DBS for Depression

The Deep Brain Stimulation surgery has shown successful results in a majority of patients suffering from advanced stages of the Parkinson’s disease and is now a well-accepted treatment. While this surgery showed major improvements in Parkinson’s disease patients for controlling motor movements and the like, until recent time there was no substantial evidence that the same surgery could be used for patients suffering from depression. However, thanks to medical research on the matter, it has been proved that DBS can be a viable option for treatment resistant depression in patients, especially for unipolar major depressive disorder (MDD) or bipolar II disorder (BP). And DBS for depression is now being talked about extensively.

Depression is a serious and incapacitating medical illness. While MDD is prone to being resistant to allopathic treatment and slowly immune to medication, bipolar II disorder patients are known to go into a hypo-manic or manic episode state when given antidepressant medications. These aspects make DBS an ideal solution for such patients. Deep Brain Stimulation uses high frequency electrical stimulation to target a specific area of the brain for a particular neuro-psychiatric disorder. While DBS has shown substantial improvement in many patients that undergo surgery for general depression, most studies on the matter have shown mixed results.


Patient selection is crucial to the success of DBS therapy for depression. It is important that the patient be offered surgical evaluation at an appropriate centre which has the expertise of evaluating such patients. At Jaslok hospital, such patients are evaluated by two psychiatrists and a neurosurgeon. They establish if the disease is indeed incurable with medical treatment and the patient has been offered adequate trial of best medical therapies. If they find it appropriate, he is referred to a committee to confirm the findings and only after such stringent evaluation surgery is offered. Remember that even though this surgery may help and show marked improvement in the patient, it may be recommended that the medication and other treatments like counseling, psychotherapy, rehabilitation, etc., be continued even after the surgery. There can be cases where DBS may not be the best option at hand, with such patients the conventional psychiatric or psychologist help with allopathic medication may be the only way for now, until there is another scientific breakthrough that can benefit them.

In view of the fact that DBS for depression is a ray of hope for many, but still not the right treatment for every person caught in the anguish of this disorder, it is important to continue the research and clinical trials on the subject. Many hope that a close understanding of DBS and how it works on the brain can provide researchers with the insight they need to find a cure for depression and other psychopathic diseases.

Parkinson’s Disease Treatments

It is no secret that currently there is no known cure for Parkinson’s disease in the world. There are many researches being undertaken and there may be a time soon when people who are long suffering from this neurological disease can breathe a sigh of relief. Today, this disorder is predominantly controlled by medications. Patients are prescribed medicines that help control most of the symptoms caused by this disease. But not all hope is lost. These days there are some modern Parkinson’s Disease treatments available that are showing tremendous results and being well-accepted by a large patient population. These include surgeries like deep brain stimulation, subthalamic nucleus lesioning, pedunculo-pontine nucleus stimulation etc. Besides surgery, regular exercises and yoga form a significant role in the control of Parkinson’s disease.

One of the most popular treatments is deep brain stimulation. This is a surgical procedure in which an electrode is implanted deep in the part of the brain that controls movement of a body. The stimulation delivered to this electrode is controlled by a device called a pulse generator. While this surgery is recommended to patients that have been suffering from the disease for a long time, partly immune to the medicines given to them, or in the advanced stages of the disease, this surgery has shown good results in controlling the involuntary movements in the patients. It should be noted that though this surgery helps to a great extent in providing patients with the desired result, in most cases the medicines prescribed by the doctor are to be continued. There are many known doctors who hold expertise in this surgery, and it may be best to consult one before deciding on taking the plunge. The idea of going through a brain surgery may be scary, but serious risks in this procedure are uncommon. In very rare cases, complications during the surgery may cause brain hemorrhage or stroke. On the other hand the statistics of risk to an infection is more, and sometimes requires a part of the device to be replaced. This is the reason it is most important to consult a reputable doctor.

Another complementary treatment for Parkinson’s disease is physiotherapy. The correct exercises can help maintain functions and improve mobility of the body parts in PD. Even though such therapy cannot stop the progression of the disease, it can help in keeping the muscle strength and agility, giving the patient confidence. Plus, exercises are the best way to improve balance and gait for PD patients.

