DBS will improve patients “ON” (good) period duration that is the time when the patients are fully functional without any side effects of medicine. This surgery will be able to increase the good period to last around 70-80% of the day. After successful DBS we can reduce the medications by 30-40%. Surgery also offers benefit on various motor fluctuations, hallucinations, dyskinesias, reducing depression, increasing weight and generating positive feeling in patients there by improving the quality of life.

However not all the patients benefit equally, and hence it is very important that your surgeon understand what he can deliver by surgery and what he can improve by medical management so that you can understand the exact outcome of surgery. Most centres do not have adequate experience to give you convincing and confident answers to all these questions.

DBS surgery is safe in experienced hands. The risks of surgery are minimal. We have analysed and found that our risk of major complication was less than 2%. This compared favourably with the best centres in the world. As a patient you need to evaluate risk vs benefit ratio. The risk of procedure reduces with learning, for example experienced and trained driver of a car is less likely to make mistakes than a new driver.

In the initial years Parkinson’s Disease is controlled by medications. With the progression of disease, side effects of the disease increase in the form of motor fluctuations, dyskinesias and hallucinations. By this time increasing the dose of medications will cause more side effects than benefits. Usually this period comes around four to six years of disease initiation. So, we believe that surgery should be offered to the patients when it is not adequately controlled by medical management, increasing the side effect of medication effecting the quality of life.

Deep Brain Stimulation (DBS) involves mainly two steps, the first one being the implantation of an electrode deep within the brain under local anaesthesia and the second one is implantation of IPG in the chest. We have perfected the art of surgery and have realized that each patient is an individual and we must cater to the mindset of every patient. During the first two days there are extensive Parkinson’s Disease related assessments, video recordings and patient counselling by our team to ensure that the patient can undergo surgery with confidence and smile. A typical surgical procedure involves admission on Day 1, followed by MRI under sedation or general anaesthesia on Day 2, surgery for electrode implantation under local anaesthesia on Day 3 and pacemaker implantation under general anaesthesia on Day 4. A typical DBS operation theatre set up is shown in the picture below. We do stimulation trial on OT table and confirm the results with patient that is why we keep the patient awake during the surgery. Usually patient stays in hospital for 8 to 10 days till the suture removal and programming is completed.

Initially there is minimal pin prick when we give you local anaesthesia, however once the local anaesthesia takes effect you will not feel any pain during the surgery, however you will realize that we are working on your head and we will be keeping you informed of all the things during the procedure as we go along. This increases the patient comfort and confidence in the procedure and none of our patient have ever felt that he had a traumatic experience from the surgery. You will not be sedated during the procedure.

Yes, elderly patients do worry about the risks and fitness for the surgery, but it depends upon the surgical procedure which you are undergoing. DBS is a safe and simple surgical procedure and along with it the surgeon’s experience of handling an elderly patient matters a lot. We do understand that elderly patients are associated with multiple co-morbidities but at our centre we are specialized in handling all such elderly patients. If the patient cannot tolerate surgery under local anaesthesia we can do it with conscious sedation. We also prepare ourselves, patients and relatives to ensure that the surgical experience remains as comfortable and safe as one would wish to be. We published our outcome of elderly patients versus young patients operated at our centre and found that there was no increase in rate of complication and the improvement in Parkinson’s disease was similar.

After surgery we will provide you with the detailed list of dos’ and don’ts to safeguard the pacemaker. Broadly speaking, you can continue to do all the normal activities that you would like to do, e.g. swimming, dancing, jogging or any kind of exercise, use of cell phone, microwave oven, driving etc.

I have a track record of programming most patients by the time of discharge. They also have minimal follow up visit requirement. More than 50% of patients do not need any follow up till 2 years. If required most of the programming can be done on out-patient basis.

Programming is the key to success for DBS surgery. To get the full benefit of surgery, correct knowledge of programming the pacemaker is very crucial. If you cannot program it correctly you will not get the desired benefits of the surgery. My team has more than 2000 hours of programming experience and hence we can immediately assess the response of each program subset and offer what is best for you. 

  There are two major companies in India which provide DBS implants.

1. Medtronic
2. Boston Scientific

The 4 key points to be checked while choosing the implant is

1. a) MRI compatibility
2. b) Rechargeable/Non-rechargeable option
3. c) Battery life
4. d) Advanced programming features

The best suitable implant varies from patient to patient due to many factors. Hence, the best person to recommend is your surgeon. Take appropriate suggestions from him before making the selection.