Dystonia Treatment Cost in India

The cost of Deep Brain Stimulation package in India for Dystonia Treatment is USD 23,000 – USD 30,000, 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.

DBS-in-India

A movement condition called dystonia is characterized by persistent or sporadic muscular spasms that result in aberrant, frequently repeated motions, postures, or both. In addition to motor symptoms, dystonia syndromes also contain a number of non-motor symptoms, each of which has a major independent influence on the quality of life in terms of one’s health.

The extensive range of dystonia symptoms, including how they affect mental health and cognitive and sensory processing, has been acknowledged. Deep brain stimulation (DBS) has been successfully used as a treatment for some kinds of dystonia, and intracranial recordings acquired during these procedures have emerged as a new source of pathophysiological information.

In medical terminology, involuntary muscular contractions resulting in repeated motions are the hallmark of dystonia disorder.

A person may feel uncomfortable motions and tremors. Different genetically based forms of dystonia exist. It is believed that dystonia is a neurological disorder brought on by nerve system issues.

The majority of the time, however, mental processes like intelligence, memory, and language are untouched. The most challenging to manage and treat is the generalized form of primary dystonia, which is primarily inherited. Thought or comprehension issues are not related to dystonia, although sadness and anxiety may be.

Dystonia Treatment Cost in India

While determining the cost one should consider all the aspects. There is no price for safety when it comes to life.

The cost is defined as the total consideration for acquiring something while the price is totally the value of the product.

Deep Brain Stimulation surgery (DBS), involves the implantation of electrodes into the target cells of the brain. Deep brain stimulation is a Food and Drug Administration (FDA) approved therapy for the treatment of certain movement and neurologic disorders including Dystonia

The treatment cost starts from $23,000

Deep brain stimulation therapy has been practiced in some Indian hospitals for many years. The most recent medical technology, including that used to treat Parkinson’s disease and Alzheimer’s disease, is available in these facilities.

All significant hospitals in India’s various cities and towns provide deep brain stimulation. A DBS surgery, a sensitive surgical operation requiring the implantation of an electrical device, is one that many patients travel to India to have done.

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Based on the body part affected dystonia exists in five different forms:

  • Focal dystonia: Muscles around the eyes, in the neck, in the throat, or in one of the limbs are affected by focal dystonia.
  • Segmental dystonia: It is a condition that affects a specific body part, such as the arm or the neck.
  • Hemi dystonia: It is a condition that affects one side of the body’s arm and leg.
  • Multifocal dystonia: It is a condition that affects two or more unconnected bodily parts, such as the left arm and leg.
  • Generalized dystonia: which may affect the entire body, and can also affect the legs.

Based on the underlying cause dystonia can be categorized as:

  • Primary or idiopathic dystonia may occur as a result of genetic mutations.
  • Segmental dystonia affects a minimum of two body parts that are close to one other. It commonly affects the eyelids, mouth, jaw, and lower face.
  • Secondary dystonia may occur due to environmental factors such as exposure to carbon monoxide; underlying conditions such as brain tumors, and certain medications.
  • Heredodegenerative dystonia may result from neurodegenerative disorders where heredity may be a cause.

Dystonia is also variable in its progression.

  • While the condition deteriorates gradually for some people, it plateaus for others. Some people’s dystonia stabilizes at a fairly early stage and does not worsen.
  • The advanced stage is characterized by irregular walking, twisting postures, contortions of the torso, quick and involuntary rhythmic movements, and, finally, permanent postural abnormalities.
  • Although the condition is typically not accompanied by discomfort, pain in the afflicted areas is definitely a possibility.
  • Because of the degeneration of the spine, irritation of the nerve roots, or recurrent headaches, cervical dystonia can be very unpleasant. Although limb dystonia may not initially hurt, it eventually could. Uncontrolled muscular motions may damage the joints and cause arthritis to develop.

