Deep Brain Stimulation: Everything About DBS Surgery and Treatment Process

Deep Brain Stimulation (DBS), also known as the brain pacemaker, is a system that regulates brain activity to treat conditions like Parkinson's, Dystonia, Essential Tremor, Epilepsy, and OCD, alleviating symptoms.

Treatment Program

**Your personal treatment plan will be determined after consulting with your doctor. The general program is as follows.

You need to stay in the country for 20-25 days in total. 3-4 days of this are hospital stay and the rest of it hotel accommodation. (organized for you and your companion).

STEP 1

• Welcoming at the airport and VIP transfer to the hospital or hotel based on your personal treatment plan
• You will have a dedicated personal assistant 24/7 to assist you on each step of your journery

STEP 2

• Hospital admission or Hotel chek-in
• Consultation with your neurologist and neurosurgeon
• Get the medical tests recommended by your doctor

STEP 3

• Pre-operative preparations, including fasting and medication adjustments
• Receive the results of your medical tests
• Pre-operative care in the hospital
• Operation is performed based on the medical test results
• Deep Brain Stimulation surgery lasts approx. 3-4 hours

STEP 4

• Post-operative care continues in the hospital under medical supervision

STEP 5

• Discharge from hospital on the day your doctor recommended after the controls by your doctor
• VIP transfer to the hotel

STEP 6

• • Continue the recovery process at hotel
  • VIP transfers from hotel to hospital and from hospital to hotel for follow-up visits on the days determined by your doctor
  • Deep Brain Stimulation battery programming is performed on these visit days at the hospital
  • VIP transfer from hotel to airport when your treatment program is completed

What is Deep Brain Stimulation?

• Deep Brain Stimulation (DBS) is a treatment used for several movement disorders and neurological diseases. Physicians may perform DBS for certain psychiatric conditions.During DBS surgery, a neurosurgeon stimulates deep brain areas with the help of electrodes. In this way, the activity of neurons is regulated. The brain surgeon places a pair of electrodes in the brain and places the brain pacemaker, neurostimulator, in the chest area under the collarbone. During the surgery, the neurosurgeon inserts the neurostimulator under the skin and combines it with the electrodes going into the brain with the help of a wire. This stimulator sends controlled electrical signals to these electrodes. In other words, the surgeon attaches the brain battery to the chest, but it functions through electrodes attached to the brain.

What are Deep Brain Stimulation Benefits

• There are pros and cons of Deep Brain Stimulation surgery.Deep brain stimulation benefits are as follows.
  • DBS improves the quality of life
  • Reduces symptoms significantly
  • Reversible treatment – can be turned off or removed
  • Reduces medication usage significantly
  • Adjustable according to the DBS patient’s needs
  • DBS is a long-term effective therapy (+15 years)
  • DBS therapy has FDA approval
  • High patient satisfaction and success rate

How Much Does Deep Brain Stimulation Cost?

DBS treatment is generally considered as a cost-effective operation. Deep Brain Stimulation cost varies from country to country. You can see the average prices below.

• the USA: $130.000
• the UK: $65.000
• Europe: $64.000
• Asia: $40.000
• Turkey: $30.000

Most patient prefers to get the DBS treatment in Turkey where they can get high-quality healthcare services with very short waiting times and affordable prices.

What are the advantages of Deep Brain Stimulation in Turkey?

• Deep Brain Stimulation in Turkey is the most preferable option for patients who cannot get the treatment in their countries due to several reasons like cost, waiting lists, insurance coverage, etc.
  

   The advantages of Deep Brain Stimulation in Turkey are as follows.

  • Affordable price ($25.000-$45.000)
  • No waiting time for the treatment
  • DBS is available for over 15 different diseases in Turkey
  • MRI-compatible devices are available with rechargeable and non-rechargeable options
  • There are package options
  • Direct flights are available to Turkey from more than 130 countries worldwide
  • High-quality healthcare service
  • JCI-accredited hospitals
  • Deep brain stimulation in Turkey is safe for international patients. Medical tourism service providers need to hold a TURSAB license and be authorized by the Ministry of Health. These service providers and hospitals are frequently inspected by the MoH.

What are the Risks and Side Effects of Deep Brain Stimulation?

DBS surgery has risks in certain cases. However, in general, it is considered to be low risk. These risks may occur due to the surgical procedure or stimulation to the brain. Your doctor will give you detailed information about your condition through pre-operative examinations and brain imaging tests.

Surgery Risks

Deep Brain Stimulation surgery includes the implantation of a device under the skin and putting electrodes into the small holes in the skull. There are some complications that may occur due to surgery:

• Infection
• Headache
• Seizure
• Electrode/lead migration
• Neurostimulator migration
• Pain around surgery sites
• Wire breakage
• Confusion
• Bleeding
• Allergic response to implanted device

Generally, complications of DBS surgery resolve in a short time after the surgery.

Side Effects

Possible side effects of deep brain stimulation are as follows. Further changes in stimulation settings can manage almost all side effects. Finding the best settings might take 4-6 months after the surgery.

• Headache
• Seizure
• Confusion
• Trouble concentrating
• Speech difficulties
• Involuntary movements
• Vision problems
• Depression
• Anxiety
• Paresthesia (tingling sensation)
• Weight gain

Who would be an ideal candidate for Deep Brain Stimulation?

Before DBS surgery, a council of healthcare professionals evaluates the patient from many aspects. This council consists of a neurosurgeon, neurologist, psychiatrist, dietitian, and psychologist.

Although eligibility for DBS varies depending on the diagnosis, physicians consider the following criteria.

