Fig. 1. Picture showing the electrodes and implantable pulse generator
Deep Brain Stimulation is an alternative to ablative surgeries conventionally offered for Parkinson's disease and other related movement disorders. The common targets for DBS surgery within the brain, for movement disorder include, subthalamic nucleus (STN) for Parkinson's disease, ventro-intermedius nucleus of thalamus for tremors, and pallidum for dystonia. Though each of this target sites can be used for different movement disorder, we believe that these are best for the respective disease as indicated.
The therapy of Deep Brain Stimulation requires additional expertise over conventional stereotactic techniques that are required for functional neurosurgical procedures for movement disorder. It requires careful understanding of the principles of DBS, understanding of the disease being treated and combining the medical therapy along with stimulation to achieve smooth control of the disease. Jaslok Hospital & Research Center has been able to develop a multi-disciplinary team to undertake this therapy of DBS. It has performed large number of surgeries for Parkinson's disease and other movement disorder during the past few years. The Multi-disciplinary team includes Movement Disorder Neurologist Dr. Mohit Bhatt, Neuroradiologist Dr. Srinivas Desai and Dr. Kohli and Functional Neurosurgeon Dr. Paresh Doshi. This team is supported by the presence of research fellow, occupational therapist, physiotherapist and anaesthesiologist. At present this centre has the largest experience of DBS surgeries in Asia.
The advantage of DBS over lesional surgeries is that there is no destruction of intracranial nuclei, thus, virtually leaving the patient and his brain intact and available for any future therapies that may come up. The morbidity of the stimulation procedure is also less than lesional surgeries. DBS leads are programmed with the help of an external programmer. This gives the surgeon flexibility in optimizing the current and electrode contacts in each individual patient to suit his requirements.
On the downside, the therapy as mentioned above requires high level of surgical expertise that may not be available at many centres. The other disadvantage is a close follow-up, though not frequent, that is required in order to achieve good and sustained control of the disease. This is not the case in lesional surgeries as patients can be followed up at their respective centres after the surgery. The therapy is also more costly than the lesional surgeries.