Based on their patterns, dystonia can also be classified as a syndrome:

  • A kind of dystonia that impacts the eyes is blepharospasm. Uncontrollable blinking frequently marks the beginning of it. Initially, it usually only affects one eye. But eventually, both eyes are impacted. The eyelids unconsciously shut as a result of the spasms. In certain cases, they even make them stay closed. The subject could see clearly. However, the person becomes functionally blind as a result of the eyelids shutting permanently.
  • Torticollis, a kind of cervical dystonia, is the most prevalent form. Age in the middle is often when cervical dystonia develops. However, reports of it have come from persons of various ages. Due to cervical dystonia, which affects the neck muscles, the head might turn and move backward or forward.
  • Muscles in the head, face, and neck are impacted by cranial dystonia.
  • The jaw, lips, and tongue muscles spasm as a result of oromandibular dystonia. The dystonia might make it difficult to speak and swallow.
  • Speaking muscles of the throat are impacted by spasmodic dystonia.
  • A medication response leads to tardive dystonia. Typically, the symptoms are transient and manageable with medicine.
  • Episodes of paroxysmal dystonia occur. Only during assaults do the symptoms show up. The individual is normal the rest of the time. Torsion dystonia is a very unusual condition. The individual who has it is severely disabled and is affected throughout their entire body. Symptoms often start in childhood and worsen with age. Researchers have discovered that torsion dystonia may be inherited and brought on by a gene mutation.
  • Dystonia specific to writing is known as a writer’s cramp. The hand and/or forearm muscles are affected.

Effects

Segmental dystonia, which can affect two or more nearby sections of your body, focal dystonia, and total body dystonia are all possible manifestations of the illness (general dystonia). Mild to severe muscular spasms are possible. They could hurt, and they might make it difficult for you to carry out your everyday activities.

Dystonia cannot be cured; however, treatment and medicines can lessen symptoms. In patients with severe dystonia, surgery may be utilized to disable or control nerves or specific brain areas.

Symptoms

Dystonia symptoms might be very subtle or quite severe. Different body areas can be impacted by dystonia, and the condition’s symptoms frequently worsen in phases.

Different people are impacted by dystonia in various ways. A muscle spasm could:

  • Start with one area, such as one’s leg, neck, or arm. After age 21, the neck, arm, or face are typically where focal dystonia first manifests itself. It often stays focused or splits into smaller sections.
  • occur when doing a certain task, like handwriting.
  • worsened by worry, weariness, or stress.
  • become more obvious over time.

Symptoms of this disease vary with its form. Some of the symptoms include:

  • Disposition to turn or drag one foot after running or walking some distance.
  • Involuntary turning of the neck when a person is stressed or extremely tired.
  • Rapid blinking or closing of eyes due to spasms.
  • Difficulties in speech.
  • Depression and anxiety.

However, sometimes, stress, a stiff neck, or a psychiatric condition are misinterpreted as dystonia. Medical professionals may come to the conclusion that a psychiatric condition is either the main cause or a contributing factor to the disorder because of its intermittent nature. Dystonia symptoms are similar to those of many other illnesses, and their wide range makes diagnosis challenging.

It may be noted, the onset of dystonia usually follows certain actions or tasks, although, in more severe phases, it can happen when at rest. The same group of muscles is often affected, leading to a repeating pattern of motions over time.

It often comes on gradually, with localized symptoms pointing to the disorder’s prevalence.

  • Blepharospasm may be indicated by eye discomfort, heightened sensitivity to bright light, and increased blinking.
  • Oromandibular dystonia may manifest as subtle facial spasms, difficulties eating, or changes in speech cadence.
  • Leg dystonia may be indicated by hand cramping when writing, weariness while moving around, or other manual tasks.

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Dystonia classification by age

  • Childhood-onset – 0 to age 12
  • Adolescent onset – age 13 to 20
  • Adult onset – older than age 20

Areas affected by Dystonia

  • Neck (cervical dystonia) (cervical dystonia)– The head may twist and move to one side, pull forward or backward, or both during contractions, which may be painful.
  • Eyelids– The eyes shut suddenly or during spasms (blepharospasms), which impairs your vision. Typically painless, spasms might worsen in bright light, while reading, watching TV, when stressed, or while engaging with others. The eyes may feel gritty, dry, or light-sensitive.
  • Tongue or the jaw (oromandibular dystonia)– Drooling, slurred speech, and trouble swallowing or chewing are all possible symptoms.
  • Oromandibular dystonia, which frequently coexists with cervical dystonia or blepharospasm, can be uncomfortable.
  • Vocal cords and the voice box (laryngeal dystonia)– The voice may be strained or whispery.
  • Forearm and hand– Writer’s dystonia or musician’s dystonia, for example, are specialized varieties of dystonia that only happen when you do a repetitive task like writing or playing a certain musical instrument. In most cases, symptoms don’t appear when your arm is at rest.

Causes

There is no known cause of dystonia. It is thought that dystonia may result from aberrant neurotransmission in the brainstem and basal ganglia. The body’s basal ganglia are in charge of starting muscle contractions.

