Deep brain stimulation ( DBS ) - The Process :

The concept of Deep brain stimulation ( DBS ) surgery evolved from the fact that the movement related disorders of Parkinson's disease and many other neurological disorders are caused by disorganized electrical signals in the areas of the brain that control movement. At CMCS Health , we along with our associated top Indian Neurosurgeons and intervention neurologists provide truly world class Deep brain stimulation ( DBS ) in India for both Indian and global patients.

How deep brain stimulation works :

The objective of Deep brain stimulation (DBS ) is to regulates abnormal electrical signaling patterns in the brain. Brain cells communicate with each other using electrical signals to control normal movement and other functions. When these signals become irregular and uncoordinated, it leads to motor symptoms. Deep brain stimulation (DBS ) interrupts the irregular signaling patterns so cells can communicate more smoothly and the symptoms are alleviated .

Deep brain Stimulation ( DBS ) process involves putting electrodes in either one or both sides of certain predetermined areas of brain ( either the Subthalamic nucleus or the Globus pallidus interna ) through a craniotomy surgery. These areas of the brain controls movements. The placement of electrodes in brain, during the Deep brain stimulation ( DBS) in India can be done in two ways.

1. while the patient is fully awake and conscious during the implanting of electrodes, so that the Neuro-surgeon can ask questions and give you some simple tasks during the procedure. This is done to make sure that the electrodes are put correctly and at the desired site of brain.
2. Procedure of implanting the electrodes in brain is done under general anesthesia with the help of imaging devices during the procedure for identification and putting the electrodes in the desired areas of brain.

The brain implanted electrodes are connected to a very small battery powered neurostimulator (electrical generator) placed under the person’s collarbone, similar to a cardiac pacemaker. This neurostimulator delivers continuous electrical pulses to the brain tissues through the electrodes. This neurostimulator also regulates and controls the amount of stimulation in deep brain stimulation (DBS ).

Deep brain stimulation ( DBS ) - Indications :

Deep brain stimulation ( DBS ) in India is the most common surgical procedure for Parkinson's disease. Deep brain stimulation ( DBS ) in India is taken up for correction of certain neurological disorders that includes:

• Parkinson's disease
• Essential tremors
• Epilepsy
• Dystonia
• Obsessive compulsive disorders

Parkinson's disease :

Parkinson's disease affects men almost 1.5 times more than women. Parkinson's disease is second most common neuro-degenerative disease of brain, after the Alzheimer. Parkinson's disease affects almost 1% of total population worldwide. It can occur even in younger people but the chances of younger people being affected with Parkinson's disease are very rare. As per the recent reports, currently more than 10 million people in the world are affected with Parkinson's disease.

Signs and symptoms of Parkinson's disease:

Parkinson's disease grows slowly, affects the nervous system and the body parts governed by the nerves. The symptoms start appearing gradually over years and may vary from person to person because of diversity of the disease. Symptoms of Parkinson's disease usually appear one side of the body first and then gradually affect the other side limbs too. The most common symptoms of Parkinson's disease are:

• A rhythmic shaking of the limbs called Tremors. It usually starts in one side of the limbs first usually the fingers and hand. The tremor will be there when the arm is at rest but may decrease when some activity is performed by the arm.
• Bradykinesia or slowed movements are also identified as symptoms for Parkinson's disease. Parkinson's disease makes simple task difficult and time consuming , even getting out of a chair becomes a big task. Patients stride while walking gets short and seems like dragging or shuffling of feet.
• Parkinson's disease patient muscles also gets impacted and become rigid. The stiff muscles restrict range of movement and makes any movement painful.
• Parkinson's disease patient's posture also changes from being upright to stooped. Patient may have balance problem and also develop an imbalanced gait.
• Patients also looses involuntary movements like blinking, smiling or swinging of arms while walking.
• Speech pattern changes occur in Parkinson's disease patients. Slurring sets in and initiation of a conservation becomes difficult.
• A Parkinson's disease patient also have change in their handwriting and the usual writing strokes changes.

Deep Brain stimulation ( DBS ) for Parkinson's disease :

Parkinson's disease is a degenerative disease of brain usually occurring because of ageing but it can occur in people as young as 20 too. Parkinson's disease in young people is very rare. Although there is still no treatment for Parkinson's disease but new technological innovations have paved way for stopping or slowing the progression of the disease and improve quality of Parkinson's disease patients. At CMCS Health , we are associated with best Indian Neurology physicians , Neurology surgeons and intervention neurologists to offer effective control on symptoms and complications of Parkinson's disease patients. we offer cost effective deep brain stimulation (DBS) in India for Parkinson's Disease. Deep brain stimulation(DBS) surgery in India has benefitted many patients of Parkinson's disease from India and abroad.

