Deep Brain Stimulation (DBS), one of the most advanced methods in modern medicine for managing movement disorders, is a preferred neuromodulation technique when medication response decreases or side effects impair quality of life. This surgical procedure aims to regulate faulty neural circuits by transmitting electrical signals to specific areas of the brain.
What is Deep Brain Stimulation (DBS)?
DBS, commonly known as a brain pacemaker, is a procedure that involves sending a continuous electrical current to targeted areas through electrodes implanted in the brain tissue. This method “resets” abnormal electrical activity in the brain’s motor control centers, thereby controlling symptoms.
How Does the Brain Pacemaker Work? Mechanism of Action
The DBS system consists of three main components: electrodes implanted in the brain, a battery (IPG) placed under the chest wall, and extension cables connecting the two. The system works similarly to a pacemaker; however, the signals are transmitted to the deep nuclei of the brain (e.g., STN or GPi) rather than the heart muscle. This electrical stimulation blocks faulty communication between neurons, allowing movements to be more fluid and controllable.
Diseases and Movement Disorders Treated with DBS
DBS is not suitable for every patient and is primarily applied when specific neurological conditions meet the criteria for surgical intervention.
Brain Pacemaker Treatment in Parkinson’s Disease
In Parkinson’s patients, DBS is usually considered when medication effects fluctuate (on-off periods) and severe involuntary movements (dyskinesia) begin. The goal is to achieve significant improvement in symptoms such as tremor, rigidity, and slowness.
Essential Tremor and DBS Application
Severe tremors, especially in the hands, can make daily activities such as eating or writing impossible for the patient. DBS has a high success rate in stopping these tremors or reducing them to a level that the patient can control.
Dystonia (Involuntary Muscle Contractions) Treatment
In cases of dystonia characterized by painful, twisting contractions in specific areas or throughout the body, surgical intervention provides functional improvement when medical treatment is insufficient.
Rare Diseases and Other Applications
Today, DBS can be applied in resistant epilepsy cases, Tourette Syndrome, and some resistant obsessive-compulsive disorder (OCD) cases with the multidisciplinary evaluation of neurosurgery teams.
Brain Pacemaker Surgery Process and Surgical Technique
The key to surgical success is meticulous preparation and the placement of electrodes with millimeter precision.
Preoperative Preparation and Patient Selection Criteria
Not every patient is a suitable candidate for DBS. Candidates are evaluated by a committee consisting of a neurologist, neurosurgeon, and psychiatrist. The risks and success of the operation are analyzed using MRI imaging and neuropsychological tests.
Surgical Procedure Stages: Electrode Placement and Battery Implantation
The operation is usually performed in two stages. In the first stage, electrodes are placed in the brain using stereotactic surgical techniques. In the second stage, under general anesthesia, the battery unit is placed in the chest area and the connections are completed.
Awake Surgery and Microelectrode Recording During Surgery
Keeping the patient awake during electrode placement is a commonly preferred method. With microelectrode recording (MER) technology, the sound of neurons is listened to during surgery, and the patient is given specific commands to test whether symptoms (such as tremors) stop.
| Feature | Medication Therapy | DBS (Brain Pacemaker) |
| Duration of Effect | Depends on dosage intervals (intermittent) | Continuous (24/7 stimulation) |
| Persistence | Temporary symptom suppression | Long-term neuromodulation |
| Side effects | Digestive and cognitive issues | Surgical risks (minimal) |
| Adjustability | Fixed doses | Remotely programmable signals |
Recommendations from Prof. Dr. Erdinç Özek: “Deep Brain Stimulation is not a cure that completely eliminates the disease, but rather an advanced technological support that minimizes symptoms. The most important factor in success is the triad of ‘the right patient, the right target, and the right programming’. Regular follow-up of post-operative implant settings by a specialized team is as critical as the surgery itself.”
Clinical Experiences and Case Examples
Anonymous Case Analysis: A 58-year-old patient diagnosed with Parkinson’s disease for 12 years. Despite taking medication 8 times a day, he experienced severe tremors and limited movement. After bilateral STN-DBS surgery, the medication dose was reduced by 50%, and it was observed that the patient was able to meet his daily needs on his own and his “on” periods increased by 80%.
Frequently Asked Questions (FAQ)
What is the lifespan of a brain pacemaker?
Depending on the type of technology used (rechargeable or non-rechargeable), it varies between 5 and 15 years. This period is longer for rechargeable models.
Is the surgery risky?
Like any surgical procedure, it carries risks; however, thanks to modern imaging and navigation systems, the rate of serious complications has been reduced to 1-2%.
Can I pass through airport security?
Yes, but to prevent the device from being affected by magnetic fields, patients must request a manual check using the “patient ID card” we provide.
Scientific References
Movement Disorders Journal: Clinical outcomes and long-term results of DBS. https://onlinelibrary.wiley.com/journal/15318257