tremor,dyskinesia,rigidity,disease,surgery

	Mr.Indrajeet Basu Flat SF-A,87/5/1C Raja S.C.Mullick Road, Calcutta-700025. Ph + 91(033)4303847(Res.)+ 91(033)3596026(Off.) E-mail:basuindra@hotmail.com
This 38 years old resident of Calcutta, engineer by profession had advanced Parkinsondisease for last 12 years. His symptoms started from right side in the form of tremor in the limb and difficulty in walking which gradually progressed to involve the other side also. In off stage he had tremor, rigidity and bradykinesia and freezing. He was unable to dress and undress himself and without help he was unable to turn to side. His symptoms were more marked on right side. In on stage he had severe dyskinesia mainly on to the right side. Sometime the dyskinesia would last for one to one and a half-hour. He was subjected to Deep Brain Stimulation Surgery on 3rd January 2001. Both sides subthalamic implantation was done and later on they were connected to Kinetra (Pacemaker). He has shown significant improvement after surgery. There is no tremor on both sides of his body, rigidity is reduced considerably There is no dyskinesia, there is no freezing and he does not require help for his day to day activity. Most of the time he remains on. He is provided with a programmer by which he can reduce/ increase the voltage as and when required. His medications have been reduced to half and according to him his improvement in day to day activities would be in the range of around 70% .
	Priya Kuruvila C-33 I.F.S.Apartments, Mayur Vihar Phase1, New Delhi-91 India. Ph +91 (011) 2490041. E-mail:priya50@bol.net.in
This 55 years old lady, wife of Late-admiral presented with difficulty in doing work from left hand along with tremor and stiffness that gradually progressed for last seven years. Her symptoms were more on left side as compared to right side along with on and off phenomena and freezing. She had severe dyskinesia predominantly on to the left side with no clear-cut pattern. She was operated on 18th October 2000. Both sided subthalamic implantation were done. She has responded very well to surgery. At the moment she has no freezing, no dyskinesia and her medications have been reduced significantly. Although she is advised not to drive but off and on she makes successful attempts to drive.
	Mr.I.S.Kakkar 23, Meadow Hill, New Malden,Surrey KT 35 RQ, England.
This 78 years old N.R.I. was diagnosed as a case of essential tremor. His illness started 20 years back from right hand in form of tremor and difficulty in writing which gradually progressed to involve the left hand also. Till the time of surgery he was having severe tremor on both hands, because of which he was unable to write, drink and eat. He was subjected to Deep Brain Stimulation (VIM thalamic Implant) on both sides. Now he has 90% tremor control on right hand and 100% tremor control on his left hand. He is able to do his work. He can write, sign cheque, a task that was not possible before surgery.
	Mr.A.P.Singh 6, Professor Avenue Pakhowal Road, Ludhiana,Punjab India. Ph + 91(0161) 560464
This 51 years old, resident of Ludhiana was a army personal 10 years back but he had to take retirement from the army because of the Parkinson disease which he had for last 10 years. In the initial stage he could cope up with the disease but gradually the disease has progressed and for last 5 years he was confined to bed. In off stage he was unable to perform any act because of tremor and associated rigidity and freezing while in on stage he has severe dyskinesia (Abnormal movement because of medications) lasting till the effects of medicine last. He was subjected to both sided Subthalamic implants in September 2000. At the moment he is much better. According to him he is fit for job. There is significant reduction in his medications and now he has no more dyskinesia.
	Mrs Shanta Kumari W/O Dr. Vimal Kumar, Medical Officer PHC Andhrathari, Madhubani, (Bihar)
This forty years old housewife of Madhubani Bihar had advanced Parkinson disease for last nine years. Her symptoms started from right side in the form of rigidity in the limb, backache and difficulty in walking which gradually progressed to involve the other side for last one and a half-year. In off stage she had mainly rigidity, bradykinesia and freezing. She had mild tremor. She was unable to dress and undress herself, unable to walk and without help she could not turn to side. Her symptoms were more marked on right side. In on stage she had severe dyskinesia on right side lasting for more than an hour. She had off and on phenomena, either she remained dyskinetic in on stage or would remain totally off. She was subjected to Deep Brain Stimulation surgery at this Hospital on 23.4.2001. Both sides subthalamic implantation She has shown 60-70% improvement in off stage. There is no dyskinesia in on stage and there is no freezing .She does not require help for his day to day activity..Her medications have been reduced significantly.
	Mr. Vishwanath Bhamri Tobacco Merchant, Old Galla Mandi Teekamgarh (M.P.) India Ph +91 07683 33144 + 91 07683 32389
This 55 years old, resident of Teekamgarh had advanced degree of Parkinson disease for last 10 years. His symptoms were bilateral with freezing; rigidity and drug induced dyskinesia. His L-dopa doses went up to 2000 mgs in 24 hours. He was subjected to left Pallidotomy Parkinson Disease on 26th April 1999. His symptoms improved after surgery on right side. For left-sided symptoms and freezing he was subjected to right STN implant on 20.1.2000. He is better after surgery. His medicines have been reduced to half and his left-sided symptoms have improved significantly.