Other Parkinson’s disease treatments that can help a patient are occupational therapies and speech therapy. If you are a believer in alternative medicines, you could try homeopathy or acupuncture with a well-known practitioner. But keep in mind that this disease is not curable currently and the most anybody can do is teach you how to control your movement and improve that area of your life.

Deep Brain Stimulation

Considered to be one of the most promising methods of managing Parkinson’s Disease, Deep Brain Stimulation is gaining due popularity for the past decade or so. Delivering remarkable results for the patients suffering from advanced Parkinson’s disease and other neurological movement disorders, Deep Brain Stimulation (DBS) is a surgical procedure that includes implanting a battery operated medical device known as a neurostimulator into a specific part of the patient’s brain (usually the subthalamic nucleus). This device is somewhat like a heart pacemaker and basically sends out mild electrical stimulation to the targeted areas of the brain. These are primarily the areas that control movement of the body. The electronic stimulation blocks the nerve signals that are causing the tremors and involuntary movement for the patient.

Providing long-term benefits, the little device is not bigger than a stopwatch, in size. The device consists of three parts. They are the lead, the extension and the neurostimulator. The lead is the electrode that is positioned in such a way in the brain of the patient that the tip of the wire is proximal to the area of the brain that governs body movement. The extension is an insulated wire which is connected to the neurostimulator, as well as the patient’s head, shoulders and neck. This wire is passed under the skin to the neurostimulator. The neurostimulator is predominantly the battery of the device and usually implanted near the collarbone, abdomen or chest.


It is important to note that deep brain stimulation is not the cure for Parkinson’s disease and most patients still need to take medication after DBS surgery. This is merely a valuable tool for people extensively suffering from Parkinson’s. The DBS procedure is being well-received for a number of reasons. The procedure does not damage any part of the brain and can be reversed at any given time. After all, with the kind of development and research going on in the field of brain science throughout the world, there may soon be other surgeries to control indications of neurological diseases such as these.

This surgery is ideal for cases in which the patient’s symptoms are not adequately controlled by the medications and other forms of treatment. There are few specialists in India that hold expertise in Deep Brain Stimulation procedure and it may be advisable to seek out the best for the same. However, it is important to know that the surgery has a learning curve and the centres having an experience of more than 5-7 years of surgical treatment should be preferred to reduce the incidence of complications. All brain surgeries are dangerous and it is crucial to find the right surgeon to do the procedure. A good way to find one is through the Internet but be sure to go thoroughly through the doctor’s website. Another wise suggestion would be to take down the contact details from the website and book an appointment with the surgeon. A face to face meeting could give you a clearer picture of what the surgery involves and other aspects of the disease.

Parkinson’s Disease

If you or someone close to you is suffering from Parkinson’s disease, it may be best to read up on the subject to gain an understanding about this degenerative condition of the central nervous system. The ailment is characterized by shaking, slowness in movement, stiffness, difficulty in moving around, loss of balance and coordination. Caused due to the lack of chemical known as dopamine, Parkinson’s disease is mostly seen in ages exceeding 50. Even though there are many recorded cases of young adults being affected by this disease as well, it is extremely rare to find this illness in children. Many Indians are tempted to ignore the symptoms of this disease and hence avoid being treated by medical professionals, without realizing that untreated this disorder will progressively get worse until the patient is completely disabled and eventually lead to an untimely demise.

Some of the symptoms involved in Parkinson’s disease are pretty mild in the initial stages of the disease. Having a professional medic take a look at persistent symptoms may be the best way to nip the disease in the bud. The indications you should keep an eye open for are things like constipation, trouble in blinking, drooling, problems with walking or balance, difficulty swallowing food or water, stiffness in the facial muscles making the person’s face seem expressionless, random aches and pains in the muscles, stiffness of various muscles in the body, shaking or tremors, slower speech pattern or monotone voice, stooped posture, low blood pressure, problems in movement, anxiety, stress, confusion, depression, dementia, fainting, hallucinations, and memory loss.

The disease has no known cure at the present time, and most medicines prescribed by doctors aim at controlling the symptoms. A large number of medicines recommended for Parkinson’s disease work at increasing the levels of dopamine in the brain. While such medicines work to an extent in the initial stages of the sickness, at a certain point these drugs become ineffective or pose other medical complications for the patient. For indications like frozen movements, speech difficulties and posture problems that do not respond well to drugs, other modes of treatment that have proved to show some effectiveness are recommended. These include diet, lifestyle changes, exercising, physiotherapy and some other forms of rehabilitation.

