Patient Selection is Important in Parkinson's Surgery

Noting that one of the most effective treatments known for Parkinson's disease is 'deep brain stimulation', as it is known among the people, Neurosurgery Specialist Prof. Dr. Ahmet Hilmi Kaya drew attention to the appropriateness of patient selection in surgery. Prof. Dr. Kaya said, “We have certain age limits for patients who are candidates for surgery. Post-surgery medications can be reduced by 50 percent.”

Parkinson's Disease

Stating that Parkinson's disease, which occurs with a movement disorder, is observed at a rate of 2 per thousand in people over the age of 65, Yeditepe University Koşuyolu Hospital Neurosurgery Specialist Prof. Dr. Ahmet Hilmi Kaya shared essential information due to April 11, World Parkinson's Day. Emphasizing that Parkinson's disease is a disease observed with degeneration in the deep core structures of the brain, Prof. Dr. Ahmet Hilmi Kaya said, “The region called the ‘substantia nigra’, where dopamine-secreting cells are located, is very affected. The disease occurs with a kind of dopamine deficiency. Dopamine is an agent that regulates the movement system. Therefore, Parkinson's disease is particularly characterized by movement disorder. In addition, it affects cognitive functions. There are signs such as tremors, body stiffness, and instability in addition to slowing of movement. We see it at a rate of 2 per thousand especially over the age of 65. Sometimes the 1 percent rates are stated. In addition, we can see it at young ages such as the 30s and 40s.”

“Not All Hand Tremors Are Caused by the Parkinson's Disease”

Explaining that genetic factors may also be effective in the emergence of the disease, Prof. Dr. Ahmet Hilmi Kaya used the following statements: “Beyond that, some pesticides, synthetic drug-based medications, viral agents are responsible before. Although the exact cause of the disease is unknown, it can be seen at an earlier age in some people. Parkinson's disease is a disease that specifically affects the movement system. When body rigidity, slowness of movement, and tremor come together, the patient becomes dependent on someone else for even the smallest daily activities. Relatives of these people have to take them to the toilet and help them walk. However, we cannot attribute every tremor to Parkinson's disease. Only the doctor should make an examination and decide on this. There are many other movement disorders. There may be different causes of tremors such as some other neurological diseases and hormonal factors. But tremor is one of the main signs of Parkinson's disease.” 

Who Can Undergo the Surgery?

Pointing out that the first step in treatment after the diagnosis will be medication, Prof. Dr. Ahmet Hilmi Kaya warned that surgery cannot be applied to every patient and said, “At first, patients benefit greatly from the medication, and they cling to life again. Findings improve almost completely. The medication is used for 3-5 or 10 years, but later on, as the patient takes more medications, medication-related side effects develop. Shaking movements, which we call dyskinesia, begin to be seen in people. The patient's quality of life deteriorates again. Surgery comes into play during this period. One of the most important weapons we have is deep brain stimulation, popularly known as the brain battery. In surgery, the appropriateness of patient selection is important. We implant a brain pacemaker in suitable patients. We have certain age limits for patients who are candidates for surgery. If the functional capacity of the patient is very good, we do not consider the age limit. Our treatment is highly effective in Idiopathic Parkinson's disease. Parkinson's disease sometimes progresses with dementia. In these patients, we do not accept surgery as much as possible. It is possible to reduce post-surgery medications by 50 percent. We know that the patient, who can only go to the toilet, eat and even get out of bed with help 20 hours a day, become able to get up on his/her own, get his/her water from the kitchen, and have a snack.”

“Surgery Requires a Special Team”

Yeditepe University Koşuyolu Hospital Neurosurgery Specialist Prof. Dr. Ahmet Hilmi Kaya, who advised patients who are considering surgery, used the following statements: “If we take the procedure we perform in the brain as a basis, the application of the brain battery is a practical operation in terms of surgical technique. Because we just make a hole and go in with a catheter and place an electrode in one spot. However, we use a special set of equipment and calculations during the surgery and make comprehensive evaluations during the procedure. The brain connects the battery to life. It makes the person free again in life. Its effectiveness is seen even in the exceedingly early postoperative period. However, we need to be in frequent contact with the patient. However, neurosurgery surgeries are not very routine surgeries. It requires specialization, it requires a special team. The neurology part of the treatment is particularly important. We manage this process together with our neurologists. The equipment you use and your experience are also very important. It is beneficial for patients to pay attention to these.”