Frequently Asked Questions

Deep brain stimulation is a major surgical procedure that requires the utmost care and expertise. In addition, it is required to get deep brain stimulation in case of debilitating conditions which cause motor problems like Parkinson's, inability to walk, the rigidity of movements, and slow movement of limbs to the extent of disturbing regular life.

The accuracy of placement is confirmed prior to implantation of the DBS electrode by the movement disorder specialist, first, by recording characteristic firing patterns of brain cells in the target area using a procedure called microelectrode recording. This is followed by a test electrical stimulation to assess the benefits or any unwanted effects of stimulation in that location. Once the location is confirmed, the DBS electrode is implanted in that spot. In the days to weeks following DBS surgery, the movement disorder specialist will select the appropriate current settings in the implanted IPG that will provide the best clinical benefits to the patient using a remote controller-like device. This procedure is called programming. It may need a few programming sessions in the first 3-6 months to identify the best stimulation settings for an individual. Thereafter, clinic visits can be annual, to check battery settings, battery life and for adjustment of drugs.

Deep brain stimulation is now being used widely with excellent acceptance for patients with movement disorders like tremors, Parkinsonism, Parkinson's disease, dystonia(loss of muscle tone), psychiatric disorders like OCD(obsessive-compulsive disorder).

A well-done deep brain stimulation can help patients for as long as 15 years with an improved quality of life.

DBS involves delivering small amounts of electricity via 2 thin electrodes (one on each side of the brain) which are introduced through 2 small holes in the skull and implanted into specific target areas deep in the brain. This procedure called stereotactic neurosurgery, is different from usual neurosurgery. The source of the electric current delivered, is a sophisticated pacemaker-like device (implantable pulse generator or IPG) placed under the skin of the chest, below the collar bone. The IPG on the chest is connected to the two electrodes within the brain through extension cables passing under the skin of the neck, behind the ear. Several software packages are available to plan the placement of the electrode using the brain MRI of the person.

Parkinson's disease is not curable. Parkinson's disease is initially treated with medicines that relieve the symptoms and enable them to function well. Levodopa is the mainstay of treatment of PD and has been used since the 1960s and gives excellent relief in the first 3-5 years of treatment. With the progression of the disease, the beneficial effects of levodopa reduce and the symptoms of patients fluctuate through the day. These motor fluctuations can be a predictable early wearing off, of the benefits of a dose of levodopa which makes it necessary to take more frequent doses. There can be delayed onset of effect of levodopa or a sudden unpredictable loss of effect of levodopa. Levodopa can also induce dyskinesias which appear as involuntary dance - like flowing movements in the neck, trunk, or limbs. These phenomena occur in about 805 of patients during the course of the disease, within 5-10 years of onset of disease. 

Parkinson's disease usually starts with physical symptoms like:  Tremor, on the one hand Tremors in both hands or limbs Reduces movement  Stiffness to walk Uncoordinated limb movements. Cognitive symptoms Cognitive issues Forgetfulness  Concentration issues.

Parkinson's Disease is a progressive neurological disease caused by degeneration of nerve cells in an area in the brain called the substantia nigra. It is a part of the basal ganglia circuit that controls movements. The cells in substantia nigra produces an important chemical called dopamine required for the normal functions of the basal ganglia circuits which allows us to make the desired type of movements and prevent unwanted movements.  It is estimated that about 7-10 million people have the disease world - wide and about 60,000 new cases are diagnosed each year. While the risk of a PD increases with age (average age of onset in the early 60s), around 5-10 percent develop the symptoms before the age of 50 and about 1-2 % have other family members affected by the same condition.

Degeneration or date of basal cell ganglia and a part of the brain which releases dopamine can cause Parkinson's disease at a later age. A steep drop in dopamine is responsible for many symptoms of Parkinson's disease. Loss of nerve endings that release norepinephrine, the chemical responsible for many motor actions. The exact cause of Parkinson's disease is not yet known, but scientists believe it to be a combination of hereditary and environmental factors(toxin exposure).  

Physical symptoms of Parkinsonism are: Muscle stiffness Rigid joints Tremors Imbalance  Hunching or stooping Inability to walk.