Deep Brain Stimulation (DBS) in Parkinson’s Disease

Deep Brain Stimulation (DBS) in Parkinson’s Disease

Parkinson’s disease is initially well-controlled with medication. Patients often experience improved movement and reduced tremor shortly after taking their doses.

However, over time, the brain may develop tolerance to externally supplied dopamine, or the medication’s effect may shorten. Patients experience fluctuations between “on” periods (when medication works) and “off” periods (when symptoms return). High doses can also cause involuntary twisting movements called dyskinesias.

At this stage, Deep Brain Stimulation (DBS)—commonly known as a “brain pacemaker”—becomes a highly effective treatment. Assoc. Prof. Dr. Mehmet Sorar in Ankara successfully performs DBS surgery for patients no longer benefiting adequately from medication or experiencing side effects.

What is DBS and How Does It Work?

DBS delivers continuous, regulated electrical signals to brain regions responsible for movement, particularly the subthalamic nucleus. These signals suppress or normalize abnormal electrical activity, reducing Parkinson’s symptoms.

The system has three main components:

1. Electrodes: Thin electrodes are implanted with millimetric precision into the brain.
2. Extension Cables: Wires under the skin connect the electrodes to the generator.
3. Pulse Generator (Battery): Placed beneath the collarbone in the chest, completely under the skin and invisible externally.

Who is a Candidate for DBS?

Not all Parkinson’s patients are suitable. Proper selection is critical:

• Idiopathic Parkinson’s: Typical Parkinson’s patients respond best; atypical Parkinson-plus syndromes may not benefit.
• Levodopa Response: Patients must have shown improvement with medication, as DBS mimics medication effects.
• Cognitive Status: Severe dementia or psychiatric disorders are exclusion criteria.
• Disease Duration: Usually at least five years of disease progression and reaching medication limits.

The Surgical Procedure: Awake Surgery

DBS is performed with the patient awake, as the brain itself has no pain sensors. Only the scalp is numbed with local anesthesia.

Frame Placement and Imaging

A stereotactic frame is attached to the patient’s head in the morning, and MRI scans are taken. Coordinates of the target area are calculated with high precision.

Microelectrode Recording and Testing

A hair-thin electrode is inserted to record brain activity. Parkinson-specific signals are identified during this phase.

Effect Assessment

After placing the main electrode, test stimulation is applied. The patient performs movements like raising hands, counting, or speaking while the surgeon observes tremor reduction and muscle relaxation.

Pulse Generator Implantation

Once brain implantation is complete, the patient is placed under general anesthesia, and the pulse generator is implanted under the chest skin, completing the system.

Expected Outcomes

DBS does not cure Parkinson’s but can significantly improve quality of life by reverting symptoms to levels seen 5–10 years earlier:

• Tremor is controlled in 80–90% of cases.
• Bradykinesia and rigidity improve by 60–70%.
• Medication doses can often be halved, reducing side effects.
• Patients regain independence in daily activities.

Frequently Asked Questions (FAQ)

Q: How long does the DBS battery last?
A: Non-rechargeable batteries last 3–5 years depending on use. Rechargeable batteries can last 15–25 years but require weekly charging.

Q: Is the surgery risky?
A: As with any surgery, there are risks of infection or bleeding, but in experienced hands, the risk is about 1–2%.

Q: Can I have an MRI with DBS?
A: Modern DBS systems are MRI-compatible, but the device must be set to MRI mode and necessary precautions followed.

Q: Will I feel the implant?
A: The chest generator may create a slight bulge under the skin but is generally unnoticeable and does not interfere with daily life.

Safe Surgery with Assoc. Prof. Dr. Mehmet Sorar

DBS is a highly precise procedure requiring advanced technology and surgical skill. Assoc. Prof. Dr. Mehmet Sorar has performed over 500 DBS surgeries, making him a leading expert in Turkey.

Using microelectrode recording, Dr. Sorar identifies the target with millimetric accuracy. Patient safety and comfort are central: the awake patient remains in communication throughout, allowing the surgeon to observe symptom improvement in real time and optimize electrode placement.

From preoperative preparation to postoperative follow-up, Dr. Sorar and his experienced team guide patients through every step, ensuring a secure and effective treatment journey.