Brain Pacemaker Improves Quality of Life in Parkinson's Disease

In Parkinson's disease — a chronic progressive condition caused by a reduction in a brain chemical called dopamine, typically seen in older age — patients' quality of life improves thanks to Deep Brain Stimulation (DBS). Prof. Dr. Ersoy Kocabıçak, Rector of Istanbul Atlas University and Neurosurgeon, stated that the Deep Brain Stimulation surgery, known as the "brain pacemaker," is the best treatment method for eligible patients.

Noting that the results are very encouraging for patients suffering from symptoms such as tremor, freezing, rigidity, slowness of movement, and involuntary movements, Prof. Dr. Kocabıçak said: "First and foremost, patients are freed from the restricted state in their daily lives."

"The so-called 'off' periods — during which patients spend a large part of the day motionless — are significantly shortened. This provides patients with a considerable degree of freedom in their lives. In addition, we are able to reduce their medication dosages after surgery. As a result, patients are also freed from the well-known side effects of Parkinson's medications."

Prof. Dr. Ersoy Kocabıçak, Rector of Istanbul Atlas University and Neurosurgeon, commented on the application of Deep Brain Stimulation in Parkinson's patients on the occasion of World Parkinson's Day on 11 April.

It Begins with Slowness of Movement and Hand Tremor

Noting that Parkinson's disease is a chronic progressive condition caused by a reduction in a brain chemical called dopamine and typically seen in older age, Prof. Dr. Kocabıçak said: "The disease generally begins with symptoms on one side of the body and progresses slowly. Slowness of movement, a resting hand tremor that can be described as a 'pill-rolling' tremor, rigidity and stiffness in the joints, walking with small steps, and gait disturbances are the most significant disease findings that impair patients' quality of life."

Masked Face and Speech Disorders Also Accompany the Disease

Prof. Dr. Ersoy Kocabıçak stated that in addition to these complaints and findings, speech disorders, masked face due to loss of facial expressions, constipation due to reduced bowel movements, decreased sense of smell, tension and pain in joints and muscles, sleep problems, depression, and certain psychological issues can also be counted among the symptoms that cause significant complaints in the disease.

Resting Hand Tremor Must Be Taken Seriously

Emphasising that hand tremor is the most commonly encountered symptom among Parkinson's disease findings, Prof. Dr. Kocabıçak warned: "Tremor occurs especially when the patient is not doing anything — that is, at rest. Slowness of movement develops, and patients begin walking in a stooped posture without swinging their arms. Patients' facial expressions diminish and their gaze becomes blank. Handwriting becomes smaller. Tremor and slowness begin on one side of the body and may eventually appear on the other side as well. Balance disorders may develop." Prof. Dr. Ersoy Kocabıçak also noted that apart from motor symptoms, sleep disorders such as excessive movement and shouting during sleep, cognitive decline, orthostatic hypotension (low blood pressure upon standing), dizziness, and constipation are among the other findings.

The Dopamine Deficiency in the Brain Must Be Replenished

Noting that there have been significant advances in the treatment of Parkinson's disease today, Prof. Dr. Kocabıçak said: "In addition to oral medications, there are minor surgeries targeting the disease, continuous drug-delivery pumps, transdermal patches, and medications that dissolve in the small intestine, among others. The fundamental principle of treatment is to replace the deficient substances. Since the problem in the disease is a 'dopamine' deficiency, this substance must somehow be replenished in the brain. What matters is choosing the right form of treatment according to the patient and the stage of the disease, adjusting the dose, and ensuring close follow-up."

A 'Honeymoon Period' Is Experienced in the First Few Years

Noting that drug treatment begins as soon as the diagnosis is made, and that patients are able to return to their pre-illness lives in the first few years as if they were never ill, Prof. Dr. Kocabıçak referred to this period as the "honeymoon period." Noting that Deep Brain Stimulation surgery may come onto the agenda in the later years of the disease, Prof. Dr. Kocabıçak said: "As the years progress, if symptoms such as tremor, freezing, rigidity, and slowness of movement cannot be controlled despite medication, if the duration of 'off' periods during the day increases, and if involuntary dance-like movements appear as the medication dose is increased, it can be said that the time has come to consider brain pacemaker surgery."

