PARKINSON’S DISEASE SURGERY DEEP BRAIN STIMULATION

DBS

'Deep Brain Stimulation' means that the nuclei containing specialized cells are continuously stimulated by low electric current. This surgical treatment is used in the treatment of Parkinson's disease, epilepsy, essential tremor, chronic pain, movement disorders such as dystonia, and psychiatric disorders such as obsessive-compulsive disorder and major depression. Through Deep Brain Stimulation, the brain's electrical activity can be controlled, regulate abnormal impulse and treated in a controlled manner in the special nuclei of the brain. When appropriate illnesses are applied, it is revealed that the quality of life increases, the side effects related to the drugs decrease, the financial burden also decreases significantly and the patients contribute significantly to their comfortable life.

 

Parkinson's disease is a neuro-degenerative disease that occurs more often in men after age 50, and brain cells that produce hormone called dopamine occur in the brain. The disappearance of these cells in the substantia nigra causes the nucleus cluster responsible for the movement to fail to reach a sufficient dopaminergic signal to the basal ganglia. This reduces the stimulant effect of the brain shell and results in complaints such as tremor, bradykinesia, impaired balance, and stiffness in the muscles. Drug therapy in Parkinson's disease is L-DOPA or the same (agonist) drugs. This type of surgery should definitely be considered in patients with severe psychiatric disease and dementia who respond well to drug treatment but do not tolerate the side effects of the drugs. In appropriate selected patients, they are seriously reduced in parkinson’s disease findings and provide significant improvement in quality of life. Patient selection and pre-surgical procedures are performed by neurologist and neurosurgeon. It is important to evaluate L-dopa drug efficacy while the patient is on medication  and without medication . Later, detailed brain MRI examinations and neuropsychiatric evaluation of the patients who are suitable for surgery are performed.

 

In particular, over the last decade, advances in MRI technology and neuroguiding techniques have allowed millimeter-sized intracerebral nuclei to be misaligned with less than 1 millimeter deflection and to allow electrodes to be implanted more safely into the brain. Before the surgery, the patient is loaded with detailed MRI images and images to be guided to the guiding machine and appropriate targets are determined on these MRI images in three dimensional. Local suredo-analgesia is preferred during the surgical procedure. Occasionally, general anesthesia is preferred. A half centimeter burr hole is opened in the skull, the trajectory of the trajectory is advanced and the appropriate brain nucleus is aimed and inspected both by synchronous MRI and by neurophysiologic microelectrode records. Microelectrode recording is based on the principle that each brain nucleus generates an electric wave at specific frequencies and ensures that it is in the proper nucleus. After the electrode is placed in the proper core, the other end is connected to the pulse generator that produces energy, and this generator is put under the skin in the chest region and a closed system is obtained. The pulse generator setting is done wirelessly from outside. In the following weeks, depending on the situation of the movements, it is very easy to be able to intervene easily with the battery setting changes from the outside. Deep brain stimulation won't cure  diseases , but it may help lessen symptoms.

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