Deep Brain Stimulation Treatment Cost in India

In this procedure a thin electrode of metal (the diameter is as small as a spaghetti) is placed in the brain which is identified by the surgeons and the electrodes are attached to a computerized pulse generator which is then implanted under the skin right below the collar bone in the chest. All the parts of the system are kept internal with no wires coming out in the open. For the purpose of optimal symptom control, a programming computer is held very close to the skin over the pulse generator which is used while going for routine office visits. Unlike gamma knife radiosurgery and any other lesioning procedures, deep brain stimulation will not destroy any brain tissue. It rather acts by altering the abnormal functions of the brain tissues in the region of the stimulating electrode. This therapy requires some amount of time investment before it starts showing its optimized effects.

DBS is not a cure for disorders related to movement but then it can treat the symptoms arising as a result of that by disrupting the abnormal patterns of brain activity that become prominent in these kinds of diseases. It is also called brain “pacemaker” due to its generation of electrical pulse charges to stabilize the normal brain rhythms and thereby it restores normal movement. The neuromodulation mechanisms are still not clear.

Any patient who can benefit from this surgery should go for it and not wait for years with painful enduring days to be diagnosed with a movement disorder. One may not require trying all combinations of medication before going for DBS. The procedure is aimed at improving the quality of life so it can be opted at any time when one thinks their quality of life is getting compromised. Some of the diseases given below are considered for deep brain stimulation.

Parkinson’s disease:  In this case, the patient will suffer from tremors and numbness in hands and fingers.  Important symptomatic relief is provided by DBS.

Dystonia: It does not cure the problem but can bring about relief in the movements and postures in dystonia. The benefits will vary depending upon the duration of the symptoms and the type of dystonia suffered by the patient. The effects will be milder for patients who have suffered dystonia as a result of a stroke or head trauma. Adults suffering from this condition will enjoy fewer benefits compared to those who have experienced a recent onset of the symptoms.

Meige Syndrome: This is a combination of two forms of dystonia: blepharospasm and oromandibular dystonia.

Essential Tremor: DBS is considered highly effective for this and often leads to an 80 percent decrease in tremor which can last for several years. Patients suffering from tremors as a result of stroke, traumatic brain injury or multiple sclerosis may not benefit so much, but surgery may improve the quality of life if hopes are true.

If the patient is a victim of diabetes and blood pressure, then it is highly advisable to keep them in control just a few weeks before the surgery and follow all medications strictly. Medications to control the symptoms of tremor or Parkinson’s diseases should be carried along with them since many times the symptoms may help surgeons test the electrode's position intraoperatively during the procedure.

Placement of the DBS electrode, while the patient is awake, using a stereotactic frame, has been the most standard way of operating for more than a decade. The surgical method is basically referred to as frame-based stereotaxis and this is also considered a traditional method for approaching deep brain targets by opening the skull through a very small opening.

Just before the start of the surgery, a very rigid frame is attached to the head of the patient and the skin is anesthetized with the help of local anesthetic. Now a brain imaging study is done with the frame in place. Multiple images are studied closely to calculate the exact position of the brain target and then devices are guided inside the brain causing as little trauma as possible.

An intravenous sedative is given in the operating room. A Foley catheter is placed in the bladder and the stereotactic frame is rigidly fixed to the operating table and a patch of hair is shaved off from the head where the opening has to be done. The scalp is washed and after making the scalp totally numb an incision is done on the head top and behind the hairline. A small opening is formed which is less than the size of a quarter in the skull to proceed further. If there are requirements of implantation on both sides, a skull opening is done on both sides. This is done before the sedation is stopped and the patient is made to remain awake.

Brain cell activities in the region of the intended target are recorded by making use of thin microelectrodes. In this way, it is ensured whether the fine adjustments are correct, or some amount of change is done in a region of 2 mm in the intended brain target to try and find out the optimal region or location in the brain tissues. If the patient is not cooperative and calm during the brain mapping activity, then the procedure has to be stopped. The surgical team listens to the distinct pattern sounds of neuronal activities that indicate the recording electrode's location by placing electrical signals of the brain over a speaker. Since each person's brain has been designed differently the mapping time will range from 30 minutes to even two for any one side of the brain.

The permanent DBS electrode is implanted and tested after the correct target site is confirmed by the microelectrode. The testing aims at focusing on unwanted stimulation-induced, side effects and does not really focus on the relief of motor symptoms. Unwanted effects are quickly recognized when they develop rapidly but the beneficial effects of stimulation can take hours to days to develop. During training, the system is deliberately calibrated at a very high intensity to create unpleasant stimulation-induced side effects such as tingling in the legs and arms or pulling feeling in the face and tongue, or speech problems. The sensations induced during the test period at high stimulation intensities are experienced as bizarre but may not be painful.

Asleep Interventional MRI-guided DBS

In some of the hospitals, the procedure was also conducted with the patient asleep in an MRI scanner instead of being awake in the operating room. Without the placement of a frame on their heads, Parkinson’s diseases and dystonia patients can undergo surgeries nowadays. This kind of procedure if suitable for

• Patients whose target in the brain is the globus pallidus (GPi) or subthalamic nucleus (STN).
• Patients who are considered to be too symptomatic to undergo awake surgery
• Patients who feel anxious and scared to undergo awake surgery
• Patients with pediatric movement disorders.

DBS surgeries do not require more than one-night stay and patients can leave for home the next day. Once the patient is at home, the medications to control the symptoms for tremor and Parkinson’s disease must be continued. After the surgery, the DBS will not be on the right and the battery will be implanted a week later. This is performed under general anesthesia which requires no hospital stay. A healthy diet is required, and patients are advised to walk but to carry less weight in the first month. After one-month regular operations can be restored slowly.

Apart from drugs and therapy, spinal relaxation is the latest way to keep the brain apart (not involved) and to aid recovery by relaxing the spinal cord. Spinal stimulation is already being used for other treatments, but now the brain stimulation is being replaced and this can be a safer process.