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Deep Brain Stimulation (DBS)

     
     

Deep brain stimulation (DBS) is a surgical treatment which is used to treat some of the treatment-resistant movement and affective disorders such as chronic pain, Parkinson's disease, tremor and dystonia. DBS surgery involves the implantation of a medical device or implant that sends electrical impulses to specific parts of the brain. The medical device is called as brain pacemaker. Even though deep brain stimulation is used to treat a variety of disabling neurological disorders, it is most commonly used to treat the debilitating symptoms of Parkinson's disease (PD), such as tremor, rigidity, stiffness, slowed movement and walking problems.

Deep Brain Stimulation is used mainly for patients who are suffering from Parkinson's disease and whose symptoms cannot be adequately controlled with medications.Parkinson's disease which is caused by degeneration of brain cells that make a chemical called dopamine, is a common disorder affecting nearly three out of one hundred persons over the age of 65 years. Nowadays Parkinson's disease is becoming increasingly diagnosed in younger persons under the age of 50 years. As mentioned earlier in Parkinson's disease thebrain cells degenerate. When these brain cells degenerate the patient runs out of dopamine and develops slowing of movement, difficulty with speech, slowed and shuffling walking and tremor. In many patients Parkinson's disease goes undiagnosed since it is often very difficult to diagnose and there is also lack of awareness among people.

Before Deep Brain Stimulation Surgery

The pre-surgery evaluation for Deep Brain Stimulation starts with a physical examination of the patient by the treating doctor. After the physical examination the doctor may prescribe imaging tests in order to locate the specific region of the brain that causes tremors and symptoms of movement disorder.One way to locate the target areas is to rely only on a computed tomography (CT) or magnetic resonance imaging (MRI) scan. While some surgeons stop there, others use an electrode recording technique to map and target the specific areas that they will need to reach. The patient will typically undergo tests like blood test, electrocardiogram, chest X-ray etc. before the surgery.The patient needs to disclose health conditions, medication that he/she is taking, alcohol consumption (if any) etc., to the doctor during medical history taking. The doctor may ask the patient to stop taking some medications for certain a number of days before the surgery. The patient should avoid smokingatleast few weeks before the surgery.

During Deep Brain Stimulation Surgery

In Deep brain stimulation (DBS) surgery, the brain pacemaker, known as a neurostimulator is implanted. This sends mild electrical signals that stimulate the brain. The signals reorganize the brain's electrical impulses, causing improved symptoms in many conditions affecting the brain. A patient may have deep brain stimulation on one or both sides of your brain, depending on his/her condition.

A deep brain stimulation system has three parts that are implanted inside the body :

  • Neurostimulator - This is a programmable battery-powered pacemaker device. The main function of a neurostimulator is to create electric pulses. It is placed under the skin of the chest below the collarbone or in the abdomen.

  • Lead - It is a coated wire with a number of electrodes at the tip. The main function of a lead is to deliver electric pulses to the brain tissue. It is placed inside the brain and connects to an extension wire through a small hole in the skull.

  • Extension - It is an insulated wire that connects the lead to the neurostimulator. It is placed under the skin and runs from scalp, behind the ear, down the neck, and to the chest.

The DBS system can be turned on or off by a handheld controller. This controller can be easily operated by the patient. The doctor programs the stimulator settings with a wireless device. It has to be noted that the stimulation settings might have be adjusted as the patient's condition changes over time. Unlike other surgeries, such as pallidotomy or thalamotomy, DBS does not damage the brain tissue. Hence DBS surgery is called as non-destructive surgery.

It may take around 3-6 hours for the DBS surgery.

After the Deep Brain Stimulation Surgery

The doctor may advise few antibiotics to prevent infection. The patient may need to visit the doctor several times after the surgery to adjust the stimulation with the help of programming. The doctormay prescribe a detailed medication planto the patient. The patient should take some precautions after the surgery and follow the instructions given by the doctors. He/she should take care of the incisions and the surgical region on the head, by keeping it dry and covered. Heavy physical activities and lifting heavy weights should be avoided for few weeks after the surgery. Regular follow-up with the treating doctor should be done.After surgery the patientmay be asked to come back after certain period of time for a follow-up and to check whether the device is working properly or not. This will depend on the treatment plan. For those employed before the surgery, it is usually possible to return to work after fully recovering from surgery. If you are planning to drive then you need to talk to your treating doctor to know when you can start driving. There are chances that the Implantable Pulse Generator may activate airport security machines. Hence you must inform airline staff and walk around machines. Further it is suggested that you carry documentary evidence that you can present to security staff at airports.

What are the advantages of Deep Brain Stimulation?

The device is programmable and hence the electrical stimulation is adjustable.This is a great advantage since as the patient's response to surgery changes over time, the stimulation can be adjusted without the necessity of repeat surgery. Moreover the patient can also go for future therapies like the brain cell transplantation since DBS surgery is not a destructive surgery and the stimulator could be turned off. This may be of great help to patients with Parkinson's disease.

It has to be noted that a Deep Brain Stimulation Surgery is not suitable for everyone and is not a cure for Parkinson's symptoms. A successful Deep brain stimulation surgery may help patients to manage symptoms of health conditions such as Parkinson's disease, Tremor and Dystonia and lead a better quality of life. The extent of benefits and the time duration required may vary from patient to patient. However it is seen that many patients have experienced some benefits which has helped them to lead a better quality of life. Some of such benefits are symptom relief, the need for lesser medications, fewer side effects and the patient may be able to resume normal activities.

What are the risks involved in a Deep Brain Stimulation Surgery?

Even though a DBS surgery is generally a safe and effective procedure, like any other major surgery, a DBS surgery has also some risks associated. Some of the risks associated with a Deep Brain Stimulation surgery are, infection, swelling, stroke, seizures, disability in movement, coma etc.

Who should consider Deep Brain Stimulation?

The first step is to see a trained neurologist. It has to be noted that surgery is always a last resort. Surgery should be considered for people who do not achieve satisfactory control through medications.

Deep Brain Stimulation Surgery for Parkinson's Disease in India

You need experts in this field. Not all neurosurgeons can successfully perform a Deep Brain Stimulation surgery. Hence it is recommended that the patient has surgery where there is a team of experts. The team should consist of neurologists and neurosurgeons who have experience and have undergone specialized training in doing these types of surgeries. In India we have few world-class centres for Deep Brain Stimulation surgery. The doctors are highly skilled and experienced in this field. A deep brain stimulation surgery is expensive. But in India the cost of DBS surgery is comparatively much lower than in US, UK or Canada. That is the reason why many patients from all over the world come to India for Deep Brain Stimulation surgery. To know more about the cost of Deep Brain Stimulation surgery in India, Deep Brain Stimulation Specialists in India, Deep Brain Stimulation Hospitals in India or anything related to DBS surgery in India, you can write to us or call us anytime.

How to get started?

By coming to India you do just save money on DBS surgery but also you get a world-class medical care under the guidance of expert team of neurologists and neurosurgeons. If you want to come to India for DBS surgery then it is very easy to get started. All you need to do is send the following details to us by an email at info@mentorsethicare.com.

  • Medical reports of the patient

  • CT scan or MRI scan images and also the report

  • Age of the patient along with brief medical history

For more information on high quality and low cost deep brain stimulation surgery in India, you can write to us at info@mentorsethicare.com or call us anytime at 0091 9611 231 188

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