Brain Stimulation Treatment Stops Tremors and Chronic Pain

The brain stimulation treatment used for movement disorders like Parkinson's and some chronic pains significantly reduces patients' complaints. However, it's crucial to see a doctor early on to catch the optimal surgical timing.

Movement disorders refer to conditions characterized by slowness, irregularity in movements, or tremors during the initiation and maintenance of movements, without loss of strength or sensation. A significant portion of these issues arises from a decrease or irregularity of the chemicals that facilitate communication between cells in the brain. Prof. Dr. Mehmet Çağlar Berk, Director of the Neurosurgery Department at Anadolu Medical Center, states, “There are also genetic foundations to the problem,” but he adds that it hasn't been fully resolved yet. For example, genetic studies in this regard exist for Parkinson's disease. It is also known that essential tremor (shaking), which is more commonly seen, has a genetic component within families. In our article, we take a broader look at the brain stimulation treatment, which improves patients' quality of life not only in movement disorders but also in pain, along with information shared by Prof. Dr. Mehmet Çağlar Berk.

Which Diseases Are Associated with Movement Disorders?

The most well-known movement disorders are Parkinson's disease and essential tremor, which are commonly seen in middle-aged and older individuals. Essential tremor is more prevalent but requires treatment less frequently. Parkinson's disease, on the other hand, is a subject of more scientific research and exploration of more effective treatments. It is characterized by symptoms such as slowness of movement, general rigidity in the body, balance issues, and tremors at rest.

In its early stages, Parkinson's disease can be confused with other movement disorders. Initially, drug therapy is applied after diagnosis. There may be periods of rapid progression, but there can also be times when the disease does not progress for years. However, with the slow progression of the disease, surgical treatment may come into consideration. Surgical options are evaluated, especially when drug therapy does not yield a response (such as insufficient medication or side effects). There is a particular phase in Parkinson's disease when surgery is most beneficial, which corresponds to the mid-stage of the disease. In very early stages, patients receive sufficient benefit from drug therapy, so they do not require surgery. In very advanced stages, patients may not benefit from surgery anymore. Therefore, it is important to consider and evaluate surgery in the early stages.

When Is Brain Stimulation Treatment Used?

The brain stimulation device is a small device placed in the chest, resembling a cardiac pacemaker. It transmits electricity with high precision to a center in the brain (where the problem occurs in movement disorders) through two electrodes. This way, movement disorders are reduced or eliminated.

The ideal time for patients to undergo brain stimulation treatment is when they do not receive sufficient benefit from their medications or when the benefit they derive from the medication begins to decrease. The primary aim of this treatment is to mimic the benefits of medication through electrical stimulation. This actually resembles reversing the biological clock in Parkinson's disease; with brain stimulation surgery, it is possible to turn back the symptoms of the disease by 10-15 years.

How Is Brain Stimulation Surgery Performed?

For brain stimulation surgery, the brain is mapped out first using imaging techniques. At Anadolu Medical Center, the preparatory part of the surgery is carried out as much as possible outside the operating room. In this phase, after the target is identified using a computer, a plan is made on how to reach it in the healthiest way. The patient is then taken into surgery under general anesthesia. Electrodes are placed in the designated areas, and their correct placement is checked again using imaging techniques. After connecting the electrodes to the device located under the skin in the chest via extension cables, the patient is awakened.

Is There Any Benefit to Performing the Surgery Under General Anesthesia?

Brain stimulation surgeries have been performed since 1987. To date, this treatment has been successfully applied to over 300,000 Parkinson's patients. In the early days, when technology was not as advanced, patients were kept awake during the surgery because there was uncertainty about where the electrodes were placed, and some tests were conducted. However, with the advent of advanced imaging techniques and innovative applications like hybrid operating rooms, this is no longer necessary. Surgeries can now be performed under general anesthesia, providing comfort to patients and significantly shortening the duration of the surgery. With the techniques applied at Anadolu Medical Center, the surgery is completed in 4 to 4.5 hours. Patients stay in the hospital for 1-2 days. To monitor them more closely, the patient is kept in intensive care on the first night, but most patients can return home on the first day after surgery.

Success Rates of Brain Stimulation

The success of brain stimulation surgery in solving problems related to Parkinson's, epilepsy, and tremors is at a high level.

Above all, brain stimulation aims not to treat the disease itself but to reduce the patient’s complaints. This is important because when a patient's complaints are reduced, their quality of life significantly increases. If the goals set during the surgery planning are achieved, the patient’s complaints can decrease by 80-85%, or even higher. Issues like not being able to hold a cup or a pen, and difficulty walking are largely alleviated. Success rates in reducing tremor complaints are between 75-85%. Improvements in slowness of movement range from 50-60%, while complaints of rigidity in the body improve by 60-70%. Of course, it is crucial that the electrode is placed in the exact target area. Considering that it is a closed surgery and the targeted area is very small, around 3-4 mm, the precise placement of electrodes is an important factor that increases the success of the outcome.

Can Brain Stimulation Treatment Be Applied to Everyone?

There is no age limit. Although most movement disorders in children are of genetic origin, brain stimulation treatment is also successfully applied to them. What is important in brain stimulation treatment is that the patient does not have conditions such as heart disease, hypertension, or lung diseases that would prevent surgery. Patients who cannot receive the desired doses due to insufficient medication or side effects also benefit from brain stimulation treatment.

Where Is the Device Placed?

The device is usually placed under the skin in the upper chest area.

Lifespan of the Brain Stimulation Device

There are two types of brain stimulation devices: rechargeable and non-rechargeable. Non-rechargeable devices last for 5-6 years. Rechargeable devices have a lifespan of 10-12 years. When the device's lifespan ends, it can be replaced with a procedure lasting 10-15 minutes. Moreover, there is no need for the patient to undergo general anesthesia.

Is Brain Stimulation Treatment Used for Chronic Pain?

There are devices placed on the spinal cord for this type of pain, and they are used not for movement disorders but for chronic pain. For instance, they are used in cases of ongoing or chronic pain following spinal surgeries—particularly after herniated disc surgeries—as well as in pain due to diabetic neuropathy and pain resulting from nerve damage.