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Parkinson's Disease Treatment Cost In India

Last Modified: April 11, 2023  |   Created on: March 22, 2023
Brain

The cost of Deep Brain Stimulation for Parkinson’s Disease package 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.

James Parkinson, an English doctor described Parkinson’s disease (PD) in 1817 as “shaking palsy” in his paper and the disease was named after him.

Parkinson’s disease is a vastly common condition, and it is more likely to happen to mostly the aged or as they are getting older. It is an age-related degenerative brain condition. It causes parts of the brain to deteriorate, mainly associated with slowed movements, tremors, balance problems and more. Parkinson’s may not be curable, however, there are many different options as a treatment for this condition. They include various classes of medications, surgery to implant brain-stimulation devices and more.

With advancements in technology, treatment and care, people can now cope-up with this condition for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms. Most cases happen for unknown reasons, but some are inherited.

Parkinson’s disease is a progressive disorder that influences the nervous system and the parts of the body regulated by the nerves. Symptoms start slowly. The first symptom is not evidently noticeable like a tremor in just one hand. Tremors are common, but the disorder may also cause stiffness or slowing of movement.

The incidence of Parkinson’s disease in persons over the age of 60 is one for every 100. Every year 50,000 more people are diagnosed with Parkinson’s disease.

Success Rate in the Case of Parkinson’s Disease

There may not be a definite line of treatment for this disease and so far, there may be no cure. However, a suitable treatment can mean increased efficiency in dealing with the symptoms and lifestyle changes.

The success rate of Parkinson’s treatment is based on an accurate diagnosis and further the most suitable treatment. Consequently, the experience of the doctor plays a key role and is the most important factor that influences the success rate.

  • India is known for the most experienced doctors, neurosurgeons, and rehabilitation specialists including physical, occupational, and speech therapists, nutritionists, psychologists, neuropsychologists and most important caregivers.

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Causes of Parkinson’s Disease

In Parkinson’s disease, specific nerve cells (neurons) in the brain progressively break down or collapse. The symptoms that are evidently noticed are due to a loss of neurons that make a chemical messenger in the brain called dopamine. When dopamine levels decrease, it triggers atypical brain activity, leading to impaired movement and other symptoms of Parkinson’s disease.

Parkinson’s causes are not a set of definite factors, but a combination of factors so, the cause of Parkinson’s disease is unknown, but several factors appear to play a role, including: –

  • Age– The biggest factor for developing Parkinson’s is advancing age. The average age of onset is 60. However, it may be early as well.
  • Parkinson’s disease implicates a small, dark-tinted portion of the brain called the substantia nigra. Most of the dopamine your brain uses is produced in this portion.
  • Dopamine is the chemical messenger that communicates messages between nerves that control muscle movements as well as those involved in the brain’s pleasure and reward centres. With growing age, it’s quite normal for the cells present and produced in the substantia nigra, to die. This process progresses slowly and silently. When 50 to 60 % of the cells are gone, the symptoms of Parkinson’s start showing.
  • Gender– There is no specific reason or cause, however, by and large, it has been observed men are more likely to develop Parkinson’s disease than women.
  • Genetics/ Familial cause– There has been a lot of new information about genetics and new genes identified over the past 10 or 15 years that have enhanced the understanding of the disease. Those individuals with one parent (autosomal dominant), a sibling who is affected or (autosomal recessive) in which the child gets a copy of a mutated gene from each parent) have about twice the risk of developing Parkinson’s.
    15 % -25% of people with PD have a known relative with the disease.
  • Environmental causes– may trigger Parkinson’s disease. It’s unlikely that most people who develop Parkinson’s disease do so because of exposure to environmental hazards, however, exposure to farming chemicals, like pesticides and herbicides; Vietnam-era exposure to Agent Orange, exposure to heavy metals, detergents or solvents at work have all been associated and have been researched for a clearer link.
    Ongoing exposure to herbicides and pesticides may slightly increase the risk of Parkinson’s disease.
  • Head trauma– Repeated blows to the head or a head injury, trauma to the head, neck, or upper cervical spine increases one’s risk of developing Parkinson’s. However, there may not be a concrete base to prove so, as the type, severity or frequency of head trauma increases and determines the amount of risk. This also means not everyone exposed to head trauma is going to develop Parkinson’s for sure.
  • Unknown factors– mainly Parkinson’s cases are termed idiopathic, which means unknown. This may also mean it could be a combination of environmental exposure to toxins or pesticides and genetic makeup. Many researchers now believe that the root cause of Parkinson’s may never be just one factor but a combination of genetic and environmental factors, such as exposure to toxins.

