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Deep Brain Stimulation
- Days In Hospital 2 days
- Outside Hospital Stay 15 days
- Success Rate 66%
Minimum Cost
$ 30000
Maximum Cost.
$ 40000
Most Asked Procedures
Overview of Deep Brain Stimulation in India
Deep brain stimulation is a procedure that places electrodes in different brain areas for stimulation. At times, the brain creates the abnormal nerve impulses, which then creates the abnormal response in the body. The electrodes are then placed to control these abnormal impulses, thereby stopping the body's abnormal reaction. The electrodes are attached to a device that is like a pacemaker. Its function is to control the amount of stimulation in the deep brain stimulation treatment. The pacemaker is placed under the skin in the area of the chest.
The wire from the pacemaker runs under the skin and toward the brain where it connects to the electrodes for deep brain stimulation. Deep brain stimulation is used for degenerative disorders of the brain, movement disorders and the conditions in which abnormal impulses are being generated in the brain like epilepsy. Deep brain stimulation treatment is used after all of the aggressive medication to treat the condition are no longer effective and there is no other way of treatment.
While deep brain stimulation is considered a low risk procedure, it does have several risks and complications which must be managed otherwise can potentially lead into life threatening conditions such as a stroke. Deep brain stimulation is never performed unless the advantages of the surgical treatment significantly outweigh the associated risks and complications.
Types of Deep Brain Stimulation:
Stereotactic Deep Brain Stimulation
In general surgery is done with the patient off their medication. An head frame is placed on the patient's head to stabilize it and provide coordinates for the surgeon to follow for placing the lead in the targeted area of the brain. Local anesthesia is injected into the scalp to maximize comfort for the patient while also providing the patient with a sedative to relax the patient throughout the surgery.
Image-guided Deep Brain Stimulation
In an image-guided Deep Brain Stimulation surgery, -i.e., interventional MRI or CT scan, the patient is typically asleep under general anesthesia. The surgeon uses images from the patient's brain to focus on placing the Deep Brain Stimulation precisely and to the desired target.
Awake Deep Brain Stimulation
Awake deep brain stimulation surgery is typically used, in which an awake patient must stop temporarily taking the medications that manage their disease. The patient helps direct the placement of the Deep Brain Stimulation electrode in precise location of the brain by performing tasks. While it is typical to be awake during surgery, and it is usual to be off medications, this can be uncomfortable to some persons.
Asleep Deep Brain Stimulation
There is the other option of deep-brain stimulation and this may be completed at clinical locations too. Asleep Deep Brain Stimulation surgery is completed when the patient is sleeping and under general anesthesia. The surgery can be completed inside of an MRI or CT scanner, allowing for accurate targeting and verification of the placement of the Deep Brain Stimulation electrodes.
Procedure:
Preoperative Assessment
The patient is to inform the physician of any past and current medications (including dosage/frequency of any medication). The patient is also to disclose what vitamins or supplements they take at the current time.
Diet
The patient is to refrain from eating or drinking anything after midnight, the night before the surgery.
Medications
The patient is to stop taking Aspirin, Ibuprofen, Advil, etc., one week before the surgery date. It is also required that any medications that the patient takes currently, to treat their present neurological condition, for example: Parkinson's or dystonia, also not be consumed after midnight, the day of surgery.
The patient needs to be admitted to the hospital one day before the surgery.
Procedure of Deep Brain Stimulation
Here is an overview of the general procedure of Deep Brain Stimulation:
Preoperative Evaluation: Before the surgery, a thorough evaluation to determine appropriateness for Deep Brain Stimulation will include the medical history, a physical examination, and potentially, various imaging or diagnostic testing such as MRI or CT scans to identify the appropriate target location within the brain.
Target Selection: A specific target location for stimulation will be selected based on the diagnosed condition, symptoms, and response to medications. The target location and area relates to the particular circumstances of individual cases and regions of the brain or brain disorder being treated.
Surgical Planning: Imaging will be used with CT or MRI scans to plan the route and angles of approach and placements for the electrodes to minimize the potential for damage to adjacent brain structures.
Anesthesia: The anesthesia plan will be based on the option employed, whether awake or asleep Deep Brain stimulation. In awake cases, local anesthesia and mild sedation could be used.
Implantation of the electrodes: For newer systems, this is most often done using an awake craniotomy technique, based off the patient's input to determine electrode placement. To complete stimulation, a neurosurgeon will drill a small hole in the skull and will take recording of the selected area of the brain.
Implantation of the accelerator: The accelerator can be compared to a pacemaker that produces electrical impulses to the brain. After placing electrodes in the brain, accelerators are then used to develop impulses. An incision is made where the accelerator will be put into the upper chest area.