	Mr.Rajesh Sharma H.No. 610 Ashok Nagar Jammu Cantt., India Ph. 0191- 436602
This 36 years old male patient had parkinson disease diagnosed in 1989 when he noticed tremor and rigidity on left side of his body. Gradually he developed Slowness. Initially he responded very well to sinemet, the dose of which gradually increased. He developed drug induced dyskinesia since 1995. Presently he has severe on and off fluctuations and severe dyskinesia lasting till the effects of medication. He has severe freezing and retropulsion. He is unable to tolerate sinemet more than three tablets of 275 Mg. He was subjected to deep brain stimulation(Subthalamus) on 2oth March 2002. After surgery his medications has been reduced to half. There is no freezing and dyskinesia. According to him he is 60 - 70% improved after surgery.
	Mukesh Maheshwari 47 years Male Jai Hind Medical Store Tilak Chowk Vidisha, Bhopal (M.P)
This 47 years old person had onset of disease 7 years back in form of tremor in the left hand which gradually progressed to difficulty in walking and for last 2 years he develop frequent freezing and tremor on the right side also. He was subjected to bilateral Subthalamic stimulation with Kinetra implantation on 2.9.2003. After surgery and subsequent follow-up he improved by 80% in tremor control. There is no freezing and he totally independent in all his activities
	Manika Bisht 14 years Female spasticity due to head injury
Manika Bisht 14yrs/F had severe head injury on 5th july2002. She was in coma for 36 days and remained hospitalized for four months. She recovered her consciousness gradually over a period of year. After recovery she developed severe spasticity (stiffness) on both upper and lower limbs, more on right side. She was given all oral medications to reduce the spasticity but there was not any significant improvement. She remained confined to bed and wheelchair. Later on she developed severe painful spasms in the limbs, which were resistant to all medications. Intrathecal trial bolus of 35ug baclofen was given and patient responded very well. Her stiffness and spasms were subsidized totally. She was advised by Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, New Delhi.to undergo implantation of Synchromed-II intrathecal baclofen pump. The implantation was done on 02/11/04.Patient responded remarkably to the therapy. Intrathecal baclofen infusion of 30ug/day resulted in relief of spasticity and painful spasms. She is now able to sit comfortably, stand with support, improvement in overall activities of daily living. Mr Sanjeet Sandhu 25 years Male resident of UK SPASTICITY PATIENT STORY
Mr. Sanjeet Sandhu met with a road side accident in summer of 2001.He noticed tremor in the left upper limb after 6 weeks of injury. Gradually his symptoms progressed. He became more lethargic and became fatigue easily. Patient developed stiffness, difficulty in walking and balance problem. The symptoms progressed very rapidly and for last 6 months he was on wheelchair and even on wheelchair he required assistance. He was put on all anti-Parkinson’s medication and on oral baclofen at highest dose without any significant improvement. His MRI was normal. He was diagnosed to have Parkinson’s plus syndrome. He was told that no therapy could benefit him. He was brought to India at VIMHANS, New Delhi in the month of Oct2004.After detailed evaluation it was decided that if his stiffness can be reduced he would be more manageable. Trial bolus of Intrathecal baclofen 50ug was given and he responded very well and rigidity (stiffness) reduced significantly. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 28/10/04. Implantation of Synchromed-II intrathecal programmable baclofen pump was done. He responded very well to therapy. At the time of his departure from INDIA patient was walking with minimal support. His family was happy. Intrathecal Baclofen therapy improved his quality of life and activities of daily living.
Mr. Raja Ram 58 years Male PATIENT STORY OF BRACHIAL PLEXUES INJURY
Mr Raja Ram 58yrs/M had an road accident in Oct 2003,followed by weakness of right upper limb. After one week of injury he reported excruciating pain in right upper limb. His NCV revealed right Pan brachial plexus injury. He was operated at VIMHANS, New Delhi. Microsurgical neurolysis was done on 13/08/04 which did not improve his pain He was lateron subjected to two successive stelliate ganglion block, which also could not improve his pain. The pain was so bad that patient wanted his right upper limb to be amputed as early as possible. On 1/09/04 he was given a trial bolus of intrathecal morphine. Patient gets immediately pain relief for a day. He was advised to undergo implantation of intrathecal morphine delivery pump. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 2/09/04. Patient responded very well and has complete pain relief till date. Patient is on only 1.9mg/day dose. Of morphine infusion.

For more details contact Dr.Alok Gupta at
guptaa@ndf.vsnl.net.in , guptaa@parkinsonindia.org