The cost of Deep Brain Stimulation in India starts from USD 25000 (INR 18,57,000), it varies with choice of hospital and the city. The deep brain stimulation treatment costs around $70000 in the US and around $60000 in the UK, which is way more than what it costs in India.
Some of these factors include:
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Deep brain stimulation is a Food and Drug Administration (FDA) approved therapy for the treatment of certain movement and neurologic disorders including:
DBS therapy is a surgical procedure used to control the symptoms of certain neurological disorders, especially Parkinson’s disease. Some of the Parkinson’s disease symptoms that are relieved with the help of deep brain stimulation therapy include tremors, walking problems, rigidity, slowed movement and stiffness.
Deep Brain Stimulation is classified under neurostimulation-based treatment which can also help control symptoms of conditions such as refractory epilepsy, chronic pain (central pain syndrome), obsessive-compulsive disorder (OCD), Tourette’s syndrome, and some major depression-related disorders.
It received FDA approval in 2009, under its humanitarian device exemption, for use in cases of treatment-resistant OCD.
Deep brain stimulation is being studied deeply for its potential use and benefits in the following conditions:
The major advantage of DBS surgery is that it does not cause damage to the brain tissue, like, other procedures such as pallidotomy or thalamotomy. And the DBS procedure can be reversed.
DBS has been found to be effective in reducing dyskinesias, the uncontrolled wiggling motions resulting from the use of high doses of medication. DBS surgery is not a permanent cure, but it helps to provide relief from the symptoms and reduce their severity so that medication doses can be lowered for better management of the underlying condition.
DBS surgery is conducted to implant a small electrical device called a neurotransmitter around the chest region of the patient suffering from tremors, stiffness, rigidity and other neurological symptoms. The neurotransmitter is always kept on by the patient after the surgery.
The neurotransmitter helps patients send electrical signals to specific areas of the brain. These areas of the brain are where the surgeons have placed the other end of the electrical leads that help deliver electrical impulses.
Sending electrical impulses to these identified regions of the brain helps patients control the electrical activity of the brain that leads to specific neurological disorder symptoms. Specific areas of the brain are responsible for producing different symptoms such as tremors and rigidity. Depending on the symptoms experienced by the patient, specific areas of the brain are targeted.
The electrical signals sent by the neurotransmitter help block the nerve signals sent by the brain that lead to PD symptoms, in addition to others. Read more.
A Deep Brain Stimulation device consists of three parts that are implanted inside the body:
Neurostimulator: This is a battery-powered pacemaker device that is programmable by a special control remote. It induces electric pulses. The device is placed under the skin of the chest, near the collarbone, or in the abdomen.
Lead: This is a coated wire with a number of contacts or electrodes at the tip. These are placed inside the brain and connected to another wire (extension wire) through the small holes in the skull. The wire delivers the electric pulses generated by the stimulator device to the specific part of the brain.
Extension: This is an insulated wire that is placed under the skin and connects the lead wire to the neurostimulator device. It runs from the head, behind the ear and down the neck to the chest.
Hand-held programmer device: This device remains outside the body and is used to adjust the device’s electric stimulation. It can turn the pulse generator device off and on.
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Prior to surgery, patients have to undergo certain medical evaluations, including:
General instructions before the surgery:
DBS surgery can be performed while you are awake (with local anesthesia and mild sedation) or asleep (local anesthesia). Some people may remain awake for a part of surgery and asleep during the other part.
If the surgery is performed while the patient is awake, local anesthesia is used to numb the scalp and no anesthesia is required for the brain as it does not have any pain receptors.
The doctors may ask the patient to stop taking the medicines that control Parkinson’s symptoms. During the procedure, the patient is asked to perform certain tasks to help guide the surgeon while placing electrodes in the accurate part of the brain.
However, remaining awake during brain surgery or not taking medicine can be unsettling for some people. So using general anesthesia is an alternative option as the patient will be unconscious during the surgery.
Following are the steps involved in a Deep Brain Stimulation Surgery in India:
The surgeon first attaches a stereotactic frame to the head of the patient. Local anesthesia is applied on the scalp where the four pin sites will be inserted to minimize discomfort. The might patient might feel some pressure as the pins are tightened.
The doctor will take imaging scans such as computerized tomography (CT) or magnetic resonance imaging (MRI). These images and special computer software are used to map the brain and identify the area for placement of the electrodes.
After the imaging scans, the patient will be taken to the operating room. The stereotactic head frame remains secured and it prevents any movement of the head while placing the electrodes. The patient may remain awake during this part of the surgery. The doctor may give a mild sedative to make it more comfortable during the skin incision. Later, the sedation is stopped so that the doctors can talk to the patient and perform the tasks.
The hair is shaved and an incision is made on the skin on the top of the head to expose the skull. The surgeon will then make two burr holes using a drill on the left and right sides of the skull. Through these holes, electrodes are passed into the brain.
The electrodes are inserted through the small burr holes in the skull and placed in the brain. Using the images from the MRI / CT scans and the planning software, the electrode is inserted into the brain at a precise depth and angle. There will be no discomfort as the brain itself does not feel any pain.