Stages of Parkinson’s Disease

Parkinson’s disease can take years or even decades to cause severe effects.

A staging system for Parkinson’s disease was created in 1967, however, it’s becoming obsolete or not commonly referred to, as staging this condition is less helpful than defining how it impacts a person’s life individually and later treating them accordingly.

Four different areas of how Parkinson’s disease affects may be categorized as

  • Stage 1: Non-motor aspects of experiences of daily living.
  • Stage 2: Motor aspects of experiences of daily living.
  • Stage 3: Motor examination.
  • Stage 4: Motor complications.

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Symptoms

The signs and symptoms of Parkinson’s disease vary from individual to individual. Generally, early signs are unnoticed as they are so minor and mild.

Symptoms often begin on one side of the body. Even after symptoms begin to affect the limbs on both sides, they mostly remain worse on that side.

The most evident and common symptoms of Parkinson’s disease involve loss of muscle control. However, it has been observed that muscle control-related issues are just a larger chunk of some other possible symptoms of Parkinson’s disease. This categorizes the symptoms as

  1. Motor-related symptoms
  2. Non-motor symptoms

Motor Symptoms indicate any and all movement-related symptoms of Parkinson’s disease including the following:

  • Shaking Or Tremor– A tremor, or rhythmic shaking, usually begins in a limb, mostly in the hand or fingers. The shaking may decrease when you are performing tasks. It’s like rubbing the thumb and forefinger back and forth. This is known as a pill-rolling tremor. The hand may tremble when it’s at rest.
  • Slowed Movement (Bradykinesia)– The very initial symptoms are slowness of movement in the limbs, face, walking or overall body. The movement slows down with time and simple tasks become difficult and time-consuming. The feet almost have to be dragged or they shuffle in an attempt to walk. Consequently, the steps may become shorter and affect the balance.
  • Rigid Muscles– Muscles experience stiffness. This may impact any part of the body. The range of motion gets impacted due to the pain because of this stiffness of the muscle.
  • Posture Instability/Walking Gait– The posture gets stooped. As a result, the balance gets highly affected due to the posture. The trouble with balance calls for possible falls.
  • Loss Of Automatic Movements– You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
  • Some additional symptoms which clearly are not totally related to movement may include
  • Hypophonia /Speech Changes– Speech may be more of a monotone rather than have the usual speech patterns. Consequently, people may speak softly, quickly, slur and usually there’s a loss of confidence.
  • Changes in Writing – writing may appear small and eventually becomes very difficult to write.
  • Less Blinking– this is also a symptom of reduced control of facial muscles.
  • Drooling– Another symptom that happens because of loss of facial muscle control.
  • Mask-Like Facial Expression– Known as hypomimia, this means facial expressions change very little or not at all.
  • Trouble swallowing (dysphagia)– This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.

Non-Motor Symptoms are symptoms that might be warning signs that start years or even decades before motor symptoms.
Non-motor symptoms include

  • Autonomic nervous system symptoms– These include orthostatic hypotension (low blood pressure when standing up), constipation and gastrointestinal problems, urinary incontinence and sexual dysfunctions.
  • Depression
  • Loss of sense of smell (anosmia).
  • Sleep problems such as periodic limb movement disorder (PLMD), rapid eye movement (REM) behavior disorder and restless legs syndrome.
  • Trouble thinking and focusing (Parkinson’s-related dementia).