Programming and testing: Once the surgery has taken place, it will take some time to recover and a few programming sessions will be completed to get stimulation optimized. A neurologist will adjust stimulation parameters to get the most effective and comfort results which will improve the patient's symptoms with the least amount of side effects.
Follow-up care: Follow-up visits will be at regular intervals to follow progress and, if needed, adjustments to ensure success with the Deep Brain Stimulation acute and chronic treatment modalities.
Follow-Up After Deep Brain Stimulation (DBS) Surgery
The patient is usually discharged within one or two days of DBS surgery. Before discharge, the patient is provided with a complete set of instructions for home post-operative care. After approximately 10 days the patient returns to the hospital for a follow-up, where the staple/suture removal occurs. An initial programming appointment is also made for 2-3 weeks after surgery, at which time the electrical stimulation is turned on. The patient is provided a list of instructions for their use, intended to accelerate recovery as well as minimize the risks for complications.
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Cost of Deep Brain Stimulation in India
Deep brain stimulation (DBS) is expensive and costs in India can range from 33000 USD to 40000 USD. It depends on the types of batteries used in the surgical procedure. Non-rechargeable batteries are inexpensive but must be replaced after a specific period. But on the other hand rechargeable batteries are very costly and do not have to be replaced over time.
|
Treatment |
Min |
Max |
|
Deep Brain Stimulation (non-rechargeable batteries) |
30000 USD |
35000 USD |
|
Deep Brain Stimulation (rechargeable batteries) |
33000 USD |
40000 USD |
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Indications of Deep Brain Stimulation:
DBS may treat a variety of conditions that involve your brain, including movement disorders, mental health conditions, and epilepsy.
The Food and Drug Administration approves DBS for the treatment of:
Dystonia.
Essential tremor.
Medication-resistant epilepsy.
Parkinson's Disease (worsening condition that is not responsive to medication).
Medication-resistant obsessive-compulsive disorders (OCD).
Scientists are also evaluating whether or not DBS may have beneficial uses for other conditions. Conditions that could potentially qualify for DBS include the following:
Addictions.
Alzheimer's disease.
Anxiety.
Cluster headaches.
Eating disorders.
Schizophrenia.
Severe pain disorders (especially pain caused by nerve conditions or brain conditions, or pain from terminal illnesses like cancer).
Severe, treatment-resistant depression.
Tourette syndrome.
The critical thing to remember with the above conditions is that while there may be a possibility they could qualify for DBS, experts still do not know if this would be the case. Research and clinical trials take years to see if a procedure like DBS could be helpful with these conditions. Even while researchers look into them, the surgery for DBS for these conditions is not common.
Risk Factors:
Even though deep-brain stimulation is low risk surgical procedure it is still a surgical procedure in itself and like any surgical procedure patients are at risk of:
Surgical Risks
Deep brain stimulation is a surgical procedure, which introduces surgical risks of infection, bleeding and anesthesia risk. Risk of surgical adverse events are usually small but can still occur.
Bleeding into the brain
The insertion of the electrodes generally can lead to risk of bleeding into the brain when the electrodes enter the brain tissue. The danger is usually minimized through good surgical technique and proper preoperative imaging and planning.
Infection
Infection can occur at the surgical site and potentially around the implanted stimulator and/or electrodes. We utilize sterile technique throughout the procedure to assist with limiting infection risks, however infection can still occur in spite of sterilization and other infection control steps. Infections require antibiotics and in some severe cases removal of the hardware may be necessary.
Lead Displacement
The electrodes can drift or be displaced from their target, resulting in less stimulation and symptomatic control. The identification of lead displacement can be completed with regular follow-up and imaging.
Side Effects
Deep Brain Stimulation may lead to many side effects harnessing remote areas adjacent to, but body parts other than the target area can lead to speech or language problems, abnormal muscle contractions, or sensory changes.
Cognitive Changes
Deep Brain Stimulation may also lead to cognitive changes such as deficits in memory, attention, or highly skilled function. These changes can vary person to person depending on the areas stimulated aside from the target area.
Device-related Complications
Device complications related to implanted hardware, including the pulse generator, or battery may occur, such as device failure, lead fracture, or lead displacement. Routine follow-up visits are essential to monitor proper functionality and integrity of all devices.
Adverse Reaction to Stimulation
On occasion, the stimulation may elicit adverse reactions in the individual such as mood changes, anxiety, and exacerbation of psychiatric symptoms. These adverse reactions are typically mediated through excessive stimulation and can be controlled by altering stimulating settings.