What is Deep Brain Stimulation? Surgery and Effects of DBS

Deep Brain Stimulation (DBS), commonly referred to as "brain pacemaker" surgery, is a surgical intervention used in the treatment of neurological disorders. This procedure involves placing electrodes within specific areas of the brain and connecting them to a battery-operated device. DBS is recognized as an effective option for managing symptoms of various neurological disorders, particularly Parkinson's disease.

What is Deep Brain Stimulation?

Deep Brain Stimulation (DBS) is a surgical procedure aimed at regulating neural activity by delivering low-voltage electrical currents to specific regions of the brain. Electrodes are implanted into the brain, and the electrical currents sent through these electrodes help modulate the activity of nerve cells, contributing to a reduction in symptoms. The principle of deep brain stimulation relies on the implantation of fine electrodes within the brain, which are connected to a stimulator controlled by a battery. The electrodes are placed in brain regions designed to alleviate symptoms of certain neurological diseases.

What Conditions is Deep Brain Stimulation Used For?

Deep Brain Stimulation is effectively utilized in the management of various neurological disorders. The conditions for which DBS is used include:

• Parkinson's Disease: Deep Brain Stimulation plays a significant role in the treatment of Parkinson's disease. It is used as an effective solution for motor control issues and tremors in Parkinson's patients. DBS may be preferred for patients who do not respond to medication or are in difficult situations due to side effects of drugs. Patients often experience a notable reduction in symptoms such as tremors, slow movement, and balance issues. Improved motor control allows patients to perform daily living activities more comfortably.
• Tourette Syndrome: Tourette syndrome is a neurological disorder characterized by tics. Deep Brain Stimulation can have a positive impact on the control of these tics. It may be considered especially when other treatment methods are ineffective or when side effects become intolerable. Electrodes are implanted in the brain regions that regulate tic control, and the stimulator sends regular electrical impulses to reduce or stop tics.
• Dystonia: Dystonia results in a loss of muscle control and can lead to involuntary muscle contractions. Deep Brain Stimulation can be used to alleviate symptoms of dystonia and control muscle spasms. The stimulator sends electrical signals at a specific frequency to reduce muscle spasms, thereby improving involuntary muscle contractions.

Benefits of Deep Brain Stimulation for Parkinson's Patients

Parkinson's disease is a neurological disorder caused by a decrease in dopamine production in the nervous system. While Deep Brain Stimulation therapy offers promising solutions for Parkinson's patients, it is essential to establish a personalized treatment plan for each individual. The benefits of Deep Brain Stimulation for Parkinson's patients include:

• Improvement in Motor Control: Deep Brain Stimulation can play an effective role in controlling motor symptoms commonly seen in Parkinson's patients, such as tremors, muscle rigidity, and slow movement. Electrodes are placed in brain regions related to motor control, and regular electrical signals stimulate the nerve cells. This allows patients to move more deliberately and regularly, making their daily lives easier.
• Reduction in Medication Dependence: Deep Brain Stimulation therapy offers an alternative for patients who do not respond to medications or cannot tolerate their side effects. This treatment allows patients to decrease their medication doses or avoid potential side effects of drugs, enabling them to go through the treatment process more comfortably.
• Increase in Quality of Life: The quality of life for Parkinson's patients can significantly improve with Deep Brain Stimulation therapy. Improvements in motor control help patients perform daily living activities more independently. This can enhance their social interactions and overall life satisfaction.
• Individual Adjustability: Deep Brain Stimulation therapy can be individually adjusted according to each patient's needs. Stimulation levels can be personalized, optimizing the treatment process for each patient in the most suitable way.

How is Deep Brain Stimulation Surgery Performed?

Deep Brain Stimulation (DBS) surgery is a surgical procedure used to control the symptoms of neurological diseases. Before the surgery decision, the patient is evaluated by a multidisciplinary team. Suitable candidates for DBS surgery are generally selected based on specific criteria. This evaluation focuses on factors such as the patient's overall health, the type of disease, and the severity of symptoms. If the patient is deemed suitable for deep brain stimulation, the surgery planning can begin.

In the pre-operative planning phase, techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are used to create a brain map. This map is utilized by the surgeon to access the correct brain regions during the procedure. During the surgery, the patient is typically awake and under local anesthesia. The surgeon places fine electrodes in predetermined brain regions. These electrodes will be used to send regular electrical signals to the nerve cells. After the electrodes are placed, the pulse generator (stimulator) is implanted under the chest. This device controls and regulates the electrical signals sent through the electrodes. The surgical team ensures the pulse generator is appropriately positioned. After the surgery, stimulation levels and adjustments are personalized according to the patient's needs.

What are the Risks of Deep Brain Stimulation Surgery?

While deep brain stimulation surgery is an effective method for treating nervous system diseases, it carries certain risks, as with any surgical intervention. The risks of deep brain stimulation surgery can be outlined as follows:

• Infection Risk: As a surgical intervention, DBS surgery carries a risk of infection. Infection may occur at the site where the implant is placed. This can be minimized with early detection and appropriate treatment.
• Device-Related Issues: The implanted device may experience technical issues such as malfunction, breakage, or displacement. These issues can be addressed by regular follow-ups and, if necessary, by adjusting or replacing the device.
• Bleeding and Tissue Damage: Bleeding that occurs during surgery may cause damage to brain tissue. This risk can be reduced by having an experienced surgeon perform the procedure.
• Stroke Risk: Surgical intervention may damage blood vessels in the brain, increasing the risk of stroke. However, this risk is generally low and can be minimized through the meticulous efforts of a skilled surgeon.
• Incompatibility and Side Effects: The stimulation from the device after deep brain stimulation surgery may cause unwanted side effects in some patients. These side effects may include headaches, nausea, or sensory changes.

The risks of deep brain stimulation surgery can vary for each patient and are related to the surgical team's experience, the patient's health, and other individual factors.

Life After Deep Brain Stimulation Surgery

After the surgery, patients collaborate with healthcare professionals for regular follow-up visits. During these visits, the functionality of the electrodes and pulse generator is checked. Adjustments are made as needed, and the patient's overall health is evaluated. While returning to daily life after surgery, patients should plan their activities according to their doctors' recommendations. Physical activities, social interactions, and proper nutrition can support overall health. Since deep brain stimulation is effective in controlling symptoms, patients may experience reductions in their medication usage. However, any reduction or discontinuation of medication should be conducted carefully under specialist supervision. Post-surgery, physical therapy and rehabilitation can help improve the patient's mobility. Specialists create a tailored rehabilitation program based on the patient's individual needs to support their return to daily living activities. The process of coping with neurological diseases is often emotionally challenging as well. After deep brain stimulation surgery, patients and their families may receive psychosocial support. Patients should remain aware of potential complications during the post-operative period.

Life after deep brain stimulation surgery requires a multidisciplinary approach, and continuous collaboration between the patient and healthcare professionals is crucial. Any signs of infection, device malfunction, or unexpected side effects should be reported to healthcare professionals as soon as possible.