First meeting

Since the patient's non-medicated and medicated findings will be evaluated many times, the patients coming from outside of Istanbul should make their plans to stay in Istanbul for a few days.

‍Test:  Is DBS Treatment For Me?

In addition to the detailed examination, the patient's brain tissue is also thoroughly evaluated from an anatomical point of view. If the patient has an MRI scan taken in the last few months, it is evaluated, if not, a new MRI can be requested.

The patient should take medicines while coming to the first examination.

In order to understand if the disease is Parkinson's disease or one of the other movement disorders, answers to some questions should be investigated:

• Is the patient responding to current therapy?

• If there is a response to treatment, to what degree?
• Is the disease pure Parkinson's Disease? Or is it a movement disorder similar to but different from Parkinson's?
• If the expected response from the drug treatment is not obtained, is it due to the insufficient dose or the disease?

Evaluation of patients' without medication and medicated states

The patient who is a candidate for DBS surgery should stop using Parkinson's medication at the time to be determined by the doctor before the second examination day. The patient should come to the examination appointment without eating anything on the next day and his drug-free status should be evaluated. After the most severe state of the patient is evaluated, the highest dose of medication is given, it is waited for approximately one and a half hours, and then the response to this treatment is examined. If the expected response is not received, the process is repeated several times.

On the other hand, the patient's brain MRI results are reviewed. It is being examined whether the DBS and the anatomical structure of the brain can adapt to each other. Mental status assessment is performed by performing some memory tests on the patient. In the light of the findings, it is decided whether the person has pure Parkinson's disease and if the person is found suitable for surgery, Assoc. Prof. Dr. Ali ZIRH informs the patients and their relatives about the operation in detail.

Hospitalization and Pre-Surgery Period

Patients who do not have any inconveniences in undergoing DBS are referred to the Neurology Department and their follow-up and treatment is planned by Neurology Specialists for Movement Disorders. In this process, while the necessary medical documents are being prepared, blood tests and other examinations of the patients are carried out.

The patient, who is decided to have surgery, is given written information and consent forms, and these people are discharged from the hospital with the suggestion that they fill out and sign the forms. It is recommended that patients not use blood thinners at least one week before the surgery. After signing the consent forms and completing the hospitalization procedure, the patients were contacted by Assoc. Prof. Dr. Ali ZIRH and decides on the date of surgery together.

One day before the agreed operation date, the patient comes to the hospital and is hospitalized. In this process, patients should have their old films, examinations and consent forms with them. In order to reduce the risk of possible infection, the hair of the patients is shaved, and it is recommended that the patient not use Parkinson's medication after 20:00 on the day of the surgery. However, patients who have medications such as blood pressure and diabetes medication that they need to take other than Parkinson's medication and blood thinners can use these drugs in line with their doctors' recommendations.

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Surgery Process

The process of DBS surgery starts with local anesthesia in the morning and the installation of the stereotactic frame, and ends after approximately 3-3.5 hours. After resting for a while after the surgery, the patients are taken back to their rooms. The operations are carried out with the patient's consciousness open, on the principle of "talk-to-talk".

In neurosurgery operations applied to advanced Parkinson's patients and young patients who need high-dose drug therapy, a frame is attached under local anesthesia in order to reach the desired coordinates in the patient's brain. This frame is fixed to the patient's head, and the patient's MRI film is taken. With the help of this method, which is applied to calculate the coordinates of the theoretical target to be reached in the brain, the area where the DBS will be placed is clearly determined.

After determining the area where the DBS will be placed clearly, two small holes are drilled in the patient's head under local anesthesia and the micro electrodes used in the microelectrode recording and stimulation technique are advanced from here. With these electrodes, the tip of which is approximately 2 microns, the electrical activity of a single cell in the brain can be listened to or the response of the cells to this electrical current is analyzed by giving an electrical current at the level of microamperes to the awake patient. With this technique, in which the map of the physiological structure of the brain is revealed, the damaged cells we aim to find are detected in the brain with an error margin of less than 80 microns.

The most beneficial aspect of the talk-to-talk surgery principle is the patient's sharing with the physicians. In brain pacing surgeries, patients instantly share with physicians which body part is more comfortable and how much benefit is seen in that electrode trace. This sharing makes it very easy to determine the physiological map of the region to be reached in the brain. As a result of this determination, electrodes are placed in the patient's brain under X-ray control. At this stage, the operation performed on the brain under local anesthesia is completed.

After the surgery process on the brain side, the stage of placing the own DBS part of the DBS, which will program the DBS into the body, begins. At this stage, the patient is given general anesthesia, and a pocket is made in an area above the heart under the collarbone and skin in the chest, and the DBS part of the DBS that will program the DBS is placed there. Afterwards, the electrodes attached to the brain with 2 extension cables are connected to the DBS. After this procedure, the patient is awakened and sent to rest in his room. The pacemaker electrodes are tested 1 day after the operation and it takes approximately 2-3 weeks for the adjustments to be fully achieved. Within 1 month after the surgery, patients open a white page in their lives with the DBS technology.

After DBS

Patients can stand up and meet their basic needs immediately after DBS surgery. While the patients can eat in the afternoon on the same day, the serum in their arms is removed the next day. In addition, the day after the surgery, patients receive preventive antibiotic treatment until discharge. Control and Computerized Brain Tomography examinations are performed on the morning of the first post operative day of the patients, and the positions of the electrodes placed in the brain and the post operative findings are evaluated. At the end of the second day, the patients are discharged after being informed about the drugs they will use and the points they will pay attention to until the next control appointment.

How the DBS Programming Process Works?

As a general practice, patients who have undergone neurosurgery visit the outpatient clinic at the beginning of the week after the operation to start the first DBS programming. For this examination, it is recommended that patients have breakfast early in the morning and come without medication. In this first programming process, it is checked whether the system works flawlessly, and each pole at the end of the DBS electrode is programmed separately, the clinical findings of the patient are examined and it is determined which setting will provide more benefit to the patient. After the detection, the programming process is started.

In order to complete this programming process in a healthy and complete manner, patients are requested to stay in Istanbul for 2-3 weeks after the surgery. In dystonia patients, this period can take up to 4 weeks. During the process, patients are seen on an empty stomach and not using drugs six days a week, at the morning appointment hours depending on the surgery schedule, and then drug treatment is programmed. Since the DBS assumes the effect of drug therapy in line with the settings made during DBS programming, the drug doses of the patients need to be rearranged in almost every examination. At the end of the programming process, patients can return to their residence without any problems.

Control Examinations

After DBS surgery, patients are checked again within 1.5-2 months after the first programming process. When necessary, the electrical current can be re-arranged by making fine adjustments, and revisions can be made in the drug treatment.

After this process, the patient is told to come for control 3 or 4 times a year, and routine control examinations are performed on average every 3-4 months. During the examinations, the working status of the DBS is controlled, recommendations for drug treatment are offered, and the general condition of the patient is followed.

Ask your doctor about your questions on our page, you can share with Dr. Ali ZIRH and learn the answers to all your questions firsthand.

SOLUTION CENTER

You can ask all your questions to our international team, who will try to support you in all matters before and after the treatment, and you canalso benefit from the experience of our patients.

You can leave your contact information in the "Let's Call You" section and have our team contact you as soon as possible. If you wish, you can contact us at our solution center at +90 533 273 40 41.

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