These days you can see a lot of patients opting for corrective surgeries for this disease. While these surgeries do not cure the illness, they do help to ease the symptoms. Surgeries for Parkinson’s disease include deep brain stimulation to control movement, stem cell transplant, and the like. To know your options for controlling this illness, medicines that can help you feel better or the best doctors to consult, it may be a good idea to browse online for more information. You could also get in touch with surgeons who specialize in such surgeries through online websites as well.

Mr. David's Successful DBS Surgery

Mr. David Motsonelidze, 51 years old, resident of  Georgia has been suffering from Parkinson ’s disease since he attained age 42. Mr. David had been on regular medication on consultation with neurologist in his country. His symptoms that were minimal initially, worsened as the days progressed and the OFF period increased progressively. Last 2 years have been worse for him as he was totally dependent on family members for his daily activities. He also suffered from severe backaches that were unbearable and mild depressions for which he was on medications.

He was utterly frustrated with the quality of life, when he found out that he could undergo deep brain stimulation surgery as the last resort to help him. He made extensive inquiries and found that this was not available in his country, or any other nearby countries. The closest place that he could undergo this surgery was Turkey. However, the cost of surgery at Turkey, Europe and USA were to prohibitive for him. On further inquiry he found that our centre had one of the largest experience of Deep brain stimulation surgery and the cost of the surgery was also affordable. He approached me with a hope of becoming normal one day and gain the ability to earn bread for his family. He also had a wish, that he would play guitar in front of his only son, who after his birth never saw his father playing the instrument, fulfilled.

The DBS surgery was conducted on Mr. David in the month November 2010 after testing him to be fit for the same and getting the consent from the patient and his relatives who had come along. To their pleasant surprise, on the seventh day of the surgery he played guitar which the JHRC provided without any difficulty. He also sang and danced to the tune of music of the guitar. He was very excited and hilarious. We could see in his eyes that he was very eager to go home and be with his family as early as possible. He expressed his desire to get home quickly to be with his family for the Christmas and the New Year Celebrations that he has been missing for years together. He could not control his emotions and getting tears of joy in his eyes he said he would fulfil his wish of playing guitar in front of his son during the celebrations mentioned above. He thanked Dr. Paresh Doshi for the successful operation he carried on and the other members of the team for wonderful job they did.  At the time of discharge he was experiencing almost continuous ON hence his medications have been decreased by 30 %.  Dr. Paresh Doshi suggested for further reduction of medications once he goes back home in consultation with the Neurologist.

Now that Mr. David has reached home on the eve of Christmas day after a succeful DBS surgery we just hope he enjoyed the festival.

David’s video can be viewed on http://www.youtube.com/watch?v=oEDkEOLFQd0

Intrathecal Baclofen for Spasticity

Recently a new movie got released in India by the name of “Guzaarish”. In this the lead actor is paralyzed down the waist (paraplegic). The movie is believed to be a remake of the 2006 Hollywood film ‘The Prestige’, which was directed by the ‘The Dark Knight’ director Christopher Nolan.

Paraplegia can occur secondary to many spinal cord diseases, which include trauma (most common), tumors, hemorrhage, genetic (familial spastic paraplegia), etc. Patients with some amount of preserved lower limb function are called paraparetic. One of the common accompaniments of loss of power in the lower limbs is spasticity or tightness of lower limbs. This can range from minor to very severe tightness. At its worst it can lead to spasm and pain. In female patients the severe tightness can come in the way of maintenance of proper hygiene. There can be associated involvement/dysfunction of bladder and bowel adding to the misery of these patients.

Presently, very little can be done in the form of direct treatment to improve the clinical conditions of these patients. Significant interest is seen in the field of engineering and robotics that use various algorithms from hand held control to nerve stimulated messages that can be delivered to regain some function in the damaged legs. However, apart from sporadic breakthroughs (e.g. Rex Robot) innovations that can significantly improve function have yet to come.

