Movement Disorder Surgeries
People who don't
suffer from movement disorders find it difficult to understand how the
conditions feel like. So it didn't surprise Roshan that failed to understand
what he was feeling.
He was in his
early forties when the first symptoms of his disease began to surface. Roshan
didn't consult the doctor. Why would he? He didn't even see it as anything
serious. He was a fool to not to realize the importance of the tremor that
shook his fingers and limbs sooner. But the time it came to him that something
about this tremor was fishy, another sign of the disease made its presence
known.
His movement got
slower, making simple tasks difficult and time-consuming. His steps became
shorter when he walked. It became difficult for him to get out of a chair. And
before he knew it, he was dragging his feet along the floor as he tried to
walk. Then stiffness and rigid muscles set in. After that, Roshan didn't waste
any time and consulted a doctor. The doctor told him that his symptoms were
similar to that of a person with Parkinson's disease. The doctor sent him to a
neurologist who confirmed the disease.
The neurologist
put him on antidepressants and dopamine promoters. But these drugs proved to be
futile. Roshan had lost all hopes when the neurologist told him that there was
one door that was still open. The door named surgery.
What are movement
disorders?
Movement
disorders mean excessive often repetitive and involuntary movements that
interfere with the normal flow of motor activity. The most common movement
disorders are:
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Essential tremor.
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Ataxia.
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Dyskinesia.
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Dysphonia.
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Dystonia.
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Parkinson's disease.
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Physiological tremor.
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Tics.
So do surgeries really help in
treating movement related disorder?
No one can answer
this question better than Dr. Paresh Doshi. After all, Dr. Paresh Doshi and his
team perform a wide spectrum of movement disorder surgeries.
Dr Paresh Doshi’s
team has performed one hundred and thirty movement disorder surgeries,
including forty-nine cases of DBS all across India. Dr Paresh Doshi is a
full-time consultant at Jaslok Hospital Mumbai. The Neurology department of Jaslok
Hospital has been featured as the best Neurosurgical Department in
India in several surveys including CNN-IBN, The Week magazine, India Today
etc. Jaslok
Hospital holds the prestigious NABH accreditation and it can boast to be the
only hospital in Mumbai to offer the best in neurosurgical practice with the
most affordable packages.
What are the surgeries
that work for the Movement Disorder?
DBS Treatment
The deep brain
stimulation is a treatment technique in which electrodes are placed in a
specific region of the brain. These regions are selected based on the symptoms
being treated. The electric terminals are placed on both the left and right
sides of the brain through small holes or incisions made at the top of the
cranium or skull. The electrodes are connected by long cables that travel under
the skin and down the neck to a battery-powered stimulator placed under the
skin of the chest.
In the correctly
selected patients, DBS is quite safe and efficient but there are some risks.
There is an estimated two to three percent risk of brain hemorrhage that may
either be of no significance or may cause paralysis, speech impairment, stroke,
or other major problems.
The circuit
inside our brains responsible for controlling our movements is called the basal
ganglia and is made up of several different groups of brain cells that connect
and communicate with each other to fine-tune movement. In Parkinson’s, the key
families of brain cells involved in the movement circuit stop working properly
as the dopamine-producing cells in the substantia nigra slowly stop producing
the optimal level of dopamine. Without the injection of dopamine, it becomes
harder to get moving and to maintain movements, and so, things like stride
length can get shorter over time. This is where DBS comes into the picture.
Although we still do not fully understand how this electrical stimulation works
to improve movement, scientists and doctors now believe that the stimulation
may disrupt abnormal electrical activity in the basal ganglia and may help to
regain the movement control. If the patient is selected carefully, the DBS can
be highly effective and reduce the symptoms by 70% and it is also completely
reversible and can be turned off or can be removed if necessary.
What are the side effects of DBS?
There are a few side
effects of DBS, and they may include the following:
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Allergic reaction to the implant
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Concentration difficulties
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Dizziness
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Jolting or shocking sensation
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Loss of balance
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Reduced coordination
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Slight paralysis
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Speech or vision problems
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Temporary pain/swelling at the implantation
site
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Temporary tingling in the face or limbs
Thalamotomy
First introduced
in the 1950s, it is a surgical procedure in which an opening is made into the
thalamus to primarily treat tremors such as those associated with Parkinson's
disease. But now, focused ultrasound, a completely non-invasive method of
thalamotomy, is now employed. It is a procedure in which a predefined small
volume of brain tissue containing nerve cells causing the tremor is destroyed
using focused ultrasound.
Unlike DBS, no
incision or electrodes are involved, hence if the symptoms are not that severe,
this surgery is preferred.
What are the side effects of
Thalamotomy?
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Weakness
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loss of
sensation
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loss of
voluntary movement
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Temporary confusion.
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Stroke caused by bleeding in the brain. It
sometimes can lead to death.
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Temporary balance problems.
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Numbness around the mouth and in the hands.
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Infection.
Pallidotomy
Pallidotomy is
another neurosurgical procedure to treat movement disorders. In this procedure, a tiny electrical probe is
placed in the globus pallidus which is one of the basal nuclei of the brain.
The electrical probe is then heated to 80 °C for 60 seconds to destroy a small
area of brain cells. Neurologists believe Parkinson's happens when a part of
the brain called the globus pallidus starts working too hard
What are the side-effects of
pallidotomy?
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Fatigue and sleepiness
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Worsening of memory
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Depression
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Aphonia
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Dysarthria
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Scotoma
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Slight facial and leg paresis
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