The surgeon may implant one lead wire into each side of the brain. The wire will run under the skin, reaching a pulse generator (neurostimulator) that is implanted near the collarbone.
Once the permanent DBS electrode/lead is placed on the correct nerve, test stimulation will be performed. The surgery team will ask if the patient feels any of their symptoms have lessened or completely gone away.
The surgeon will place a plastic cap over the small hole on the head to hold the lead in place. The incision of the scalp is closed with sutures or staples. Later a bandage is placed on the surgical wounds.
After a week later, outpatient surgery is performed to implant the stimulator in the chest. This is performed under general anesthesia and the patient will remain unconscious during the procedure.
In the operation theatre, the surgeon will reopen a portion of the incision on the scalp to access the leads. Then a small incision is made near the collarbone where the neurostimulator will be implanted under the skin. The electrode/lead is attached to the extension wire that is passed under the skin down the neck to connect to the stimulator/battery in the chest.
The stimulator might be visible as a small bulge under the skin, but it usually remains hidden under the clothes.
It is advisable to avoid movement of the arm over the shoulder or excessive stretching of the neck as the incision heals.
About a few days after the surgery, the patient will have their stimulator programmed in a follow-up visit. The doctor programs the pulse generator in his clinic using a special remote control. It may take some time to find 3 to 4 programming sessions to find the optimal setting. The amount of stimulation required is customized depending on the person’s condition. Once the simulator is programmed, the medication dosage will be adjusted.
DBS is a risky and a lengthy procedure that requires proper aftercare and follows up a visit to the neurosurgeon to check on the progress and recovery. The stimulation is regularly adjusted by the neurosurgeon during the follow-up visit, depending on the needs of the patient and any improvement in their condition.
The pulse generator attached during the surgery is completely adjustable through programming and can be varied according to the needs of the patient. This can help reduce the severity of symptoms as per individual needs, but the only drawback is that the patient is required to make a visit to the doctor on a regular basis.
Pulse generator battery last for over a period of three to five years and this is when it must be replaced. The DBS battery replacement procedure is performed as outpatient. An incision is made near the placement of the pulse generator (mostly chest or abdomen) and the battery is replaced.
The neurosurgeon also adjusts the medications of the patients after the DBS surgery, the dosage of medications is likely to be reduced after DBS treatment.
DBS has proved to be a remarkably safe and effective treatment for the conditions in properly selected patients. Although it does not cure the underlying condition, DBS provides symptomatic relief and significantly improves the quality of life in most patients. Promising results have been seen for the conditions DBS is still being investigated for.
Once the stimulation system is programmed, the patient is sent home with instructions on how to use the handheld device to adjust the stimulation themselves. The handheld controller can turn the stimulator on and off, adjust the stimulation strength, and select appropriate programs.
Mostly, patients are asked to keep their DBS system turned on all day and night. But in some cases, especially with essential tremors, it might be used during the day only and turned off before sleeping. The doctor will make adjustments in the settings to improve the stimulation if required.
The DBS system can have either a primary cell battery or a rechargeable unit. The surgeon will discuss the pros and cons prior to surgery and help you choose the suitable type. If the DBS system has a rechargeable battery, a charging unit can be used. Usually, the charging time of 1 to 2 hours per week is enough.
It is important to keep in mind that electronic devices such as cellular phones, microwaves, pagers, security doors, anti-theft sensors and household appliances will not affect the stimulator. However, one should carry the Implanted Device Identification card when traveling by air as the device is detected at airport security gates.
Some of the common DBS complications and risks include the following:
Stimulation of the neurotransmitter may also lead to certain side effects in some patients. Some of the DBS side effects include the following:
Deep brain stimulation in India is available at all major hospitals located across different cities. Many patients visit India to undergo a DBS procedure, which is a sensitive surgical intervention involving the placement of an electrical device.
Certain hospitals in India, such as Apollo Hospital, New Delhi, have been there in the field of deep brain stimulation therapy for decades now. These hospitals are equipped with the latest technology used for the treatment of neurological disorders, including Parkinson’s disease and Alzheimer’s disease.
The best Indian deep brain stimulation hospitals are located at the entire perimeter of the country, especially in all the major cities that are well connected through air, rail and road transport. This is the reason why patients from abroad can easily access treatment in the best neurology hospitals in India.
Since DBS is a lengthy and a sensitive procedure, the hospitals also possess the facilities to make patient recover from the procedure after the surgery. The hospitals are equipped with the in-house facilities to make the patients comfortable and relax after the surgery.
The top deep brain stimulation hospitals are equipped with all the latest technology used to implant the stimulator and connect it to the wires that transmit the electrical signals to the brain.
The neurology and neurosurgery department in these Indian hospitals is run by highly experienced doctors, neurosurgery and neurology specialists, who are educated and trained from abroad.
They hold the expertise and the experience that it requires to handle simplest to complex neurological conditions and are experienced with the techniques used to manage the symptoms and the condition.
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