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Dystonia, a complex neurological condition, significantly impacts the global quality of life. This movement disorder constitutes 3-8% of neurological disorders in India, affecting approximately 31 to 45 individuals per 100,000 who are above the age of 60, particularly in rural areas. This underscores the urgency for modern approaches to dystonia management.
Deep Brain Stimulation (DBS) has become a cornerstone in the treatment of severe, medication-refractory Dystonia. It is CE (Conformite Europeene) marked in Europe and has been approved by the US Food and Drug Administration under a humanitarian device exemption. Several randomised and controlled clinical trials have demonstrated the efficacy and relative safety of DBS in the treatment of various types of dystonia.
India has approximately 1800 neurosurgeons that have a high level of knowledge and comprehension in the field of neurosurgery. Several national institutions, notably the All-India Institute of Medical Sciences (AIIMS), National Institute of Mental Health and Neurosciences (NIMHANS), and Postgraduate Institute of Medical Education and Research (PGIMER), have outstanding infrastructure and medical facilities.
Furthermore, several state-of-the-art corporate hospitals with significant infrastructure and an unrivalled reputation represent India's enormous ability to give high-end neurosurgical therapies. As a result, finding the best doctor for Deep Brain Stimulation and the best hospital for deep brain stimulation in India is growing easier and more affordable every year.
Dystonia is a diverse set of illnesses that is categorised as a clinical syndrome rather than a single pathology. It is a type of movement disorder where muscles undergo uncontrolled spasms, causing strange and often repeating movements or body postures. These movements are often twisting and shaky. It is often made worse by voluntary effort and results in excess muscular activity. This clinical phenomenon is seen in a wide range of disorders with different causes.
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Deep Brain Stimulation (DBS) is a type of neuromodulation which is the practice of influencing brain activity in order to investigate and treat disease by using electrical stimulation.
DBS is a surgical treatment for dystonia and other neurological disorders that involves a medical device implantation. This procedure stops the aberrant brain activity. The device's stimulation of the brain decreases the excessive signals which alleviates dystonia symptoms.
This procedure was formerly reserved solely for severe cases of generalised dystonia and is now being used to treat a wider range of dystonia patients than ever before. Its application is changing as research advances. The field of movement disorders now has almost two decades of expertise and data on the long-term safety and efficacy of deep brain stimulation.
You will need to visit the team of Brain Specialists during your initial evaluation. The procedures included in evaluation appointment are:
The team including Neurosurgeons, Neurologists, Neuropsychologists, Movement Disorders specialist, and a DBS program coordinator meets you to review your condition and any potential risk factors associated with the treatment. The neurosurgeon will discuss the surgical possibilities, risks, and response to the treatment if DBS surgery is the best option for you.
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Deep Brain Stimulation involves implanting a battery-powered stimulator, effectively a Brain Pacemaker, in the body and delivering electrical stimulation to the parts of the brain responsible for dystonia symptoms. The stimulator is inserted in the chest, and extension wires connect it to brain leads (electrodes). Most of the time, both sides of the brain are treated. The brain stimulation is regulated via remote control to achieve the best settings for each unique patient.
Numerous studies have also demonstrated that this therapeutic procedure provides long-lasting symptom relief even five- or ten-years following surgery. However, current scientific research shows that this procedure is generally safe and is linked to a low and maybe non-existent side effect profile. So, in the treatment of severe and medically refractory Dystonia, Deep Brain Stimulation is the ray of hope to get a better life. However, it can be accompanied by following adverse effects in few cases:
Patients who have had Deep Brain Stimulation (DBS) surgery must follow precise post-operative recommendations to support optimal healing and the best potential outcomes. These instructions may vary significantly depending on specific circumstances and the advice of the medical team, but here are some broad guidelines:
1. Post-Operative Pain: Mild pain and swelling in the area surrounding the surgery site are usual. If the discomfort becomes unbearable, contact your doctor.
2. Wound Care: Keep the incision area clean and dry. Follow the surgeon's instructions regarding when you can remove any dressings or bandages. Avoid scrubbing the incision area. Gently pat it dry if needed.
3. Activity & Diet: Avoid heavy lifting, strenuous exercise, or activities that could strain the incision site. Gradually resume physical activities under medical guidance. The patient can increase his/her diet as per tolerance.
4. Constipation: Reach out to your doctor if you experience constipation or take over the counter medications for the same under medical supervision.
5. Driving: Do not drive for two weeks following the procedure.
6. Medications: Unless directed, continue to take all of your movement disorder medicines in the same manner you would before surgery.
7. Follow-up appointments: You need to visit your neurosurgeon 7-12 days following each procedure to check on wound healing, remove sutures, and schedule any additional post-operative care visits that may be required.
8. Hair Care: Avoid every kind of hair care including hair colouring and hair cuts 6 weeks following the surgery.
9. Flights: Avoid flights for two weeks after the procedure.
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The days and weeks following DBS surgery for dystonia are unique to each patient. However, keep the following in mind:
Rest: When you get home, try to get as much rest as possible. Return to normal activities gradually.
Falls: You are at a higher risk of falling in the weeks following DBS. If you used a walker or cane before surgery, keep using it until you are stronger and more stable.
Symptoms: Your symptoms may improve temporarily following surgery. The symptoms will return to normal after the DBS system is programmed.
Time: It may take a few months of changes until your DBS system functions as effectively as it can.
Deep Brain Stimulation treatment for various forms of dystonia resulted in an improvement in involuntary movements initially, with postural benefits often requiring longer. The symptoms may improve more slowly to stimulation than other movement disorders. Patients may achieve maximum relief after 3-12 months.
Among the most prominent improvements for patients with dystonia are:
The cost of Deep Brain Stimulation significantly depends upon the patient's health status, patient requirements, hospital choice, and the availability of treatment options. This procedure can cost roughly between Rs.7 lakhs to Rs. 15 lakhs in India which is fairly economical when compared to treatment costs in developed countries.
However, the following information can provide you with a broader view of its cost and expense:
Approximate cost of Deep Brain Stimulation (INR)
Surgery & hospitalization
₹ 1,00,000-₹ 2,00,000
Expense on neuro specialists
₹ 1,00,000-₹ 2,00,000
Rough total expense
The common drivers of overall cost of Deep Brain Stimulation are due to the following factors:
The cost of diagnostics for Deep Brain Stimulation may include various preoperative evaluations and tests that are typically conducted before the surgical procedure. It mainly requires an MRI and CT scan of the brain.
Brain MRI scans might cost between 12,000-15,000 rupees and Brain CT scan might cost you between 5000-7000 rupees in India. However, the cost of these scans is determined by the scan type and machine quality (1.5 or 3 Tesla). Therefore, the total diagnostic expenses (including facility fees, specialists’ fees, and diagnostic tests) will be roughly around 50,000 INR.
The price of a diagnostics for this procedure varies significantly depending on the following factors:
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