The 8 most frequently asked questions about brain pacemakers

As time progresses, patients may find themselves increasingly unable to perform basic functions that healthy people take for granted as part of their daily lives, such as walking, running, and using their hands for various tasks.

In cases where medication for movement disorders begins to prove insufficient and/or drug-related side effects occur, a 'brain pacemaker' comes to the fore for suitable patients.

Brain and Nerve Surgery Specialist Prof. Dr. Fatih Bayraklı states that the brain pacemaker, which is widely used today, allows patients to perform their daily functions again in a way that is very close to normal, noting, "A brain pacemaker is a method that allows for changing the electrical activity in brain cells in the region where the electrical current is applied.

Thanks to the elimination of the movement disorder, the quality of life of the patients improves. Being freed from dependence on others also has a positive effect on the patients' psychology," he says.

What is a brain pacemaker?

Most movement disorder diseases stem from the destruction (degeneration) of cells in the regions of the brain that enable movement, and the subsequent irregularity or reduction of chemicals (neurotransmitters) produced by these cells that facilitate communication between cells.

Also defined as deep brain stimulation (DBS) or neuromodulation, a brain pacemaker is a method that provides electrical stimulation to a desired region of the brain (a nucleus related to movement). This system consists of a battery, two electrodes placed in the targeted region within the brain tissue, and two extension cables connecting the electrodes to the battery.

An electrode is placed in the targeted brain region to provide electrical stimulation to that area. Although the dimensions of the battery vary, it is approximately 6.5x5x15 millimeters and weighs 50-60 grams. Externally, only the marks of surgical incisions and slight bumps can be seen on the patient.

What is the mechanism of action?

A brain pacemaker works by placing an electrode in the targeted brain region and providing electrical stimulation to that area. In movement disorders, there is destruction (degeneration) in the cells located in the regions of the brain associated with movement.

This destruction causes a change in the electrical activity generated by those brain regions to produce normal movement, disrupting the synchronization process necessary for movements to occur properly.

An electrical signal is sent to these regions. By bringing the disrupted signal activity back closer to normal (as a result of activation or suppression), improvement in movements is achieved.

What is the lifespan of a brain pacemaker?

Although the lifespan of a brain pacemaker is approximately 4-5 years, this period can increase or decrease depending on usage parameters.

In dystonia patients, the battery life can be shorter. Prof. Dr. Fatih Bayraklı says, "After this period, it can be replaced with a new one through a simple surgical procedure without interfering with the old battery cables."

This period is longer with rechargeable batteries. However, the patient and those caring for or assisting the patient must be very compliant with the use of rechargeable batteries (such as ensuring they are charged every week). Because if charging is forgotten, the battery shuts down and must be replaced with a new one.

What preparations are made before the surgery?

Before brain pacemaker surgery, a brain MRI scan is performed to see the brain region where the electrode will be placed. On these MRI scans, the surgeon performs the targeting work for the desired region using software.

On the day of the surgery, a rigid frame is attached to the patient's head under local anesthesia or general anesthesia if necessary, and the patient is taken for a brain tomography scan.

The tomography and MRI scans are combined via software, and numerical values are obtained regarding the coordinates at which the target electrode will be advanced. Then, the patient is taken to the operating room and the surgical procedure begins.

How is brain pacemaker surgery performed?

Brain pacemaker surgery is performed in two stages. Brain and Nerve Surgery Specialist Prof. Dr. Fatih Bayraklı explains the surgical process by saying, "In the first stage, we evaluate the responses to electrical stimulation by talking, especially with Parkinson's and essential tremor patients," and continues: "Electrophysiologically determining that the brain electrodes have reached the desired region shows that we are at the target we determined on the pre-operative MRI. In addition to these, finding the target in the patient who is awake during surgery and then providing stimulation to create a benefit and side-effect profile makes post-operative battery adjustment easier.

When improvement is seen in the patient's findings, a permanent electrode is placed, and the 2nd stage of the surgery begins.

The patient is put under general anesthesia, and the battery is placed under the skin on the right chest, 5-7 centimeters below the collarbone. In dystonia patients, all of these procedures are performed while the patients are asleep due to their clinical condition."

Can pacemaker treatment be applied to everyone?

It is not possible to perform brain pacemaker surgery on every patient experiencing movement disorder problems. Whether this method will benefit the patient or whether the patient is a candidate for such an intervention is determined after detailed clinical evaluation and examinations.

When can patients return to their daily lives?

Patients are usually discharged two days after the surgery. The brain pacemaker is usually turned on after 2 weeks in Parkinson's and essential tremor patients, and immediately in dystonia patients. Medication and battery settings for patients are adjusted over the following 2-3 months.

Why is regular physician follow-up important?

The brain pacemaker method does not treat the cause of the disease; it only offers a solution to the clinical findings that arise. Prof. Dr. Fatih Bayraklı states that for this reason, the brain pacemaker may become ineffective in the later stages of the disease, noting, "Furthermore, although patients' lives become better than before the surgery, it is necessary to be aware of additional or supplementary problems that may arise because the diseases leading to movement disorders progress. Therefore, patients must continue their physician follow-ups and treatments after the surgery."