Q. Is the Deep Brain Stimulation procedure: a cure for Parkinson disease ?
Deep Brain Stimulation is not a cure for Parkinson disease. It improves the quality of life, improves tremor, stiffness, freezing and drug-induced dyskinesia associated with the disease. After Deep Brain Surgery the requirement of medications reduces by 40-50%. We expect 60-70% improvement in quality of life. This therapy is reversible, programmable and does not preclude new therapies in future.
Q. At what time in the stage of the disease parkinson surgery is indicated ?
In advanced stage of Parkinson disease when patient has developed drug induced side effects like dyskinesia, hallucinations and when despite adequate medications a person is incapacitated for performing his day to day activity, surgery is indicated.
Q. Is there any risk in this surgery and how long the effect of Deep brain stimulation will last ?
As such the risk of Deep Brain Stimulation surgery is less than 1%. There can be possible risk of Mechanical malfunction, infection or bleeding. We have one patient who had infection in our series of 500 procedures performed. Normally the life of I.P.G. (battery) is five years and after that new battery replaces it. The brain electrodes will remain in position for life long. The rechargeable implant would last for 10-15 years.
Q. How many surgeries have been performed by you for movement disorder ?
We have performed more then 500 Deep Brain Stimulation and 55 Brain Lesioning procedures( Pallidotomies) for Parkinson disease Essential tremor and various other indication.
Q. After deep brain Stimulation how frequently one has to come for programming ?
After surgery initial programming is done by the neurologist at the time of operation. After that once in three month time programming would be required initially and later-on it would be need based. Minor setting will be done by patient himself by the hand held programmer given to the patient . Programming at distant places can be arranged by local Medtronic representative anywhere in the world.
Q. What are the cheaper alternatives to Deep Brain Stimulation surgery for movement disorder ?
Patients with advanced Parkinson disease and Essential tremor can be subjected to Pallidotomy/Thalamotomy. The cost of this therapy is around 3 Lac (4000-5000$). But the beneficial effects do not last for more than 2-4 years. However Pallidotomy has long lasting effect on dyskinesia. The risk of neurological deficit is more in lesioning.
Q. Are there any electrical devices that I need to avoid?
The most basic household electrical equipment is safe to use after a Deep Brain Stimulation Surgery. Some high power industrial machinery could be dangerous.MRI should be performed under supervision of company representative. Patient who had implant should avoid diathermy machines used in physiotherapy, Dental drill and Monopolar cautery should not be used in surgery. Bipolar cautery can be used.
Q. What are the other diseases where Deep Brain Stimulation therapy is effective ?
Other than Parkinson disease and Essential tremor this therapy is effective in Dystonia, Obsessive compulsive disorder, intractable epilepsy. Future use of this therapy would be for depression and Alzheimer’s disease.
Q. What is your experience in deep brain stimulation for epilepsy
DBS is very effective in cases of refractory epilepsy where open surgery cannot be done. We have started doing this surgery since 2012 and 8 cases have been done. Two pts are seizure free and remaining has 70-80% seizure control. This Surgery has no risk and complication related to open surgery as we are not damaging any part of brain . Since battery consumption is more we normally use rechargeable implant in epilepsy.
Overall, DBS is a very effective method to reduce symptoms of tremor and movement disorders and return to normal life as soon as possible.
Q. What is your experience in deep brain stimulation for OCD
We have started doing deep brain stimulation for OCD since 2010 and we are following our patients and they are better by 60-70% and their requirement of medications have gone done. They are in better state and living a comfortable life after surgery. They have symptoms but are manageable with medications.
In OCD we use rechargeable implant in view of more power consumption.