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A man with movement disorder effectively cured
with Deep Brain Stimulation technology

Deep Brain Stimulation (DBS) is widely acknowledged as one of the most technically advanced and sophisticated procedures in Neurosurgery that has now come of age, and is effective for several neurological disorders. It involves stereotactic implantation of battery powered electrodes in different nuclei of the brain that controls human movement, Epilepsy and behaviour. It is globally used for advanced Parkinsons Disease, Essential or Familial Tremor, Dystonia and sometimes, for Epilepsy and Psychiatric diseases like Resistant Obsessive Compulsive Disorder and Depression.

THE CASE

A 35-year-old civil contractor visited Nanavati Super Speciality Hospital with complaints of abnormal movements in all limbs, progressive in nature for 9 months. The complaints kept increasing progressively and by the end of 9 months, the patient was wheelchair bound, unable to move around or conduct his daily routine. His social and interpersonal relationships saw a gradual decline, and he started suffering from Depression. The patient did not respond to Levodopa, Tetrabenazine & Trihexiphenidyl, or other antidepressants including Escitalopram. An MRI of the brain was normal and so were other investigations. Neurologists ruled out other secondary causes of Dystonia.

THE PROCEDURE

The procedure included Deep Brain Stimulation [DBS] with the help of a CRW–FN Stereotactic frame. A Pre-operative 3T MRI was done wherein fusion images which merge MRI and CT scan, were obtained with the help of a workstation, planning software [Framelink 5.0] and an intra-operative Micro Electrode recording [Lead point 4], so as to get signals from the Globus Pallidus Internus. Macro stimulation was then carried out to check for benefit and adverse effects. Once a satisfactory result was obtained, the location was then confirmed. DBS electrodes were placed one after the other on both sides repeating the same recording and macro stimulation process. An Implantable Pulse Generator [IPG battery] was then placed in the subclavicular pouch and the electrode wires were tunnelled subcutaneously from cranium to chest and connected to the IPG. The patient showed a remarkable `Microlesion’ or stun effect due to the placement of the electrodes even without starting the battery. He experienced immediate post-operative relief in his painful distorting movements and posturing.

THE RESULT

A week later the patient was discharged and the programming was commenced on OPD basis. He showed results with programming which included parameters such as pulse width, frequency, voltage, current and impedance and was clinically well maintained on his adjusted programming parameters. He is now completely free from his Dystonia and has resumed his normal life. He has recommenced his prior occupation as a civil contractor. The patient can now drive on his own and even takes time out for his favourite sport – Cricket.


Dr. Mohinish G. Bhatjiwale

Dr. Mohinish G. Bhatjiwale
Director & Senior Consultant
Deptt. of Neurosurgery
Nanavati Super Speciality
Hospital, Mumbai





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