ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Brain Pacemaker

Individuals may lose their mobility and control due to damage to the areas where some specialized cells involved in the control of movement in the brain are collected and/or the insufficiency of the production of substances called neurotransmitters that are responsible for providing this control. The most important surgical method used in the treatment of neurological disorders that cause these damages is the brain pacemaker. Brain pacemaker, one of the surgical methods that can be adjusted and controlled, is especially effective on patients with essential tremor (uncontrolled shaking during voluntary movements), Parkinson's disease and dystonia (involuntary contraction). 

Thanks to the brain pacemaker, the electrodes placed on the patient can be controlled without touching the patient, and the disease can be brought under control by making adjustments to correct the patient's complaints. Brain pacemaker operations performed using advanced technology carry less risk than other neurosurgery operations. The quality of life of patients who have undergone brain pacemaker operation, especially Parkinson's patients, can increase and their daily lives can continue in their normal course. 

In Which Diseases Is It Used? 

The brain pacemaker is used to minimize the symptoms of some diseases. 

    Parkinson's disease 

    Epilepsy 

    Tremor disorders in some parts of the body (Essential tremor) 

    Involuntary contraction diseases seen in some parts of the body (Dystonia) 

    Tic disorder (Tourette) 

    Obsessive compulsive disorders 

    Major depression 

In addition to these diseases, studies are being carried out for the use of brain pacemakers for Alzheimer's and obesity. 

What are its effects?

After brain pacemaker operations, patients can return to their daily lives very quickly. Especially the daily lives of Parkinson's patients and patients who experience involuntary contractions change depending on these symptoms. Reasons such as trembling seizures and excessive contraction of the muscles cause patients to be unable to control their movements. Thanks to the brain pacemaker, patients suffering from these symptoms return to the initial stages of their disease. While the majority of patients who have undergone brain pacemaker operation reduce their drug doses, some of them stop the drugs they use completely. 

Although the brain pacemaker is effective on the symptoms, it does not completely eliminate the disease. Most neurological diseases are caused by damage to certain parts of the brain. The brain pacemaker does not restore these damaged areas to normal, but it is effective in relieving symptoms such as tremor, inability to control movement, and slowness in movements in the patient, which develops due to the dysfunction of this region. 

Especially in Parkinson's patients, these symptoms are minimized thanks to the brain pacemaker. Individuals who are in the 10th year of the disease and have advanced Parkinson's disease can return to the first stage of the disease after brain pacemaker operations. Patients who cannot perform their daily tasks such as buttoning a shirt, preparing food or tying shoes and who are disconnected from social life can continue their daily lives without the need for help. 

How is Brain Pacemaker Surgery Performed?

The purpose of brain pacemaker applications is to give electrical stimulation to the ares of the brain with damaged and impaired electrical activity at regular intervals. For this purpose, it is necessary to first make a brain map of the patients. MRI and other imaging methods are used for the map. Then, considering this map, the regions where the electrodes should be placed are determined and thin cables are placed in these areas that will provide electrical activity. The battery that will give the electrical stimulus is placed under the collarbone or in the thoracic cage cavity. 

Although the general process of the brain pacemaker surgery are like this, a series of procedures are applied before, during and after the surgery. 

Preoperative Period

Before the operation, various tests and examinations are applied to the patients in order to determine their condition. MRI and brain tomography are imaging methods used to make brain maps of patients. In addition to this, some tests are applied for the patients' suitability for anesthesia. 

Blood tests and urine tests are performed to learn the general condition of the patient. Tests indicating the general health status such as blood count, hormone status, kidney functions are carried out. In this way, it is understood whether the patients are ready for surgery or not. Apart from these tests, other tests deemed appropriate by the physicians are also applied. 

Brain pacemaker surgeries affect patients not only physically but also psychologically. For this reason, psychiatry interviews are conducted for patients deemed appropriate by physicians to provide relief for patients. 

After listening to the patient's medical history, learning the drugs used, and these examinations and tests, the patient is ready for surgery. 

