Deep Brain Stimulation

Deep brain stimulation Parkinson’s is a neurological procedure done to cure movement or other affective disorders. Parkinson’s disease affects voluntary movement as it is a progressive disorder of the nervous system. Deep brain surgery is a treatment plan for Parkinson’s disease and dystonia. The surgery helps in controlling the brain activity. This neurosurgical procedure permits blinded studies (wherein the information about the test is concealed until it is conducted). Deep Brain Stimulation (DBS) is often called a pacemaker for the brain as it sends electrical signals to the brain rather than the heart. The surgery is ideal for patients who can’t control their disorders with medication. Although DBS might not be a complete cure for the disease, it helps in managing it in a highly effective manner and drastically improves the patient’s quality of life.

INDICATIONS
Brain surgery is usually recommended by doctors to treat the following conditions:

  • Parkinson’s Disease
  • Dystonia
  • Essential Tremor (ET)
  • Chronic Pain
  • Severe Depression

Obsessive Compulsive Disorder (OCD) Some of the commonly known symptoms that indicate a need for Parkinson’s brain surgery include:

  • Rigid muscles causing difficulty in movement and extensive pain
  • Feeling light-headed or dizzy when standing up
  • Unsteady balance
  • Difficulty in swallowing or writing
  • Decreased facial movements like smiling, blinking or swinging arms while walking
  • Difficulty in speaking clearly
  • Tremor in a finger or hand at rest
  • Reduced ability in movement and walking, especially difficulty in rising from a bed or chair

PRE-PROCEDURE
A few days before brain stimulation therapy, your surgeon will prescribe a series of tests to check your overall health and fitness level for the surgery. These include an electrocardiogram, chest X-ray, blood tests, etc. An MRI scan of the brain is also done to plan the sections where the electrodes will be placed. It is important to follow all the medications and instructions given by your surgeon before the surgery. Intake of all anti-inflammatory medicines and non-steroidal pills is strictly prohibited. You also need to quit smoking, alcohol and tobacco as it can lead to bleeding issues.

DURING PROCEDURE
A DBS procedure is conducted in two parts – the first is a brain surgery and the second is a chest wall surgery. For the brain surgery, the patient is given a local anaesthesia and sedatives. The surgeon keeps the patient awake so that he can stimulate the exact section of the brain as planned. This is a 6-step surgery as follows:

1. Fixing Stereotactic Frame – Using Velcro strips, a frame is fixed onto your head stereo-tactically. In order to reduce the discomfort to the patient, local anaesthesia is given at the four pin sites during the procedure.

2. CT / MRI Scan – The surgeon will fix a localizing apparatus in a box shape at the top of the frame. The device helps in seeing the highlighted three-dimensional coordinates of the area in the brain with the imaging scans.

3. Skull & Skin Incision – The head frame is again fixed along with a sedative to relieve your pain during the skin incision. The hair is removed along the incision line and then, a drill is used to make two quarter-sized burr holes on the left and right side of the skull. These holes help the electrodes to easily pass through the brain.

4. Inserting the Electrode – Using the hole, an electrode is implanted in the brain. Based on the MRI and CT scan reports, the electrode is inserted at the precise angle and depth in the brain. The doctor conducts a number of tests to gauge the accuracy of the incision of electrode.

5. Stimulation of brain cells – Once the exact nerve cells are located, the surgeon will replace the electrode incision with a permanent DBS lead or electrode and test its functionality.

6. Closure – After the team is satisfied with the placement of the electrode, the burr hole is covered with a plastic cap to ensure the lead stays in place. A coil of wire is also left below the scalp to attach the stimulator with the extension wire. Chest Wall Surgery This is performed 2-3 days after the deep brain therapy. You are given general anaesthesia and a device is implanted in the chest below the collarbone. Wires from the electrode in the brain are then connected to this device and they are used to send electrical pulses to your brain on a regular basis.

POST PROCEDURE
Post a deep brain surgery, patients are kept in the ICU under close monitoring to ensure desired recovery. Many patients might notice a swelling around the electrode tip in the brain for a few days or weeks. The doctor will give some antibiotics to reduce and avoid further infections in the wound. After the chest wall surgery, your surgeon will active and program the device in your chest using a remote control. Based on your existing condition, you can start operating the device using the controls. It is important to regularly visit your doctor post-surgery to make sure the device is working properly.

RISK AND COMPLICATIONS
Deep brain stimulation surgery is a serious procedure and thus, your doctors will carefully weigh the benefits against the risks and only then advise this surgery. Some of the commonly known complications associated with the surgery include:

  • Infection at the site of the surgery
  • A rare possibility of bleeding inside the brain
  • Cognitive dysfunction
  • Stroke
  • Breathing problems
  • Seizures It is important to remember that a DBS surgery may not be successful for everyone. However, if it is successful, patients notice a significant improvement in their prevalent conditions and symptoms.

MORE INFO
A number of leading hospitals in India offer world-class treatments for Parkinson’s disease surgery at an affordable cost. Normally, Approximate Cost :On Request Duration : 3-10 Days. India is widely recognised as a destination for medical tourism due to the state-of-the-art technology, good patient care and affordable DBS cost. If you have any questions regarding the surgery, please feel free to contact us at +91-9999332093 and our doctors will be happy to help you.

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