Diagnosis

There are no biomarkers or objective screening tests that indicate one has Parkinson’s. There may be no definitive test for Parkinson’s so far. They can often be diagnosed by a general neurologist, who is trained to diagnose and treat neurologic disorders.

As with many degenerative neurologic disorders, nonpharmacological management such as rehabilitation can offer relief. There are diagnostic and lab tests that are possible and prescribed to rule out other conditions or certain causes. Based on this most lab tests aren’t required unless there’s no sign of response to treatment for Parkinson’s disease. Then this may mean there’s another condition. An experienced doctor will only consider the diagnosis of Parkinson’s disease considering:

Clinical Examination

  • The person being examined has at least two of the core motor symptoms of Parkinson’s, including tremor, the characteristic bradykinesia (slowness of movement), or rigidity.
  • There is a relevant medical history and a physical examination is conducted.
  • There are medical conditions and the corresponding medications- current and past. Some medications may cause symptoms that mimic Parkinson’s disease.
  • The physician performs a neurological examination, testing alertness, muscle tone, gait and balance.

Examination Through Tests and Scans

  • Although there is no lab or imaging test that is recommended to confirm if it is Parkinson’s disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brain’s dopamine system.
  • Primarily a DaTscan accesses any difference in idiopathic Parkinson’s disease from certain other neurologic disorders.
  • Imaging studies evaluate Parkinson’s disease and Parkinsonian syndromes. They include magnetic resonance imaging (MRI), which examines the structure of the brain. Other imaging studies may also be considered, like: functional MRI (fMRI), a specialized form of brain imaging that examines brain function, and positron emission tomography (PET), which can measure certain brain functions.
  • Karyotype test for genetic influence. Pathologists or geneticists with training in chromosome analysis examine the blood or fluid in a lab.

Management and Treatment

Evidently, at present there is no definite line of treatment or no cure for Parkinson’s, however, there are a number of treatments that can ease symptoms and help improve the quality of life for the patient and the caregivers. Treatment is extremely individualized and adjusted over time based on symptoms and side effects.

Parkinson’s medications are the backbone of treatment; however, modalities are frequently used in combination. Nearly all patients with Parkinson’s disease ultimately need to take the medication in case of some evident motor symptoms.

Numerous courses of medications are available like Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. In some cases, it also may be used in combination with other classes of medications with Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents.

Several medications treat specific symptoms of Parkinson’s disease. Symptoms treated often include the following:

  • Erectile and sexual dysfunction.
  • Fatigue or sleepiness.
  • Constipation.
  • Sleep problems.
  • Depression.
  • Dementia.
  • Anxiety.
  • Hallucinations and other psychosis symptoms.

Physical, occupational and speech therapy are definitely significant partners in the treatment plan.

  • Physical therapy can improve gait and direct the patient to the right exercise regimen.
  • Occupational therapy helps in maximizing fine motor skills.
  • Speech therapy addresses speech and language barriers that may arise with Parkinson’s disease.

Surgical options also have an important role in the subcategory of patients with Parkinson’s disease. In some cases, patients with Parkinson’s disease may seek Deep Brain Stimulation (DBS), a surgical therapy that has been FDA-approved for over a decade. This treatment method is all likelihood an option in the later stages of Parkinson’s disease when levodopa therapy becomes less effective, and in people who experience tremor that doesn’t seem to respond to the normal medications.

  • Who Qualifies: Patients with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance are considered suitable candidates for this procedure.
  • What does it work: Surgically, an electrode is implanted into a targeted area of the brain, usually the subthalamic nucleus (STN)/ the globus pallidus internal (GPI). It’s optional to place the implants on a particular side of the brain or sometimes on both sides, as required. The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest.
  • Is it helpful: This procedure does help patients with medication-resistant tremors.
    It can also be beneficial to patients who have major motor fluctuations in which medication response changes during the day and dyskinesias or extra movements may arise as a side effect of medication.