It Protects Against the Known Side Effects of Parkinson's Medications

Noting that Deep Brain Stimulation treatment is a very effective method in patients found suitable for this surgery following testing, Prof. Dr. Kocabıçak said: "The results are very encouraging for patients suffering from symptoms such as tremor, freezing, rigidity, slowness of movement, and involuntary movements. First and foremost, patients are freed from the restricted state in their daily lives. The 'off' periods during which patients spend a large part of the day motionless are significantly shortened. This provides patients with a considerable degree of freedom in their lives. In addition, we are able to reduce their medication dosages after surgery. As a result, patients are also freed from the well-known side effects of Parkinson's medications."

The Best Treatment Method for Eligible Patients

Emphasising that Deep Brain Stimulation is not a treatment that completely halts Parkinson's disease, Prof. Dr. Kocabıçak said: "Unfortunately the disease continues to progress over the years. However, for eligible patients, the brain pacemaker is currently the best treatment. This view has been confirmed numerous times in scientific studies. In particular, comparative scientific studies involving patients receiving drug therapy have demonstrated the superiority of Deep Brain Stimulation treatment. In other words, for patients found suitable for this treatment, Deep Brain Stimulation has effectively become a patient right."

Brain Pacemaker Surgery Is Not Recommended in the First 5 Years

Stating that brain pacemaker surgery is not recommended in the first 5 years following diagnosis, Prof. Dr. Kocabıçak said: "The onset of the disease must date back at least 5 years for brain pacemaker surgery to be considered. The most important reason for this is that Parkinson's disease can be confused with other conditions. In the so-called 'Parkinson-plus' conditions, brain pacemaker surgery unfortunately does not yield results as successful as in Parkinson's disease."

Which Parkinson's Patients Are Not Suitable for a Brain Pacemaker?

Expressing that brain pacemakers are not recommended for some Parkinson's patients, Prof. Dr. Kocabıçak stated: "Brain pacemaker surgery is not recommended for patients who fall frequently and for whom the medications they use provide almost no benefit even for a short period of time. Moreover, in patients with particularly advanced falls and balance problems, a certain increase in complaints may even be observed after surgery. Likewise, brain pacemaker surgery should not be performed in patients with severe psychiatric depression or in patients with a serious psychiatric disorder we call psychosis. Since patients with Parkinson's disease may experience sadness and anxiety due to a reduction in their quality of life and living a restricted life, mild clinical psychiatric conditions of this kind do not constitute an obstacle to surgery."

It Should Not Be Applied in Patients with Dementia

Noting that drug treatment should be initiated first in more severe psychiatric problems, and that these surgeries should be performed after the patients' psychiatric treatment is complete, Prof. Dr. Kocabıçak said: "Patients who had such complaints in the past and improved with psychiatric drug treatment should still be closely monitored after brain pacemaker surgery. This information should be shared in detail with the patient and their relatives before the operation. Another surgical obstacle consists of patients whose cognitive status is behind what would be expected for their age. Brain pacemaker surgery should also not be applied in patients with dementia findings. Furthermore, brain pacemaker surgery is not suitable for patients with other severe and uncontrolled chronic diseases. However, conditions such as controlled hypertension, heart disease, or diabetes are not an obstacle to surgery."

A Multidisciplinary Approach Is of Great Importance

Stating that the contribution of the patient and their family to the process is extremely valuable, Prof. Dr. Kocabıçak said: "Exercise, physiotherapy, appropriate nutrition, and psychological support are very helpful in overcoming obstacles and preventing possible complications. As with other chronic diseases, collaboration with different specialties in Parkinson's disease, identifying the needs of both the patient and the family, and planning on a multidisciplinary basis are the key to success."

What Is a Brain Pacemaker?

Deep Brain Stimulation (DBS), also known to the public as a "brain pacemaker," is a surgical method used in the treatment of certain neurological and psychiatric conditions such as Parkinson's disease, tremor, dystonia, and epilepsy. This technology aims to regulate brain activity by sending electrical impulses through electrodes placed in specific regions of the brain. Applied via surgical intervention, the brain pacemaker works with a battery system connected to electrodes placed in the disease-related region of the brain. The battery is placed subcutaneously in the patient's chest area.