Operation

Brain pacemaker surgeries can be performed while the patient is awake or under anesthesia. This is determined by the patient's disease and physician preference. In surgeries performed while the patient is awake, a small hole is drilled in the area where local anesthesia is applied by the surgeons and electrodes are placed in the areas determined on the brain map. Although the patients are conscious during this procedure and the adjustment of the electrodes, they do not feel any pain. The batteries are placed under the skin of the patients, usually in the rib cage. Therefore, general anesthesia is applied to patients so that they do not feel pain during the operation. 

In the surgery performed under anesthesia, the patient is first put to sleep. Then the electrodes are placed on the targeted area, and then the battery placement is performed in the same session. 

Brain pacemaker surgeries are shown among the most risk-free brain operations. Although the duration of the operation varies from patient to patient, it is between 2-5 hours on average. 

Postoperative Period

Patients should be in the hospital on the first day after the pacemaker surgery, due to the possibility of some complications. It is normal to have pain in the head after the surgery. Along with the pain, dizziness is one of the common side effects. If this temporary pain and dizziness is abnormally severe, medical intervention is required. 

Although brain pacemaker surgeries are one of the most risk-free surgeries, it is possible to have some complications and side effects, as in any surgery. Vascular occlusions, infections, bleeding, visual disturbances, loss of balance and nerve damage are some of the complications that may occur. 

What Are the Risks of Brain Pacemaker Surgery? 

Brain pacemaker operations carry less risk than other surgeries performed in the field of neurosurgery. However, it has some risk factors that are likely to be seen in every surgery. Studies show that the serious complications seen in brain pacemaker operations are around 2%-3% on average. Compared to these serious complications, minor complications occur in approximately 10% of patients. 

Some complications that can be seen during and after brain pacemaker surgery are: 

    Brain hemorrhage 

    Wound problems 

    Loss of vision 

    Shifts in brain electrodes 

    Infection problems 

    Contact disorders 

Frequently Asked Questions 

Does the brain pacemaker affect daily life? 

The brain pacemaker used to eliminate the symptoms of some diseases does not affect daily life. Those who have a brain pacemaker can maintain their daily life like healthy individuals. 

How long can a brain pacemaker be used? 

The brain pacemaker, which has a similar function as a battery, has a certain lifecycle, too. The lifespan of the brain pacemakers used for different diseases also varies. Brain pacemakers applied to Parkinson's patients are generally used for 3-5 years. In patients with dystonia, the battery life is shorter due to application differences. Rechargeable brain pacemakers can be used for more than 5 years. The projected life of these batteries is approximately 15 years. 

Can patients with a brain pacemaker engage in physical activity?

Yes. Patients with a brain pacemaker can do all kinds of physical activities like healthy individuals. They can engage in physical activities such as exercising regularly, swimming, and engaging in sports activities such as football and tennis. However, extreme sports and driving should be avoided in order to avoid head injuries due to accidents. 

Who cannot have a brain pacemaker?

Patients who will undergo a brain pacemaker surgery must meet some criteria. In early stage Parkinson's patients who respond to drug treatment, using a brain pacemaker is not a preferred method, especially in the first 5 years. Brain pacemaker is not applied in patients with moderate and severe dementia, in patients with severe depressive episodes, and in patients with a condition that prevents taking anesthesia. 

Is infection seen after brain pacemaker application?

Most of the researches point out that 3% of infection cases are seen after brain pacemaker applications. The majority of these infections are seen in the chest area where the power supply is placed. 

Can patients with a brain pacemaker benefit from radiological imaging?

MRI, tomography, brain imaging methods and X-Ray devices do not affect patients with brain pacemakers. However, body imaging with an MRI device is not recommended for these patients. 

Can non-rechargeable brain pacemakers be reused later?

Although this situation varies depending on the model of the rechargeable brain pacemakers, it is possible to recharge most rechargeable models after shutdown. 

How long does it take for patients to recover after brain pacemaker surgery?

The average recovery time for patients after surgery is 1 month. In this 1 month, there are also the first few days when the patient is kept under observation and 10-14 days until the dressing and stitches are removed. This period may be longer in case of complications such as the persisting side effects. 

No. Brain pacemaker is applied in order to minimize the symptoms in diseases such as Parkinson's and dystonia. The absence of symptoms such as tremor is due to the use of a brain pacemaker . In this sense, patients show the same symptoms when the pacemaker is not used. 

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