Dystonia’s precise aetiology is unknown. While certain forms of dystonia are either acquired or inherited, idiopathic or primary is frequently passed down from parents. Some people who carry the condition may never experience their own dystonia. Additionally, even among family members, the symptoms might differ greatly.

Damage to the basal ganglia, the part of the brain that triggers muscle contraction, is the primary cause of dystonia. The harm might be brought on by:

  • Stroke.
  • Deprivation of oxygen.
  • Poisoning due to carbon monoxide or lead.
  • Infections like tuberculosis.
  • Reactions due to certain medications.
  • Brain tumor.
  • Parkinson’s disease.

Other diseases such as Parkinson’s, Huntington’s, Wilson’s, traumatic brain damage, birth injury, brain tumor, oxygen deprivation, and infections including TB and encephalitis can also cause dystonia.

Major risk factors are:

  • Family history.
  • Women are more likely to develop cervical dystonia.
  • The probability of the disorder arising after the age of 30.
  • History of postural tremor.

Diagnosis

While there is no conclusive test to diagnose dystonia, clinicians can do so by learning about the symptoms and doing a neurological exam. To be sure something else is not the cause of the symptoms, doctors may utilize additional tests like a brain MRI.

Doctors may advise genetic testing for people with early-onset dystonia or those who have a family who is afflicted.

Treatment

Treatment options for dystonia are numerous. Based on the nature and severity of the dystonia, the doctor will choose the appropriate course of therapy.

Since dystonia cannot be cured, therapy focuses on symptom management. The three tiers of treatment for dystonia include:

  1. Botulinum toxin (Botox) injections
  2. Medication
  3. Surgery.

These can be utilized separately or in conjunction. Botox and medications both work to stop the nerve from communicating with the muscle, which may minimize atypical postures and motions.

  • Botulinum toxin, popularly known as Botox or Xeomin, is a modern medication.
  • The afflicted muscle receives an injection of the poison.
  • The acetylcholine molecule, which causes muscular contractions, is blocked there. Every three months or so, the injection must be repeated.

Medication

Medications can lessen the “overdrive” signals that lead to dystonia’s excessive muscular contractions. Among the drugs utilised are:

  • Levodopa
  • Procyclidine hydrochloride
  • Diazepam
  • Lorazepam
  • Clonazepam
  • Baclofen

Surgery

If medicine and other therapies are ineffective and the symptoms are degrading one’s quality of life, surgery may be an option.

Deep brain stimulation is the basis of surgical therapy for dystonia (DBS).

How it works: A battery-operated stimulator, akin to a pacemaker, is inserted in the body during DBS surgery and sends electrical stimulation to the parts of the brain that are responsible for the symptoms of dystonia. By using a remote control, the brain stimulation may be adjusted to the ideal levels for each patient. The electrical pulse frequency and strength are controlled by the patient’s physician.

Due to its effectiveness and lesser risk of complications, DBS has taken the place of previous surgical procedures such as stereotactic thalamotomy, pallidotomy, and cervical rhizotomy.

However, the advantages and disadvantages of any operation should always be carefully compared. Although some individuals with dystonia report considerable symptom reduction following surgery, there is no assurance that everyone will benefit.

Other than medication, another choice is a sensory trick. By applying stimulation to the injured or neighboring body region, the muscles may contract less forcefully. People have the ability to regulate their own contractions by just touching this spot.

The symptoms of dystonia may also be managed by stress reduction, physical treatment, and speech therapy.

  • 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.

Success Rate of Dystonia Treatment in India

  • After a diagnosis and course of therapy for dystonia, life expectancy is not at risk. Aggressive dystonia, however, affects several bodily regions and may need emergency care.
  • Some of the symptoms of dystonia include involuntary movements, speech difficulty, uncontrollable blinking, dragging legs, and foot cramps.
  • Although certain causes of dystonia are treatable with particular medicines, the majority of dystonia cases are treated symptomatically.
  • There are no curative treatments available. Deep brain stimulation, injections of botulinum toxin (BoNT), and oral medicines are available as treatment options (DBS).

Prevention

Primary dystonia is not preventable as it is inherited. However secondary forms can be prevented by:

  • Adopting a healthy lifestyle.
  • Regular exercising and muscle stretching.

Self-management

  • Dystonia does not have a treatment. However, some dietary changes and natural therapies may help to lessen the signs and consequences of dystonia.
  • Certain body parts can be touched to momentarily halt muscular spasms.
  • Avoiding stressful events may stop your symptoms from getting worse.
  • Pain may be reduced by applying heat or cold to the afflicted regions.

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