• If the patient's quality of life is severely diminished due to symptoms
• If the patient does not respond adequately to medications
• If symptoms come back when the medication wears off
• If a Parkinson's patient experiences freezing in his/her movements for more than 2 hours a day, even though taking the medications
• If the patient cannot use the medications due to side effects despite dosage adjustments

Your doctor will give you the most accurate guidance after the consultation.

How is Deep Brain Stimulation Surgery Performed?

Preparation for Surgery

When you enter the preparation process for surgery, physicians make a number of tests and neurological evaluations to understand your health condition. Some of these tests may vary depending on your other diseases, the medications you use, and their frequency. The main tests performed are blood tests, imaging studies (MRI, Computed Tomography), and respiratory tests, as well as neurological and psychiatric evaluations.

Before the surgery, doctors map the brain to ensure that they send the electrodes to the correct area of the brain. Healthcare professionals place a special head frame on your head to accurately image your brain and take accurate mathematical measurements. This frame is called a stereotactic frame and is the necessary measurement tool in mapping your brain.

Surgery Part

After this imaging and brain mapping process, the neurosurgeon performs the surgery. In most cases during surgery, you will be awake so your doctor can contact you to test the stimulation to your brain. The physician applies local anesthesia to numb only your scalp and no anesthesia to the brain itself because there are no pain receptors in the brain.

The first part of the surgery is the placement of a wire with electrodes, or contact points, to the area of your brain determined during mapping.

In this part, the doctor places a wire with electrodes, or contact points, in the area of your brain determined during mapping. This process is mostly performed bilaterally, that is, right and left. After the neurosurgeon places the electrodes, extends the wire subcutaneously, and combines it with the neurostimulator (battery) placed under the skin close to your collarbone. During the surgery, the surgeon and neurologist constantly monitor the brain carefully.

The neurosurgeon inserts the brain pacemaker under the skin of the chest in the second part of the surgery and applies general anesthesia. In some cases, depending on your health condition and other evaluations, your doctor might apply general anesthesia for the entire surgery.

Programming the stimulation

This battery placed in your body sends pulses to the brain and stimulates electrical activity within the brain. These electrical signals are programmable and can be controlled with a remote control. Your neurologist performs DBS Programming and adjusts the amount of stimulation in detail.

How Does Deep Brain Stimulation Work?

Physicians have put forward many hypotheses for the working mechanism of Deep Brain Stimulation. The general understanding is as follows.

The brain has electrical circuits that manage many functions in the body, and some of these circuits govern our movements. Movement disorder may occur when there is a problem in the circuits that manage movement, and if this problematic circuit can be electrically stimulated correctly, movements can be controlled and tremors can be prevented. Deep Brain stimulation therapy is a treatment method that restores balance by detecting these circuits that are not working properly.

What is the Success Rate of Deep Brain Stimulation?

The success rate of DBS depends on the disease and the patient's condition. In general, patients who undergo DBS surgery experience significant symptom relief over 15 years of follow-up. DBS generally stands out as a successful treatment.

The patient may need medications in certain conditions. In most cases, DBS reduces medication use by half. Patients’ motor symptoms can improve by 85-90% comparing the condition before DBS surgery. Deep brain stimulation treatment significantly reduces the symptoms and improves the quality of life.

Why do doctors perform Deep Brain Stimulation surgery?

Deep brain stimulation surgery is a treatment method developed for movement disorders such as Parkinson's, Dystonia, and Essential Tremor. It also reduces seizures in Epilepsy, which is difficult to treat. In addition, physicians can perform DBS for the treatment of certain psychiatric diseases.

Physicians perform DBS surgery when the patient cannot control his/her symptoms with medications.

How Long Does Deep Brain Stimulation Last? What is the battery life?

The lifespan of the brain battery may vary depending on the settings made and whether the battery used is charged or not. DBS can improve the life of quality up to +15 years after the surgery.

How much does Deep Brain Stimulation Battery Replacement Cost in Turkey?

Deep Brain Stimulation Battery Replacement cost in Turkey is around $15.000-$30.000

What does the Deep Brain Stimulation package include in Turkey?

Our DBS treatment package includes;

• Hotel accommodation at a 4 or 5-star hotel (for two people including breakfast)
• VIP transfer between airport-hotel-hospital
• Translation service
• Hospital stay
• Medical tests and exams required by your doctor
• Brain imagining
• Surgery fee
• Device and its components (charger, remote controller, etc.)
• DBS device programming
• Consultation with a council of healthcare professionals; neurosurgeon, neurologist, psychiatrist, dietitian, and psychologist.

Please contact us to get more detailed information and evaluation.

How long does Deep Brain Stimulation Surgery take?

The first and second parts of deep brain stimulation surgery take a total of 3-4 hours in total.

How long does it take for DBS to work?

It may take few programming sessions to find the optimal setting. Your doctor activates the device 1-2 weeks after the surgery. You will see full deep brain stimulation benefits after 4-6 months. In some cases, your doctor may program the brain pacemaker to allow minor adjustments to the remote control.

You can see important things to know about Deep Brain Stimulation as follows.

• Deep brain stimulation treatment increases the quality of life.
• DBS is a reversible treatment.
• DBS effectiveness might not be the same for everyone.
• DBS reduces the symptoms. It does not stop the disease.
• Deep brain stimulation treatment has FDA approval for several neurological conditions for more than 20 years.
• More than 160.000 people had Deep brain stimulation treatment (by 2019) worldwide according to AANS (American Association of Neurological Surgeons).