What is brain pacemaker therapy? For the treatment of Parkinson’s disease, a clear diagnosis is the first step and medication is the second. Drug therapy is followed by surgery. Pacemakers are one of the newest treatment modalities and represent the highest level of human scientific and technological development. What is a pacemaker? We say that a pacemaker is called deepbrainstimulation – deep brain electrical stimulation therapy. When a computer dies, we reboot, and this therapy is like rebooting our brain. How is the surgery for the brain pacemaker done and how does it work? It comes down to the pathogenesis of Parkinson’s disease. After years of research, it was discovered that there is a nucleus accumbens in both the left and right hemispheres of the brain, which was given the name substantia nigra because of its dark color. The cells in this substantia nigra are dopaminergic, and what is dopamine? What is dopamine? It is a chemical that is stored in the cells, and it usually acts as a messenger, producing dopamine to regulate our activities, so that our hands can do fine movements, run faster, and walk in a more coordinated way. With its regulation, our muscles are not very stiff and our hands do not shake. So, what happens when it gets sick? If a patient has Parkinson’s disease, it means that more than 70-80% of dopamine cells have been lost in the substantia nigra. Is this apoptosis not reproducible? No, it is not reproducible. This diagram shows a brain with two small red dots near the substantia nigra, where is the substantia nigra? Where is the substantia nigra? It is under the two little red dots. This red dot is a schematic, but it’s not actually red in color. It’s called the nucleus accumbens, and it’s in the deep part of the brain. If we compare the human brain to a watermelon, the two nigrostriatal nuclei are the two watermelon seeds at the core of the watermelon, the deepest part of the watermelon. How is this surgery done? The nigrostriatal cells are not working properly, and the dopamine produced by them does not command the operation of the brain properly, thus causing the physical activity to be affected. We drill a small hole from the top of the head and put an electrode (about 1 mm in diameter), which is half the thickness of a matchstick, through this small hole, and insert it very deeply into the nigrostriatal area. Depending on whether the patient has unilateral or bilateral onset, the electrodes are either unilateral or bilateral. After the electrodes are inserted, there is a wire that is drilled under the skin and connected to the pacemaker. This machine, also known as a pacemaker, is embedded under the skin of the chest, and it generates electrical impulses, which are transmitted through the wire to the electrodes, which discharge and stimulate the two nuclei. Originally the nigrostriatal mass was in a natural state, but now this nucleus is releasing less and going into abnormal activity, we stimulate it by electrode discharge to bring it back to its natural state and suppress its overactivity, so that the hands don’t shake so much and the body doesn’t get so stiff. This small box buried under the skin of the chest contains mostly batteries and a small part is a pulse generator, which is used to generate pulse waves, and the batteries are inside the machine to maintain the operation of the system. The operation is basically the same for bilateral and unilateral surgery, right? There is a figurative analogy, just like when we install air conditioning in our home, whether it is a single unit or one to two. It’s the same thing. Bilateral means that two stimulation leads go out of the machine, one into the left nucleus and one into the right nucleus. The pacemaker treatment is to stimulate it with an external disturbing force to bring it back to a relatively normal state when the natural state is no longer normal, is that how you understand it? Yes, that’s right. Parkinson’s disease is a functional brain disease, unlike cancer, where the site of the lesion can be detected by CT or MRI. It is like a computer that has been poisoned, the machine is fine on the outside and inside, but it is not working properly because there is a virus. To make it work properly, you have to kill the virus and reboot the machine. The pacemaker stimulates the nucleus for a similar reason. Is pacemaker surgery safe? Does it have a high success rate? The safety of the treatment has to be the first priority, safety first and effectiveness second, both of which are equally important. My answer to this question is that the implantation of a pacemaker is a very, very safe procedure. Just as I always tell patients’ families, don’t force me to say that there is no problem, but what if? Just like there are times when you don’t feel comfortable eating, let alone a surgery.