LET ME PUT A STRONG REMARK HERE CAUTIONING ONE AND EVERYONE THINKING ABOUT EXPLORING THE USE OF STEM CELLS TO IMPROVE THEIR CONDITION. IT IS A COMPLETE SHAM AND LACKS ANY CONCRETE MEDICAL PROOF THAT THEY ARE EFFECTIVE IN ANY WAY.

In this situation, the present day treatment aims at reducing the spasticity. The main therapy for this is oral Lioresal tablets. However, above a certain dose it causes marked drowsiness and other side effects. An alternative to this treatment is the use of intrathecal baclofen pump. This is a drug delivery system that is implanted over the spinal cord to delivery baclofen directly to the target tissue. (Fig. 1.) This highly sophisticated pump reduces the requirement of baclofen by 1/300 times.  The therapy can be programmed to deliver 1ml. of volume over 24 hours. It can further be programmed to increase or decrease the dose based on different requirements during the day. The therapy can be tailored to each individual patients requirement. This reduces the spasticity, spasm and pain associated with it. We have had several patients who after implantation of the pump have regained their mobility (though wheel chair bound) and self esteem. For more information visit http://www.neurologicalsurgery.in/

DBS for Parkinson’s Disease also cures OCD

Chandru Sharma is a relaxed  man now. Obviously for the following reasons.

A successful DBS surgery conducted by Dr. Paresh Doshi , Neurosurgeon on his wife Sharada who when  visited the doctor was in an advanced state of Parkinson’s disease and had also been suffering from Obsessive Compulsive Disorder (OCD) for over 20 years.

After surgery, Sharada’s OCD also became completely under control. 

More importantly barely three days after  the surgery sharada walked without anybody’s help which had moved both Chandu and his daughter to tears.

Now  she plays veena which she was fond playing in her younger days.

Chandru’s daughter also is a relaxed person. She was 10 years when her mother showed sign of OCD. She had a miserable teenage and always in confused state because of the sufferings and violent behaviour. She was confused even when her showed love and affections towards her. Even Chandru, despite willing to explain everything to his daughter about what had been happening to Sharada, could not do so as the daughter was too young to understand

Sharada’s debilitating mental illness made her suspicious of all those who dropped in at her house. She never hesitated to ask her guests what all they stole from her house. Whats more, every day morning she would pack bags and move out.   Then she developed Parkinson’s. She found it hard to move without assistance. As her Dopamine producing cells were dying she had terrible pain, stiffness, tremor and severe depression. The doctors were in dilemma. Medicines for one disease were making other worse. The dopamine producing drug that she was taking played havoc with her emotions and she was in a miserable state.

As Sharada became log-like her then ten year old daughter was shattered by her suffering and violent behaviour. Chandru recalls  “ Our child had a miserable teenage.  Even when Sharada showed love and affection the child looked confused”.

Then he got to know about DBS which was being experimented in India. It is a surgical procedure which involves implantation of medical device known as brain pacemaker. The battery operated neuro stimulator sends electrical stimulation to specific areas of the brain which control the movement.

Chandru took Sharada to Dr. Paresh K . Doshi of Department of Stereotactic and functional Neuro surgery  at Jaslok Hospital and Research Centre in Mumbai who is also pioneer of DBS in INDIA.

“ When I saw the patient I was quite confused as to how I am going to improve her quality of life, She was in an advanced state of Parkinson’s Disease with OCD. But DBS brought her Parkinson’s under control. She could bring down the medication from 900mg to 200mg. Mean while she got the bonus of an accidental cure too. It was the first time that such a surgery was done on a patient having both Parkinson’s as well as OCD “ Says Dr. Doshi.

Dr. Doshi further explains about accidental cure “ Over activation of the direct pathway has been linked by some researchers to the development of the abnormal and intrusive thoughts and behaviours that are associated with OCD. The Deep Brain Stimulation that had been used in Sharada may have also reduced the hyperactivity along with the pathway by regulation through the Subthalamic nucleus [Component of brain that performs action selection] and substantia nigra [ brain structure that controls movement and regulates mood]”

With the Positive side effects that Sharada was benefited with after the DBS surgery was done by Dr. Joshi was a pleasant surprise for every one involved. The DBS (Deep Brain Stimulation) Surgery proved double boon for the 60 year old Sharada Sharma from Thane who had been suffering from OCD for last 20 years.