Deep Brain Stimulation Surgery (DBS)
Deep brain stimulation surgery was first performed in 1987 and in a very short time it has become a widespread treatment all over the world due to its high effectiveness and low risk.
DBS is a surgical treatment that we frequently apply in patients with essential tremor and dystonia, especially in Parkinson’s patients.
In DBS surgery, by the cables placed in special areas in the brain and a generator connected to this cable; At very low voltages, electrical energy is delivered to special nuclei in the brain and disrupted cellular activity is regulated.
In this way, complaints such as tremor, contractions and stiffness seen in different parts of the body are controlled.
It has also been used in the treatment of some psychiatric diseases in recent years.
Frequently Asked Questions About DBS
Assoc, Prof. Dr. Sait OZTURK, MD / Neurosurgeon
- The main treatment for Parkinson’s disease and other movement disorders (essential tremor, dystonia) is drug therapy. Usually, drug treatment is started after patients receive the first diagnosis and this treatment is effective for an average of 3 years. This period is called the “honey moon” period. During this period, when drugs are effective, the patient should not be operated on as a precautionary measure. DBS surgeryt should be applied during the period when the effect of drugs decreases or unwanted twists / bends are observed in the body due to the use of high-dose drugs (dopamine). It is an appropriate approach to evaluate the patients together by both a team.
- In patients whose complaints are under control with drug use,
- In patients with uncontrolled psychiatric disease,
- In patients who have frequent falling attacks during the day,
- In patients with severe metabolic disease (uncontrolled diabetes, severe heart failure, etc.)
- Disabled and elderly patients
DBS surgery is a two-stage operation. In the first stage, cables are sent to the targeted nuclei in the brain through small holes opened on both sides of the patient’s skull with the help of a special frame. This is done while the patient is awake. General anesthesia is not given to the patient for any reason. Because electrical energy is temporarily applied to the area where the cables are placed, and it is tested whether the patient’s complaints are resolved. Therefore, it is important for the patient to be awake during this test phase. When this process is completed, the second stage of the surgery, the placement of the generator in the chest area, begins. This process is done by giving general anesthesia to the patient. The ends of the two cables sent into the brain are brought under the skin to the chest area and a pocket is created in the chest area where the generator will be placed. Cables are connected to the battery and the battery is placed in the chest area. The surgery is completed. The entire DBS surgery takes an average of 4-5 hours.
- After the surgery, the patients are carried out at 6 hours and they start feeding. On the 1st day of the operation, they return to their normal lives. Usually, on the 2nd day, they are discharged and return to their normal lives.
- DBS surgery is one of the safest surgeries among all neurosurgical procedures.
- Generator settings are made via an electronic tablet. By the programmer, which is brought closer to the battery in the patient’s chest area, adjustment is made in a very short time.
- This time varies, as different generator adjustments will be made for each patient. However, it will have an average battery life of 4 to 6 years. When the battery level decreases, only the former wound in the chest area is opened, the generator is removed and replaced with a new one, under local anesthesia. Patients are discharged one hour after the procedure.
- The DBS system is a MR compatible device. However, there is a very low risk of damage to the generator during MRI. For this reason, whole body MRI is not recommended. It is recommended that the generator be turned off immediately before the MRI scan, and the generator activated again after the acquisition. There are no restrictions on X-ray or computed tomography; necessary shots can be taken without the need to turn off the battery. In addition, a generator remote control is given to our patients. With this control, patients can control the life of the battery and, if necessary, turn the battery on and off.