Overview of Deep Brain Stimulation (DBS) Surgery in India and Its Benefits

What is Deep Brain Stimulation?

Deep brain stimulation (DBS) is a neuro-surgical procedure that treats various neurological symptoms that are disabling. DBS involves implanting a medical device that is battery operated and similar to a pacemaker. It is called a neuro-stimulator and it has the size of a stopwatch. This device sends electrical signals to specific areas in the brain that are responsible for movement disorders. DBS is mainly used to treat the symptoms of Parkinson's disease (PD) such as tremors, stiffness, rigidity, slow movement, and difficulty in walking. DBS can also treat other disorders such as essential tremors, dystonia, chronic pain, major depression, and obsessive-compulsive disorder.

How does Deep Brain Stimulation Surgery work?

The brain function of people with PD is disrupted by electrical feedback loops that are out of balance. Some parts of the brain are overactive while others are underactive. This causes normal muscle movements of arms and legs to be replaced by tremors, rigidity, and slowness in Parkinson's Disease. By using neuro-stimulators to deliver electrical stimulation to deep brain structures, it is possible to block the abnormal signals that occur between these structures. This does not cure PD, but it helps rebalance the brain's electrical activity, which can reduce the main motor symptoms of PD. The DBS system consists of 3 parts- the lead/electrode that is implanted in the affected brain region, the extension, which is a wire that goes under the skin to the neurostimulator and the battery/neuro-stimulator which is implanted under the skin of the collarbone or abdomen. Unlike older surgeries that destroyed small areas of brain tissue, DBS works by interrupting electrical signals from targeted brain areas.

Who should undergo DBS Therapy?

• Patients who have had PD for more than 5 years and have tremors or other movement symptoms that are not well controlled with medication.
• Patients who experience intolerable side effects of Parkinson's medications such as frequent on/off fluctuations
• Not everyone is eligible for DBS- the person's mental state and general health conditions are also considered. It is important that a movement disorder expert or an experienced neurologist be consulted.
• Individuals with dystonia (muscle tone disorders) do not respond to DBS in the same way as those with other movement disorders. It is seen that people with PD quickly respond to DBS treatment. In patients with dystonia, improvement may take days, weeks, or even months. DBS does not necessarily eliminate the need for subsequent drug or botulinum toxin treatments.

When should DBS surgery be considered?

Some doctors recommend surgery for individuals with mild PD, which is thought to delay the progression of the disease. However, there is not enough evidence that proves the delay of disease progression or protection of brain cells. Surgery may prove beneficial in improving the quality of life of people with PD who have entered the phase of dyskinesias, i.e., impaired voluntary movement. At some Indian centres, potential DBS therapy candidates have to undergo a simple test aimed to predict the results of surgery. This test is called the 'levodopa challenge'. The person with PD is given a dose of levodopa (or sometimes apomorphine), and the improvement that follows the dose is used to estimate the potential benefit of DBS.

Each person with PD is unique and their goals for surgery are different; some want to reduce tremors while some want to reduce dyskinesia. It is very important that individuals opting for surgery have a clear idea as to what can and what can't be fulfilled using DBS.

DBS Procedure

DBS involves implanting electrodes inside deep structures of the brain, such as the subthalamic nucleus; this part is often done with local anaesthesia so that the team can test the electrodes. These electrodes are then connected to the implantable pulse generator, which is placed underneath the skin through connecting wires; this too is performed under general anaesthesia. The device is then programmed by the medical team, and individuals can use a patient programmer to check it or switch it on and off. The stimulation of these brain nuclei can improve the symptoms of PD.

DBS Procedure- Step by Step

1. The head is shaved, and the head frame is attached to the skull.
2. Magnetic resonance imaging is performed for brain mapping.
3. Two small holes are made in the skull; anaesthesia is used, and any pain is managed with medication.
4. Electro-physiological brain mapping is done using a microelectrode.
5. The deep brain stimulator is then inserted into the brain.
6. Implantable pulse generator is placed in the chest wall and connected through a wire in chest, tunnelled under the skin of neck, and connected to the deep brain electrode at the scalp.

Recovery times vary; many people go home within a few days of surgery, and the device is programmed over the following weeks.

Why DBS Surgery?

DBS surgery offers several advantages and can improve the quality of life of suitable patients. Some of the benefits of DBS surgery include:

• The risk of serious brain injury is low, but like any surgery, DBS has risks such as bleeding, infection and problems with the device.
• DBS is adjustable, and the stimulation can be switched off.
• Good improvement in quality of life generally observed after this surgery; this includes people at both 'on' and 'off' stages of disease.
• Stimulator adjusted according to individual's need.
• Many individuals experience relief from PD symptoms
• Medication doses can often be reduced, which can reduce their side effects

DBS surgery in India

Indian neurologists and neurosurgeons include many experienced specialists. Many Indian doctors and healthcare professionals have trained or worked at leading hospitals abroad and handle such delicate and complicated cases. Today India is a popular medical tourism destination, with treatment costs much lower than in many other countries. People from different countries travel to India to seek medical treatment because these advanced facilities are either too expensive or unavailable in their own country. Indian hospitals are well equipped with world class amenities and infrastructure. Quality accommodation options with all required amenities to help you during and after procedure are also readily available in India.

DBS surgery cost in India

The cost of DBS surgery in India can vary depending on several factors, such as the type of implant, the location of the hospital, the surgeon's experience and qualifications, and the patient's individual medical condition. DBS surgery cost in India starts from about USD 18,000, which is considerably lower than the cost of DBS surgery in countries like the USA or the UK, where it can cost several times more.

For more information about DBS surgery in India and help in choosing the Best Hospital for DBS surgery in India, write to us at info@indicure.com or WhatsApp us at +91-932-003-6777.