DBS surgery for essential tremors:

Although deep brain stimulation ( DBS ) is approved for Parkinson's disease patients but patients of other movement disorders like Essential tremors also get benefitted with DBS.

Deep brain stimulation ( DBS ) for epilepsy:

Deep brain stimulation ( DBS ) in India is also used for those epilepsy patients who are 18 years or over in age and in whom seizures could not be controlled with anti epilepsy medications. DBS in epilepsy patients work by modulating brain cells and areas of the brain responsible for seizures through electrical stimulation. DBS is also used along with seizure medications for epilepsy patients.

Deep brain stimulation ( DBS ) for dystonia:

Earlier DBS was used only for severe cases of dystonia but in the last few years Deep brain stimulation surgery is used to treat greater varieties of dystonia patients.

DBS for obsessive compulsive disorders OCD :

Deep brain stimulation (DBS) is a newer treatment for major depression (MD) which is resistant to other treatments and obsessive-compulsive disorder (OCD). Obsessive-compulsive disorder (OCD) and major depression (MD) are common and disabling psychiatric disorders.Patients with MD or OCD may not respond well to pharmacological, psychotherapeutic, or somatic treatments. DBS was found to modulate dysfunctional neuronal networks involved in depression. It is documented in various studies that DBS is a promising alternative non ablative treatment for MD and OCD.

Selecting the right candidate for deep brain stimulation ( DBS ) :

Younger patients tolerate the DBS surgery better and may get benefitted more but there is no age restriction for the patients who can have deep brain stimulation (DBS) in India. Patients with significant dementia are not the right candidate foe deep brain stimulation ( DBS ) surgery.

It is evident from recently published data that deep brain stimulation (DBS) outcomes are best in improving quality of life and better control over motor function when it is performed before motor complications become disabling. So those Parkinson's disease patients in whom the motor dysfunction becomes evident should be considered for DBS before motor complications become disabling.

Parkinson's disease patients having mild cognitive disorders can be considered for deep brain stimulation ( DBS ) in India. But they need to be manged with medications for cognitive disorders . Patient with more severe forms or progressive changes may stand a risk of further deterioration triggered by the surgical process or DBS.

As with all elective brain surgeries, patient-specific medical conditions must be evaluated before deep brain stimulation ( DBS ) surgery.

• Cardiac patients with a history of coronary vascular disease or history of angina should first be evaluated by a cardiologist before DBS.
• Patients on antiplatelet agents for cardiovascular disease or anticoagulants for atrial fibrillation, pulmonary emboli, or deep venous thrombosis must temporarily stop taking these medications prior to deep brain stimulation surgery.
• Patients who have co-morbid conditions such as hypertension and diabetes need proper control over hypertension and diabetes before DBS, to avoid intra-procedural and postoperative complications.

Why India for Deep brain stimulation (DBS ) surgery :

Top Indian hospitals offering neurological disease treatments are equipped with the latest , state of art technologies and neurology physicians , neuro-surgeons as well as intervention neurologists who are the masters in their craft.

• The cutting edge technologies adopted by top neurology hospitals of India , combined with expertise and competency of Indian speciality doctors and high success rates have made India a preferred destination for global guests seeking Deep brain stimulation (DBS ) treatments. Cost of deep brain stimulation (DBS) in India is also quite reasonable as compared to other centers.
• As DBS treatment may require a longer India stay , cost of rental apartments is a big consideration for patients seeking DBS treatment offshore. India offers many choices with readily available fully furnished guest houses and rented apartments in safe and secure environment that is close to the treating hospitals.
• No waiting period for commencement of treatment.
• Proper follow up of patient with treating Indian doctors once the patients reach back their respective countries.

Best in the world DBS devices available in India:

At CMCS Health , our associated deep brain stimulation treating hospital offers the choices among the best available DBS devices in the world. Although all the DBS devices are same in basic components and their function , but each device is designed and programmed in a different way to offer tailormade treatment for every individual patient . Some DBS devices offer the options of rechargeable batteries or electrodes that can deliver stimulation in novel ways or sense and record brain signals. The treating doctors will help in choosing the best suited DBS device for every individual patient by discussing about the suitability and pros and cons of every DBS device.

The best in the world DBS devices which are available in India are:

• Infinity Deep brain stimulation system by Abbot.
• Activa devices from Medtronic offers the choices of re-chargeable and non-rechargeable batteries.
• Percept is the latest DBS device from Medtronic . It is first of its kind DBS device that can sense and record an individual’s unique brain signals.
• Vercise from Boston scientific.

