Turkey has been emerging as a destination of choice for deep brain stimulation surgery due to its high-quality healthcare standards and a pool of sought after neurologists and neurosurgeons. Although the technique is relatively in infancy stage not only in Turkey but all over the world, Turkey has a very high success rate because of the availability of internationally trained doctors, advanced technologies and safe treatment. More than 1200 neurosurgeons are practicing in various JCI-Certified Turkish medicals centers.
The Government of Turkey is in the process of making Turkey one of the most preferred medical tourism destinations. The number of medical tourists visiting Turkey is increased by 30% per year in Turkey and Turkey is expecting around 1 million medical tourists for treatment by the end of 2019.
Although Deep Brain Stimulation in Turkey is in its infant stage, the cost of this procedure in Turkey is highly competitive as compared to other countries, especially the developed countries.
Deep brain stimulation (DBS) is a neurosurgical procedure that involves implantation of electrodes within the specific targeted areas of the brain. It is used to treat a variety of disabling neurological symptoms. Deep brain stimulation procedure can be opted for treating a number of neurological conditions, including Parkinson's disease, Essential tremor, Dystonia, Epilepsy, Tourette syndrome, obsessive-compulsive disorder and chronic pain. Deep brain stimulation uses a neurostimulator, commonly referred to as deep brain stimulator, to deliver electrical stimulation to targeted areas in the brain that control movement.
The impulse sent by deep brain stimulator interferes with and blocks the electrical signals that cause tremor and other Parkinson’s disease symptoms. The targeted areas most often include the thalamus, subthalamic nucleus and globus pallidus. Deep brain stimulation procedure has a long history of research. It was first introduced in 1987 and The Food and Drug Administration (FDA) approved deep brain stimulation treatment for essential tremor and Parkinson's disease in 1997.
Deep brain stimulation treatment is recommended for people who have had Parkinson’s disease for at least four years, are still getting benefited from medications, but have motor complications, such as significant on-off time periods. Brain stimulation therapy works by inactivating the parts of the brain that cause Parkinson's disease symptoms. However, DBS Parkinson does not damage the healthy brain tissue by destroying nerve cells. It blocks electrical signals from targeted areas of the brain.
Deep brain stimulation treatment has proven effective in most of the cases, but it could potentially result in serious complications and side effects. This is the main reason why deep brain stimulation treatment is used only for patients whose symptoms are not appropriately controlled with medications.
During the deep brain stimulation therapy, the neurosurgeon first uses magnetic resonance imaging (MRI) or computed tomography (CT) scan to identify the exact target within the brain where electrical nerve signals generate the symptoms. Some doctors may use microelectrode recording (a small wire that observes the activity of nerve cells in the target area) to more specifically and precisely identify the target in the brain that will be stimulated during the treatment.
After identifying the targets in the brain, there are several ways in which the permanent electrodes are placed into the target areas. The patient is given a local anaesthetic before the procedure, and then the neurosurgeon implants electrode by making small holes in the skull. The implanted electrodes are connected with extensions (a thin insulated wire) connected with the stimulator. These extensions are passed by some incisions under the skin of the head, neck, and shoulder. Deep brain stimulator is a battery-operated medical device similar to a heart pacemaker. It is implanted under the skin near the collarbone or in the chest.
Typically, patients need to stay in the hospital until their incision-related pain is under control, they are able to eat, drink and walk. Mostly, the patients are required to stay for only one night at the hospital after the surgery, but some patient may be advised to stay for at least two nights. The patient will not be able to shower or wet the area around the incision until the wound has completely healed. Deep brain stimulation programming takes place about 3 to 4 weeks after the surgery and this is when the actual benefits of the treatment can be reaped.
After a few weeks of surgery, the neurostimulator (IPG) is activated by a specialist. The specialist can easily program the IPG from outside the patient’s body using a special remote control. The amount of stimulation is customized as per specific needs. Stimulation may be constant or the specialist may advise to turn the IPG off at night and back on in the morning, depending on the condition of the patient. The batteries of stimulator may last for three to five years. The IPG replacement procedure is relatively simple. Inform your doctor immediately in case you experience any problems related to speech, balance, and coordination or in case you experience mood swings, numbness, muscle tightness, or lightheadedness.
Deep brain stimulation is a neurosurgical procedure to manage various disorders related to the brain. A lead is inserted at specific areas of the brain and is connected to a neurostimulator with the help of insulated wires. Neurostimulator is placed well below the collarbone and its function is to generate the electrical impulses. These impulses help manage the irregular impulses occurring in the brain as seen in various movement disorders.
Deep brain stimulation is generally recommended for patients suffering from the following disorders:
Parkinson’s disease: It is a progressive neurological disorder in which nerve cell degenerates due to the reduced level of dopamine. Parkinson's disease affects the movement. Although the disease is not cured through deep brain stimulation, it helps in controlling the symptoms such as rigidity, tremor, walking problems.
Dystonia: It is a neurological movement disorder which causes involuntary muscle contraction which leads to uncontrollable, slow or jerky movement of the head, limbs, trunk, or neck.
