Parkinson’s Disease is a disorder that affects the CNS or Central Nervous System. It causes a wide range of motor disabilities that affect movement, gait, balance, stability, expression and speech. There is no permanent cure for the ailment, and the patient gradually progresses through advanced stages of the disease with pronounced symptoms. Medication is given to help control the symptoms so that the patient can live a better quality-of-life. In recent years, Deep Brain Simulation has emerged as a breakthrough in treating brain-related conditions including Parkinson’s disease. In this article, we will learn more about it.
The brain is made up billions of cells called neurons that communicate with each other and with the rest of the body, to achieve a wide range of voluntary and involuntary activities desired by the person. Chemicals called neurotransmitters are used by the brain to control how the neurons communicate with each other. One such chemical is dopamine, the most important among all neurotransmitters.
Parkinson’s Disease (PD) is an ailment which causes a drop in dopamine levels as well as deterioration in a specific area of the brain called basal ganglia. As a result of these two developments, all those abilities controlled by this area of the brain, are deeply impacted. While movement-related symptoms are easily noticed by everybody, there are a whole lot of non-motor symptoms also. Some of the known symptoms are:
Deep Brain Simulation (DBS) is a neurosurgical procedure in which electrodes are implanted in the brain to simulate, reactivate, and manipulate how certain regions of the brain work. The logic is that, neurological conditions are caused by disturbed or disorganized electrical signals that travel back and forth between neurons in the brain and other parts of the body. If an electrical device can send out small electrical signals on a continuous basis to the affected areas of the brain, some of these disturbed neuro-signals can be corrected to a significant extent.
The procedure started off as an experiment done in 1987 to treat Parkinson’s related tremors. The US Government body, FDA, approved the same in 1997. Thereafter, DBS has been used successfully to treat a range of neurological conditions other than PD such as non-PD tremors, conditions such as Meige syndrome that cause dystonia (repetitive and continuous twitching, spasms and cramps of muscles in different parts of the body), epilepsy, Tourette syndrome (repetitive movements, unwanted sounds, offensive language) and Obsessive Compulsive Disorder (OCD) which is a behavioural disorder. Its also being evaluated to treat Huntington’s Disease, obesity, chronic pain, addictions, cluster headache, depression and dementia.
In recent years, DBS is becoming increasingly popular with PD patients and their families. It comes with its own risk of complications and side-effects; and patients can never fully return to a normal, healthy life. However, the benefits outweigh the disadvantages. For example, PD patients who are undergoing DBS from a long time show marked improvement in their quality-of-life. They are able to eat and use the bathroom on their own, their quality of sleep improves, their pain and urinary urgency reduces.
DBS is not just as simple as implanting electrodes and being done with it. Since we are talking of manipulating areas of the brain, it has to be done very carefully. Else, there can be complications, or the desired outcome may not emerge. So, a series of investigations and evaluations of the patient, and consultations with medical teams, will be involved. The patient and his/her family members must be able to commit time for all these. So, people who live far from the hospital where DBS is offered, must factor this in the decision.
Once the electrodes are implanted, the electrical signals must be programmed and re-programmed again and again over a period of time, so that the desired outcomes are achieved. It is similar to modern-day technologies like machine learning and data sciences where the device/equipment must be ‘trained’ over time to behave in a particular way. In this case, that device is the brain. Some patients or their family members who are impatient for quick results may not be able to appreciate the rigours involved in this process.
The procedure is fairly costly in India as of now, and some insurance companies may not cover the same. These should also be factored in the decision. However, reputed hospitals like Kauvery Hospital offer the same at reasonable prices, and handhold patients’ families through all the formalities.
In short, while some patients or their families may opt out of DBS because of the above factors, most of them choose to go ahead because of the positive outcomes involved.
When it comes to the patient profile
DBS is undertaken for patients:
DBS is not undertaken for patients:
DBS involves two surgical procedures, one to implant the electrodes in the brain, and the second to implant the neurotransmitter under the skin, near the collarbone. These 2 surgeries are done some days apart. The first surgery to implant electrodes in the brain is of 2 types:
Initiating a DBS therapy follows the below sequence:
This is done under general anaesthesia. The neurostimulator is inserted under the outer layers of skin just below the collarbone in most cases, or in the chest or abdomen sometimes. Then the extension wire from the lead is attached to the neurostimulator.
After both surgeries, the patient stays in the hospital for 24 hours. In this duration, the vitals are monitored and side-effects of anaesthesia if any are noted and taken care of.
Essential tremor is a neurological condition in which there is rhythmic and involuntary shaking (tremor) of the hands and legs. DBS helps regulate the brain signals that cause trembling. While DBS cannot cure tremors completely, it can reduce tremor symptoms hugely. Almost 90% of people with tremor who underwent DBS showed moderate relief from symptoms.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
