Treatment of Movement Disorders and Pain with Electrical Stimulation

What is a movement disorder?

Movement disorders are defined as conditions characterized by slowness, irregularities, or tremors during the initiation and maintenance of movements, occurring without loss of strength or sensation.

What Causes Movement Disorders?

Most movement disorders arise from a decrease or irregularity in the chemicals that facilitate communication between cells in the brain. There are also genetic foundations for the issue, but they have not yet been fully resolved. Genetic studies are being conducted in relation to Parkinson's disease. Notably, essential tremor (shaking), which is more commonly observed, is known to have a genetic component within families.

In which diseases are movement disorders more commonly experienced?

The most well-known movement disorder diseases are Parkinson's disease and essential tremor, which are seen in middle and older age groups. Essential tremor is more common but requires less treatment. In contrast, Parkinson's is a condition that has received more scientific research attention and for which more effective treatments are being investigated.

What are the symptoms of Parkinson's disease?

Slowness of movement
General stiffness in the body
Balance disturbances
Tremors observed at rest

What is the diagnostic and treatment approach for Parkinson's disease?

In the early stages, Parkinson's can be confused with other movement disorders. Once a diagnosis is made, medication is the first line of treatment. There can be periods of rapid progression, while at other times, the disease may not progress for years. However, as the disease progresses, surgical treatment may also be considered. Surgical options are evaluated particularly when there is insufficient response to medication (such as when medications are inadequate or have side effects).

Is there an appropriate time suggested for more effective surgical treatment?

Especially in Parkinson's disease, there is a specific period when surgery is most beneficial, which corresponds to the mid-stage of the disease. In the very early stages, patients often experience sufficient benefit from medication, so surgery is not necessary. In very advanced stages, the situation may no longer be suitable for surgery. Therefore, considering and evaluating surgery in the early stages is important.

When is brain stimulation therapy considered?

Brain stimulation involves a small device similar to a heart pacemaker that is placed in the chest. It precisely delivers electrical impulses to a center in the brain through two electrodes. These centers are the very ones that create problems in movement disorders. In this way, the movement disorder is reduced or eliminated.

How is brain stimulation surgery performed?

For brain stimulation surgery, first, imaging methods are used to create a map of the brain. At Anadolu Medical Center, the preliminary preparations for the surgery are conducted as much as possible outside the operating room. In this stage, once the target is identified via computer, a plan is made on how to reach this area in the most effective way. Afterwards, the patient is brought into surgery under general anesthesia. Electrodes are placed in the specified locations, and their correct positioning is verified through imaging methods. After connecting the electrodes to the implanted device under the skin in the chest via extension cables, the patient is awakened.

What are the benefits of performing brain stimulation surgery under general anesthesia?

Brain stimulation surgeries have been conducted since 1979. According to statistics, this treatment has been successfully applied to over 300,000 Parkinson's patients to date. In the early days, when technology was not as advanced, patients were kept awake during surgery, and some tests were conducted because there was uncertainty about where the electrodes were being placed. 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, which provides comfort for the patient and significantly shortens the duration of the operation. At Anadolu Medical Center, the surgery is completed in approximately 4 to 4.5 hours using these techniques

What is the recovery time after surgery?

Patients typically stay in the hospital for 1 to 2 days. On the first night, the patient is kept in intensive care for closer monitoring, but most patients are able to go home on the first day after surgery.

What is the success rate of brain stimulation surgery in addressing Parkinson's, epilepsy, and tremor issues?

First and foremost, brain stimulation is a treatment that aims to reduce the patient’s symptoms rather than treat the disease itself. This is important because when a patient's symptoms are reduced, their quality of life significantly improves. If the objectives established during the surgical planning are achieved, the patient's symptoms can decrease by 80-85% or even higher. Issues such as difficulty holding a glass or a pen, and inability to walk are largely alleviated. Brain stimulation achieves an 85% success rate in reducing tremor complaints. Improvements of 60-65% are observed in slowness of movement and stiffness in the body. Balance issues decrease by 50-60%. It is crucial that the electrode is placed precisely at the intended target. Considering that the surgery is minimally invasive and the targeted area is only about 3-4 mm, the accurate positioning of the electrodes is a significant factor in enhancing the success of the outcome.

Is stimulation therapy applicable to everyone?

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

What is the lifespan of the batteries used? Are they replaced at regular intervals?

There are two types of batteries: rechargeable and non-rechargeable. Non-rechargeable batteries are used for 5-6 years, while rechargeable batteries have a lifespan of 10-12 years. When the battery’s life ends, it can be replaced in a 10-15 minute procedure, and there is no need for the patient to receive general anesthesia.

Where is the battery placed?

The battery portion is typically placed under the skin, beneath the clavicle in the chest.

Should we consult a doctor at the slightest sign of tremors?

It is important for patients to consult a doctor in any troubling situation. Especially in movement disorders, early consultation with a doctor can prevent the patient from missing the most suitable time for surgery.

Is stimulation therapy also used for chronic pain?

There are batteries placed on the spinal cord for these types of pain. They are not used for movement disorders but for chronic pain. For instance, they are used in cases of ongoing or chronic pain following spinal surgery (such as pain related to diabetes, pain due to nerve damage, and after herniated disc surgeries).

Last Updated Date: 11 December 2023

Publication Date: 11 December 2023