Other diseases which may be positively affected with DBS are:
Obsessive-compulsive disorder: It is a type of mental illness characterized by fear without any reason.
Major depression: It is a common and serious medical illness in which a person has a loss of interest in various activities and has mood swings.
Within the last decade, Turkey has become one of the fast-growing countries in the field of medical tourism. Turkey has provided deep brain surgery at an affordable price as compared to other western countries. There are following reasons to undergo treatment through deep brain surgery in Turkey:
49 Turkish clinics have been received a quality certificate by the International Joint Commission.
Turkish government attracts a large number of investments in healthcare sectors.
Turkey hospitals provide world-class facilities, with the latest diagnostic procedures, and highly qualified and internationally trained surgeons.
The success rate for deep brain stimulation surgery is very high in Turkey.
Turkey government has provided a unique visa-free policy.
Patients can easily travel to Turkey from Europe and the Middle east.
Deep brain stimulation is done for those people who are suffering from Parkinson's disease and when their symptoms are not controlled by medicines. Other diseases that can be treated with Deep Brain Stimulations are:
Multiple Sclerosis: It is an autoimmune disease, which affects the nervous system including the brain and spinal cord. In this disease, the immune system attacks the myelin sheath ( that covers the nerve fibers) and causes communication problems between the brain and the body parts.
Essential Tremor: It is a neurological disorder that causes an involuntary shaking movement.
Tourette Syndrome: It is a neurological condition that causes repetitive quick movements or unwanted sounds.
Chronic pain: Pain is a signal from the nervous system which causes discomfort to the patient. Chronic pain may last for a few weeks, months or years.
The affordable price for deep brain stimulation in Turkey is one of the main factors which attracts a large number of medical tourists every year. Many JCI-Certified Turkey hospitals offer competitive price as compared to other European and western countries like the US, Australia, etc. The average cost of deep brain stimulation is USD 35,000. There are various factors which affect the overall cost of deep brain stimulation in Turkey which include:
Types of hospitals
Experienced surgeons with advanced degree neurological science
The quality or brand of the stimulator is used
Pre-surgery testing charges
Used of the latest medical technologies
Physical therapist session
Patients health status
High success rate
Following are some of the types of Deep Brain Stimulation:
Globus Pallidus DBS: Although this technique is not effective in preventing gait and imbalance in Parkinson's disease, it has the potential to manage other symptoms such as involuntary movements. It is less effective than Subthalamic DBS when it comes to alleviating symptoms.
Thalamic DBS: This technique has limited use because of its complications related to speaking and swallowing.
Subthalamic DBS: It is one of the highly recommended DBS because of its efficacy in managing the symptoms and reducing the dose or stopping medications.
Pedunculopontine nucleus DBS: It is relatively a new technique with the potential of managing various symptoms of Parkinson’s disease and other neurological disorders.
The top hospitals in Turkey for deep brain stimulation are:
Memorial Sisli Hospital, Istanbul, Turkey
Memorial Atasehir Hospital, Istanbul, Turkey
Hizmet Hospital, Istanbul, Turkey
Memorial Antalya Hospital, Antalya, Turkey
Memorial Bahçelievler Hospital, Istanbul, Turkey
Memorial Dicle Hospital, Diyarbakir, Turkey
Memorial Kayseri Hospital, Kayseri, Turkey
Medipol Mega Hastaneler, Istanbul, Turkey
Liv Hospital, Istanbul, Turkey
Anadolu Medical Center, Kocaeli, Turkey
There are following neuro-surgeons in Turkey for deep brain stimulation:
Dr. Ali Zırh, Medipol Mega Hastaneler, Istanbul, Turkey
Dr. Mustafa Önöz, Memorial Atasehir Hospital, Istanbul, Turkey
Dr. Salim Şentürk, Hizmet Hospital, Istanbul, Turkey
Dr. Prof. Mahmut Akyüz, Memorial Antalya Hospital, Antalya, Turkey
Dr. Kemal Paksoy, Memorial Bahçelievler Hospital, Istanbul, Turkey
Dr. Adil Yilmaz, Memorial Dicle Hospital, Diyarbakir, Turkey
Prof. Ahmet Menkü, Memorial Kayseri Hospital, Kayseri, Turkey
The patient is required to stay in the hospital for at least one day after surgery but in some cases, the surgeon may advise staying for two days. The deep brain stimulation programming takes around 3 to 4 weeks after surgery. There are following recovery process follows after surgery:
Patients should not take shower specifically in the area around the incision.
Use a gentle shampoo and avoid hair conditioner.
Do not apply any ointment to the area of the incision
Do not lift heavy items ( more than 10 pounds)
Patients should wash head by using a damp cloth carefully.
Patients take medication such as antibiotics (prevent from infections) strictly as prescribed by the doctor.
Stitches and staples are removed around 7 to 10 days after surgery
Heavy activities and swimming are avoided for 4 to 6 weeks of surgery.
The neurostimulator has been activated by specialists after a few weeks of surgery which is customized by special remote control.
The specialist gave the advice to turn off the neurostimulator at night and turning on in the morning according to the patient's conditions.
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