Deep brain stimulation surgery in India

Overview

Deep brain stimulation is the surgical intervention which involves implanting a medical device, called brain pacemaker in the skin of the chest, below the collarbone. The pacemaker, also known as implanted pulse generator (IPG) sends electrical impulses to specific parts of the brain to help in the treatment of otherwise treatment resistant disorders of nervous system like Chronic pain, Parkinson's disease, rigidity, tremours, dyskinesia, dystonia etc.

Deep brain stimulation is most commonly used to treat the symptoms of these common neurological conditions:

Parkinson's disease

Deep brain stimulation, approved by FDA in 2002 to treat Parkinson's disease has now become the standard treatment for Parkinson's disorder. Symptoms associated with Parkinson's which include stiffness and tremor are controlled with medication for only short duration while DBS offers complete control and thus better quality of life.

Dystonia

Dystonia is a condition in which patients experience involuntary muscle contractions that force parts of the body into abnormal postures. DBS has been FDA approved for this condition under what is known as the Humanitarian Device Exemption (HDE.) This means that DBS surgery can be done on those with debilitating dystonia that does not respond well to medication, and in whom dystonia is the only neurological condition.

Essential Tremor

When patients have inadequate response to medication, deep brain stimulation is an option to effectively treat essential tremor. Research shows that medications often only elicit a response in about half of patients with essential tremor. However, patients who undergo deep brain stimulation can experience approximately 80 percent improvement in hand tremor.

Obsessive Compulsive Disorder (OCD)

Deep brain stimulation has been approved by the FDA under the Humanitarian Device Exemption (HDE) for the treatment of obsessive compulsive disorder (OCD.)

The goal of DBS is:

To improve the mobility and overall functioning.
To improve and maintain quality of life
To improve gait, balance, posture, speech and writing skills
To reduce tremors and rigidity
To restore dyskinesias and to maintain the mental sharpness

Candidates

If you are diagnosed with Parkinson's disease and have the abnormal motor symptoms for past 5years with disabling dyskinesia, dystonia, or if you are suffering from OCD or tremors and if drug therapy and other interventions have not helped you to relieve the symptoms, you can be candidate for DBS surgery.

Procedure

This neurosurgery is done under general anaesthesia. Most of the patients may require surgery on both sides of the brain. To start with, the surgeon locates the area to be treated either by using the MRI / CT scan or they use the electrode recording technique for mapping and targeting the brain area to be treated. After locating the area, the electrodes are implanted in the target area whose loose end in placed under the skin of the head and the incisions are sutured back.

The second part of the surgery is the placement of the impulse generator in the chest. It is done using general anaesthesia and generator is placed and positioned to connect with the electrode using extension wires.

Once activated, the device sends continuous electrical pulses to the target areas in the brain, blocking the impulses that cause tremors ( involuntary movements and can affect the hands, arms, eyes, face, head, vocal cords, trunk, and legs).

Recovery

After the surgery, you may often feel fatigued and there might be some irritation and soreness at the site of stitches which is taken care of with the medicines.You can expect a smooth recovery though in few patients there is possibility of dis-orientation for few days after the surgery.

Expected Results

After the surgery, most of the patients experience tremendous improvement in their symptoms and there is significant reduction in the medication. However, patient is advised to take the medication for few weeks after undergoing DBS and gradually taper it off.

Time & Cost

The average hospital stay for deep brain stimulation surgery is 24 to 48 hours. You would need to stay in India for around 2-3 weeks after the procedure for follow up with the treating surgeon.

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