodes under the skin with an extension cable and connect them to a battery part that we place under the skin like a pacemaker in the chest. Of course, the whole system is in the brain and under the skin, and nothing can be seen from the outside. Patients do not feel any pain or ache other than the pain of a few numbing needles during the surgery; They can tell jokes and sing songs during surgery.
Of course, as in any surgery, there are risks, albeit small, in these surgeries. However, thanks to the Microelectrode Recording and Stimulation Technique, which ensures that the results are extremely pleasing, these risks are reduced to almost non-existent. In experienced hands, it can be said that there is a 1% risk of infection and 1% risk of cerebral hemorrhage. I have not encountered such a serious complication during more than 1300 movement disorder surgeries and more than 800 neurosurgery surgeries I have performed.
In patients with a brain pacemaker, the pacemaker is switched on with outpatient controls a few days after the surgery, and after a 2-3 week follow-up visit, the battery settings that are most suitable for these patients and that will provide the most efficiency for them are reached. Afterwards, patients come to outpatient check-ups 3-4 times a year every 3-4 months, and they continue their lives by having both battery checks and medication checks done.
Brain pacemaker patients can continue their normal lives and can do all kinds of sports activities. Of course, they should avoid blows. Patients need to play matches, head the ball or stay away from far eastern sports. But apart from that, pacing patients swim, play tennis, do all kinds of activities and can lead a life close to normal.
Our patients receive warnings in airports and strong security systems because they carry some kind of metal implants and electronic devices. We give a certificate to our patients who have a brain battery, showing that they carry a device in their body, and by showing this certificate, patients can pass through manual security measures, not electronic.