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Deep Brain stimulation for Parkinson’s disease

Parkinson’s disease (PD) is a progressive, neurodegenerative disease. Parkinson’s disease most often occurs after the age of 50 and is one of the most common nervous system disorders of the elderly. The disease is caused by the slow deterioration of the nerve cells in the brain, which create dopamine.

Parkinson’s disease affects men more commonly then women, with an average age of presentation being 60 years. A variant of this disease may start earlier in the fourth decade, and it is called “Early onset Parkinson’s disease”. People with PD have about the same life expectancy as the normal population, however the quality of life may become progressively poor as the disease progresses and hence Deep Brain Stimulation Surgery will be required.
Parkinson’s disease likely results from multiple interacting inherited (genetic / familial) and environmental factors that set the disease processes in motion. Around 5 percent of cases are hereditary in the classic sense that if one or both parents have it, their children are at higher risk. But in the vast majority of cases, no obvious familial link is present. Instead, it is believed that there are a variety of triggers, including exposure to toxins and severe head injuries.

What are the symptoms of Parkinson's disease?
•    Tremor. Your tremor, or shaking, at rest usually in form of a back-and-forth rubbing of your thumb and forefinger known as a “pill-rolling tremor”
•    Bradykinesia- Slowing of movements. Parkinson's disease reduces your ability to move around and slows your movement. It makes simple tasks difficult and require progressively longer time. While walking steps become shorter, and even simple motor functions like getting up from chair becomes difficult. While walking feet's drag and turning becomes very slow and difficult. 
•    Rigid muscles. Muscles become rigid and may occur in any part of your body.
•    Impaired posture and balance. While standing, posture becomes stooped, and balance becomes impaired due to muscle tone.
•    Loss of automatic/spontaneous movements.  Movements that are performed subconsciously, like blinking, smiling or swinging of arms while walking diminish. Your gestures when talking, smiling decrease and It appears as if a person is wearing a mask.
•    Speech changes.  Speech becomes soft, quick, with slurring or hesitation in talking. Speech may be more of a monotone rather than with the usual intonations. A speech-language pathologist may help improve your speech problems.
•    Writing changes. While writing, alphabets become small and fluency decreases.

Medications greatly reduce most of these symptoms. People with Parkinson's disease have low brain dopamine concentrations.

Diagnosis
Essentially based on clinical features of the patient. However, imaging of the brain may be done to rule any other disease.
Treatment
Medical management is the first line of therapy for this disease. Carbidopa-levodopa combination is the mainstay of the medical therapy. One may have significant improvement of your symptoms after beginning Parkinson's disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled.
Deep brain stimulation
In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of the brain. The electrodes, which are connected to a generator implanted in the chest, send electrical pulses to the brain, which can help improve many of the symptoms of PD and reduce the need for levodopa. Deep brain stimulation surgery in Delhi NCR is most often used in the late stages of the disease after levodopa is no longer effective.

Patients likely to respond better with surgery
        Shorter duration of surgery
        Younger patients
        Good clinical improvement with Levodopa.

Important Things to Know About Deep Brain Stimulation Surgery in Delhi NCR

Patients’, who do not show improvement in clinical symptoms with levodopa, are not good candidates for surgery.
The degree of improvement obtained with a supramaximal dose of levodopa after overnight withdrawal of antiparkinson medication is highly predictive of the response to deep brain stimulation. Patients who have good clinical response to Levodopa-carbidopa combinations initially, but with time the clinical improvement lasts for significantly shorter periods are good candidates for surgery.

Deep Brain Stimulation Surgery in Delhi NCR  is performed with the patient awake to facilitate feedback as to the beneficial and adverse effects of microstimulation and macrostimulation. First, a stereotactic head frame is fixed to the skull to establish a 3D coordinate system. This is carried out by making the local area numb.
 
With this head frame in place MRI of the brain is done to calculate the coordinates of the target for stimulation. During surgery, electrical activity is recorded at the approximate target site and analyzed. While being operated, you would be asked to do multiple motor movements to assess the stimulation effects and side effects.  The target nucleus has some characteristic pattern of electrical activity that can be picked up by the recording electrodes. The stimulating electrode is passed to the designated target as identified by electrical recordings. Subsequently the patient is put under general anesthesia, to place the battery under the skin and connect it to the electrodes through a tunnel under the skin


Battery for the stimulation may be either rechargeable, or non rechargeable. The battery usually lasts between 2 and 5 years. The battery life varies depending on the settings needed to control your symptoms.
The Activa RC (Medtronic inc., USA) is a rechargeable IPG and will last up to 9 years. Your DBS programmer should periodically check the battery life and inform you as to when the neurostimulator needs to be replaced. Devices such as the Access Review can also be used to check your battery. When the battery life is approximately 10% or less, it is recommended that the battery be replaced.


Cost of procedure in India-  $23000-30000
Cost of procedure in USA-   Each DBS surgery can cost between $35,000 and $50,000 and upwards of $70,000 to $100,000 for bilateral procedures. These estimates include the cost of the surgery, devices, anesthesia, hospital fees, and physician fees.

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