The rechargeable batteries may last up to 15 years (or more in some people) and non-rechargeable last, on average, about three to five years. The length of battery life depends on your individual settings. All current DBS devices also are safe for MRI, as long as certain safety conditions are met.

Cost of deep brain stimulation (DBS ) in India:

The cost of Deep brain stimulation ( DBS ) in India depends on the Indian hospital , expertise of the Indian doctor and the type and make of DBS device. Depending on these factors the average cost of DBS surgery in India:

Cost of investigations ( for ascertaining Suitability of DBS surgery , kind of device )	800 - 1200 USD
Cost of Deep brain stimulation ( DBS ) in India including the cost of device.	22'000 - 40'000 USD

Top Indian Hospitals for deep brain stimulation ( DBS ) surgery :

Most of the top hospitals in India are JCI ( joint commission international ) & NABH ( National accreditation board of hospitals ) and offer hassle free medical treatments for global patients. Many of these hospitals treat patients insured with international health insurance companies enlisted in their panel.

Max super-specialty Hospital , Saket , New Delhi is the flagship hospital for Max healthcare. Max super-specialty hospital , New Delhi claims that they provide unparalleled patient care and best hospital experience for patients of Deep brain stimulation ( DBS ) in India.

Manipal hospital , Dwarka , New Delhi ,claims that " To tackle various disorders pertaining to the nervous system, the Department of Neurological Disorders at Manipal Hospitals offers comprehensive services in Neurosurgery. Not just technology but it also has a team of world renowned neurologists and neurosurgeons, many of whom are faculty members with extensive experience in teaching and research to its credit. Disorders of the nervous system such as dementia, epilepsy, movement disorders, chronic pains, sleep disorders, headaches, multiple sclerosis and various other neuro-muscular diseases are effectively handled here."

Medanta - The Medicity is one of the leading multispecialty hospital of India. It is located in Gurugram and well connected to New Delhi by road and Metro rail ( Tube train ). It is at 20 minutes drive from New Delhi - Indira Gandhi international airport. Medanta is having a full fledged and dedicate neuro-sciences department with India's leading Neurologists and latest diagnostics facilities.

As per Medanta- The Medicity hospital - " Over the past few years, Brain Pacemaker surgery or Deep Brain Stimulation (DBS) surgery has emerged as an effective therapy in such cases. Herein, a neurosurgeon implants a device that sends electrical signals to specific brain areas, depending on the disease being treated. As the disease progresses, these signals can be re-programmed or modulated to accommodate changing symptoms.

The essence of a successful brain pacemaker surgery is its precision and accuracy. In this regard, the inculcation of cutting-edge technological advances in the conduction of a DBS stands to logic.
An ingenuous innovation, Directional DBS has emerged as a game-changer. Unlike a conventional DBS surgery, which only allows neuromodulation in one direction, the segmented electrodes (leads) of a Directional DBS system helps in steering the stimulation of the specific region of interest in all three dimensions, thus significantly enhancing the surgical focus and precision while minimizing inadvertent side effects.

Another promising technological advancement of DBS is a real-time Brain-Sensing biomarker-guided feedback analysis of the local field potentials by the brain pacemaker pulse generator itself which would then automatically release a closed-loop anticipatory stimulation response.

Recently, we implanted North India’s first Directional- and Brain Sensing-coupled DBS system in a 70-year-old patient suffering from incapacitating Parkinson’s disease for almost 15 years.
An interesting innovation nowadays being increasingly used in clinical practice of brain pacemaker surgery is patient-specific direct targeting of neural circuits, which is an emerging approach for refractory Parkinson’s disease patients as the next step forward."

Fortis memorial research Institute , Gurugram is the flagship hospital for Fortis group of hospitals. Very close to New Delhi's Indira Gandhi international airport and well connected by road and delhi metro.

Artemis Hospital is a preferred hospital in north India among the global medical travelers. Located in national capital region , Gurugram.

"The distinct faculty of the Artemis Institute of Neurosciences uses their vast experience in to help diagnose and treat disorders of the nervous system affecting the whole body, the spine, brain, hands, legs, arms and face. The Neurosurgery department offers some of the most advanced surgical treatments along with a variety of non-surgical approaches to restore his patient's health and relieve their pain.  Artemis Neuroscience Hospital considers to be one of the best neuro hospital in India."

Indraprastha Apollo Hospital in New Delhi , is one of the pioneer Indian hospital that started the trend of Global travelers coming to India for super specialized medical treatments. Indraprastha Apollo hospital offers Deep brain stimulation

Best Doctors for deep brain stimulation( DBS) in India:

Speak to best Indian deep brain stimulation (DBS ) specialist doctors one to one through WhatsApp to clear any doubts about deep brain stimulation ( DBS) surgery in India.