Complementary therapies may prove effective to treat some Parkinson’s disease symptoms. Lifestyle changes are extremely helpful. These changes involve proper exercise schedules like

  • Cardiorespiratory exercise (fitness training)
  • Resistance exercises (strength training)
  • Flexibility exercises (stretching)
  • Gait and balance training.

Experimental treatments: There is continuous research to find a definite line of treatment that helps patients with Parkinson’s disease. Today, there may not be widely available, however, it is a sign of hope to people with this condition. Some of the experimental treatment approaches include:

  • Stem cell transplants– These add new dopamine-using neurons into the patient’s brain to replace the damaged ones.
  • Neuron-repair treatments– These treatments try to restore the damaged neurons and encourage new neurons to form.
  • Gene therapies and gene-targeted treatments– These treatments target particular mutations which are responsible for Parkinson’s disease. Some also enhance the efficiency of levodopa or other treatments.

A thorough, accurate and timely analysis and examination by an experienced team of doctors can help in determining the best treatment plan for any obvious and discreet symptoms.

Participating in Clinical Trials. These trials and their participants have revolutionized Parkinson’s treatment. They have not only changed the lives dramatically of those affected but also helped make available many new treatments. Furthermore, they have improved the delivery methods of medications and new deep brain stimulation techniques.

A robust team of doctors and caregivers, which may include:

  • Movement disorder specialist
  • Primary care provider
  • Rehabilitation specialists including physical, occupational, and speech therapists
  • Nurse
  • Nutritionist
  • Psychologist
  • Neuropsychologist

A robust team of doctors and caregivers is extremely beneficial in case of Parkinson’s disease as there are some additional complications which may not be disregarded when understanding the course of treatment.

The additional complications may include:

  • Thinking difficulties.
  • Depression and emotional changes
  • Chewing and eating problems
  • Swallowing problems
  • Sleep problems and sleep disorders
  • Bladder problems
  • Constipation
  • Blood pressure changes
  • Smell dysfunction
  • Fatigue
  • Pain
  • Sexual dysfunction

India is a hub to the best Parkinson’s treatment hospitals that are equipped with the latest infrastructure, technology and doctors.

The cost of treatment of Parkinson’s Disease in India can be 1/5th to 1/3rd of the cost in other countries without compromising the quality and standard. The cost is based on some evident facts and factors such as

  • The type of hospital: a super specialty hospital vs a single-specialty hospital
  • Type of rooms: a deluxe room, a single room, or a shared room based on comfort and amenities.
  • Specialists’ fees in accordance to the experience.
  • Diagnostic procedures and tests including imaging studies as per the condition and severity of the patient and the disease.
  • Cost of Surgery if required.
  • Medications.
  • Cost of Physical Therapy.

Treatments Offered in India

  • Deep Brain Stimulation (DBS) Surgery
  • Pallid thalamic tractotomy (PTT)
  • Pallidotomy
  • Thalamotomy
  • Medications- Levodopa, Dopamine agonists, Monoamine oxidase-B inhibitors
  • Ayurvedic Treatment
  • Physiotherapy
  • Occupational Therapy
  • Speech and Language Therapy
  • Stem cell therapy- as prevented the progression of
  • Parkinson’s in 74% of patients and has even shown some promise in reversing advanced conditions.

Prevention/Recovery

As people get older, Parkinson’s disease is a very common condition. While Parkinson’s isn’t curable, there are many different ways to treat this condition for an improved quality of life along with acceptance.

The treatment includes numerous classes of medications, surgery to implant brain-stimulation devices and more to help people all across the globe to cope with this condition. Because there is no specific cause, there may not be a corresponding cure, however, this also highlights the fact that it may happen to just anyone around us.

A little compassion, understanding and awareness can make any treatment much more effective. Thanks to technical and medical advances in treatment and care, many stand a chance to live for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms. Each day of strength is another day of recovery!

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