Doctor’s Opinion

Background
Have you noticed anyone around you having some movement problems, like tremors in fingers, or locking of legs? Have you seen anyone having problem is doing simple tasks like buttoning the shirt, holding the glass or tying the shoe laces. Or anyone speaking in a slur voice and often hesitating before speaking. Well, if your answer to anyone of this is ‘yes’, then read on.

The sad part is that, the person may be suffering from some nervous system disorder like Parkinson’s disease. And still worse, as of now there is no cure for this.

How DBS works?

The main reason behind the Parkinson’s is the decrease in the dopamine level inside our brain. This lower level of dopamine causes abnormal activity in the brain. In Deep Brain Stimulation, a small electrode is implanted into a specific area of the brain, where it delivers short pulses of electricity. These electrical pulses alter the patterns of activity in the brain responsible for the disease symptoms.

This technology is quite similar to the one used in pacemakers for heart. In fact, the two devices are so similar in design, that DBS devices are commonly known as “brain pacemakers”

DBS Procedure:

PThis surgery involves implanting a thin wire with electrodes at the tip. The electrodes can be precisely controlled to target the affected tissues. Then, high frequency electrical stimulation are delivered through these electrodes. These stimulation alter the abnormal signals, thereby resulting in improvement in the symptoms.

Pre-Surgery Procedure:

Prior to the surgery, the patients are subjected to some tests to enhance the success rate of DBS. The tests include brain MRI scan, neuropsychological testing, videotaped evaluation of movement both on and off medication, and others if required.

The MRI Scan and the intro-operative micro electrode mapping helps in precise placement of the electrodes. Then, the wire is connected to the neuron-stimulator power supply (a battery-operated generator), which is placed under the skin near the collarbone.

Once the electrodes start stimulating the high-frequency impulses, they start blocking the faulty signals in the brain, which are responsible for causing tremors and other movement symptoms. In simple words, they help normalize abnormal impulses. And, all this is done, without any damage to healthy tissues.

Who Should Consider DBS ?

Patients, who are not getting the desired benefits from medication, should seriously consider Deep Brain Stimulation therapy. Patients, who are finding it more and more difficult to do routine work, should consult a doctor to see if DBS is the right treatment.

Specifically speaking, the following categories of patients, must consider going for DBS:

Medicines are no longer helping as quickly or as effectively as desired.

Medicine dosage required is going up

Medicines are resulting in side-effects like hallucinations and/or dyskinesias

The side effects of medication have become intolerable.

Life After DBS

Though like most of the treatments, different patients respond differently to Deep Brain Stimulation.In most cases, results are noticed shortly after the initial programming of the DBS. However, it may require few visits to adjust the settings for optimum results without side effects. These can continually be updated as your symptoms change over time.

Since the experiment days, positive treatment results have been observed. Tens of thousands of people worldwide who have been implanted with a DBS device, are a testimony to this. That’s no wonder, that in 2002, the Food and Drug Administration (FDA), has approved Deep Brain Stimulation, as the standard treatment for several brain disorders including, Parkinson’s.

A word of caution. Since it is not a cure, medication may still be required, but with DBS, patients have been able to reduce medication dosage. It should be noted that DBS will not alter the progression of conditions like Parkinson’s disease or essential tremor.

Here comes the good news!Over the past few years researchers have done lot of work and have developed a therapy that replaces the complex and risky brain surgery (Lesioning Surgery) or the treatment with levodopa, which was found to have serious side-effects over a period of years.

In 1980’s, the experts found that the desired effects of the brain surgery minus the side-effects could be achieved by stimulating the affected tissues with harmless pulse of electricity. This therapy is called Deep Brain Stimulation (DBS)”.

This was a path-breaking find, because unlike the brain surgery, the effects of electrical stimulation are completely reversible. As soon as, the stimulated is turned off, the brain resumes normal functioning. Also, just like any drug, doctors could monitor the stimulation and target it at the intended part and to the extent required.

Patients with Parkinson’s and other movement disorders have shown great improvement with Deep Brain Stimulation. Though the disease is not cured completely, but it reduces the muscle tremors and restores control over movements to a significant level.

Name: Dr Sujith Ovallath

Designation: Associate consultant at Aster MIMS, Aster Medcity | Director, James Parkinson’s Movement Disorder Research Centre, Kannur medical college

Qualifications: Fellowship in Movement Disorders (Pacific Parkinson’s Research Institute & UBC Hospital, Vancouver, Canada) | DM in Neurology (Govt. Medical College, Calicut) | DNB in Neurology (National Board of Examinations, New Delhi) | MD in General Medicine (Govt. Medical College, Calicut) | MBBS (Govt. Medical College, Calicut)

Contact: sujithok@gmail.com

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