Movement Disorder Treatment

What is Movement Disorder Treatment?

Commonly known worldwide as “Functional Neurosurgery, ” Movement Disorder Surgery is a surgical discipline that diagnoses and treats movement disorders associated with neurological diseases, certain psychiatric disorders, spasticity, pain syndromes in the face and body, and peripheral nerve damage. This field requires a multidisciplinary approach, involving brain and nerve surgeons, neurologists, physical medicine and rehabilitation specialists, psychiatrists, and psychologists who participate in the diagnosis and treatment process according to the needs of the patients.

Diseases for Which Diagnosis and Treatment Services Are Provided

Some of the diseases for which this discipline provides diagnosis and treatment services are as follows:

• Parkinson's disease
• Dystonia (muscle spasm disorder)
• Tremor
• Hyperkinetic syndromes such as chorea and dyskinesia
• Certain motor nerve-related gait disorders
• Neuropsychiatric diseases such as obsessive-compulsive disorder, treatment-resistant major depression, and Tourette Syndrome
• Pain syndromes such as trigeminal neuralgia, glossopharyngeal neuralgia, and postherpetic neuralgia
• Pain and functional motor loss following spinal and spinal cord diseases
• Drug-resistant angina pectoris
• Pain and open wounds in diabetes, peripheral vascular disease, and peripheral nerve diseases
• Pain following nerve injury
• Chronic pain syndromes and cancer pain

Methods Used in the Treatment of Movement Disorders

The discipline of functional neurosurgery employs many different methods centered around surgical interventions for the treatment of movement disorders and chronic pain syndromes.
One of these, which has come to the fore in recent years, is “neuromodulation.”

Neuromodulation can be explained simply as sending low-level electrical stimuli to the nervous system using an electrical device. Electrical stimuli help restore normal functioning of the nervous system by regulating nerve communication or affecting the perception of nerve signals. Neurostimulation therapy can be an effective option for various conditions such as chronic pain, Parkinson's disease, epilepsy, depression, and other nervous system disorders. Depending on the organ to be used, neurostimulation therapy, also known as “brain pacemaker” among the public, is named deep brain stimulation or spinal cord stimulation, and the device that generates electrical stimuli is usually implanted in the nervous system. This device manages and, when necessary, regulates electrical signals in the nervous system. During treatment, a multidisciplinary team manages this device and regularly monitors the patient's condition. Patients undergoing neuromodulation surgery typically stay in the hospital for 1-3 days and return to their daily lives after the device is adjusted.

Neuromodulation therapy may offer an alternative option for individuals who cannot take medication due to side effects or for whom medication therapy has been unsuccessful.
The placement of pumps that automatically release medication into the nervous system continuously or at regular intervals is another treatment option offered by this discipline. Treatment can be administered by implanting morphine pumps, which are used particularly in the treatment of spasticity resulting from brain and spinal cord diseases and in cancer pain. Following the pump implantation procedure, many patients can be discharged after a 1-day hospital stay.

In the treatment of chronic pain, destroying the nerves that cause pain perception to relieve pain is also one of the treatment methods used. DREZ (dural entry zone) destruction, used especially in the treatment of pain resulting from nerve injuries, and cordotomies applied in cancer pain treatment are prime examples of this treatment area.

Other applications of this discipline include nerve decompression and radiofrequency applications used in conditions such as trigeminal neuralgia and hemifacial spasm, which occur particularly in the head region, as well as peripheral nerve stimulation used for pain arising after thoracic surgery, herpetic neuralgia, occipital neuralgia, and surgical wound pain. While the hospital stay after decompression surgery is often around 4 days, radiofrequency application is an outpatient procedure that takes a total of 30 minutes.