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Dr. Nithin

Neurologist, Bangalore

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Dr. Nithin Neurologist, Bangalore
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Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences....more
Our team includes experienced and caring professionals who share the belief that our care should be comprehensive and courteous - responding fully to your individual needs and preferences.
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Dr. Nithin is one of the best Neurologists in OMBR Layout, Bangalore. You can visit him at Dr. Nithin@Chaya Hospital in OMBR Layout, Bangalore. Book an appointment online with Dr. Nithin on Lybrate.com.

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How Physiotherapy Can Help with Neurological Disorders

MSPT (Master of Physical Therapy), BPT
Physiotherapist, Gurgaon
How Physiotherapy Can Help with Neurological Disorders

Neurological disorders are problems with any one or a combination of the central nervous system or any of its peripheral systems such as cranial nerves, neuromuscular junctions, and the autonomic nervous systems among others.

Some extreme examples of neurological disorders are:

- Dementia
- Alzheimer's disease
- Parkinson's disease
- Epilepsy
- Disorders brought on by strokes
- Multiple sclerosis and others

What is physiotherapy and how can it help?

Physiotherapy is a form of treatment where practitioners use physical forms of treatment such as massages, exercises, heat treatment and other controlled forms of external stimuli to treat physical disorders.

This method of treatment can be very effective in correcting neurological disorders.

Some of the physiotherapy techniques, which can be implemented to help patients, are as follows:

  • Electrical Stimulation: This method is commonly used to treat muscular problems, especially incurred after an accident or any other form of injury. In this method, controlled electric stimulation is given to specific nerve areas over the skin to stimulate them.
  • Heat treatment: This method involves applying heat to parts of the body such as joints or muscles where there is nerve or muscular damage. This treatment is especially effective for muscle related problems.
  • Ice or cold treatment: Vertically opposite to the principle of heat treatment, ice or cold treatment is used to contract muscles within the body. This is especially effective where inflammation needs to be controlled.
  • Manual therapy: Possibly the most common form of physiotherapy, this method employs massages, pressure points, stretching and hands on strengthening exercises and helps regularize nerve impulses to areas where they have been affected.

'Consult'.

Tip: 5 Reasons You Must Rid Yourself of Anxiety on Daily Basis

3815 people found this helpful

Sir I am 20 years old female and I have a migraine. can you tell me any solution for this problem.

MBBS, cc USG
General Physician, Gurgaon
I am giving some health tips for Migraine headache •1.You can turn off light for some time •2.Apply hot or cold compresses to your head or neck. •Ice packs have a numbing effect, which may dull the sensation of pain. •Hot packs and heating pads can relax tense muscles. • •3.Warm showers or baths may have a similar effect. •4.You can take Tea or coffee( but not excess) 5.Sleep well Here are some tips to encourage sound sleep. Establish regular sleep hours. •Minimize distractions. •Your eating habits can influence your migraines. •Be consistent. Eat at about the same time every day. Don't skip meals. Fasting increases the risk of migraines Avoid foods that trigger migraines kindly consult Physician for further management
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1. I have a pain in neck, low back ache and joints. 2. Pain, numbness in arms & limbs. 3. Burning sensation in feet and eyes. 4. Ear nerve pain. My age is 58 and I am male.PLease do help

Hand Surgery, M.S. (Orthopaedics
Orthopedist, Ahmedabad
Dear well I think you need a detailed work up and a diagnosis. Then we can offer you various means of treatment.
1 person found this helpful
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On 4th April 2015 I got an Epilepsy attack in morning around 5 A.M. My wife told me that whole body got folded and after Epilepsy I was feeling vomiting issues. After 5 days I realized that some sound is coming from my mind or Ear I do not know but it is coming continuously. Till then I have contacted many Neuro /ENT .Some one says its Tinnitus and I have started medicine. Epilepsy : Encorate Chrono 500 MG two times (Regularly). For Tinnitus : Bilovas and rejunex cd. Some of my friends have told that you are not taking correct medicine for Epilepsy so you are hearing this sound as an side effect. I am not sure because all 3 Neuro doctors have prescribed me same medicine for Epilepsy. Kindly suggest me that if this can be the case or not. I am really confused and getting depressed / anxiety issues now.

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
Epilepsy is a complex disorder of the brain which has various psychiatric components in it. Anxiety and depression are common. Encorate chrono is no doubt a very good medication for epilepsy. But i hope you have investigated yourself in detail for the first attack of epilepsy at your age. Epilepsy due to some reversible and treatable cause should always be sought for complete cure. Sounds from your mind/ ear need evaluation because sounds in tinnitus are peculiar and can hardly be confused with anything else.
1 person found this helpful
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I am feeling numbness in a small portion in the middle of right thigh from around 1 year. I took D-Rise 2000iu capsules on prescription of a doctor but it had no effect on me. I am afraid if this is any nerve related issue. Can you please help me with this.

Diploma in Orthopaedics, MBBS
Orthopedist, Alappuzha
I am feeling numbness in a small portion in the middle of right thigh from around 1 year. I took D-Rise 2000iu capsul...
This is may be related to tight belt .or may falter to to lower spine .D rise is not for that particular complaint .u need orthopedic doctors consultation.
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Well guys. I started to have this panic disorder around 3 days ago. It started at night, for no reason. I bet because of ive been worrying abt my family members health. My whole body felt numb, until now. And idk why my chest feel kinda weird sometimes. And I can not even feel happy or anything.

MBBS
General Physician, Chandigarh
Well guys. I started to have this panic disorder around 3 days ago. It started at night, for no reason. I bet because...
Pull ip yourself have positive control on your thoughts these are all psychological symptoms try to come out of it on your own by determined mindset otherwise take the help of a psychotherapist to take you out of this thought process.
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I am having migraine problem since one and a half year. Suggest me the best home remedies and exercises.

PDDM, MHA, MBBS
General Physician, Nashik
Avoid triggers. If certain foods or odors seem to have triggered your migraines in the past, avoid them. Reduce your caffeine and alcohol intake and avoid tobacco. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress. Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches. Obesity is also thought to be a factor in migraine headaches, and regular exercise can help you maintain a healthy weight or lose weight.
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Sir aapne jo migraine ke symptoms bataye mera waise hi hota hai tab main PARAMET 500MG tablet leta hun isse pura thik kerne ka solution bataiye please

BAMS
Ayurveda, Bangalore
Hi take tab. Shirashooladi vajra ras 1-1-1 with ginger juice. Apply ginger paste on the forehead. Instill cephagraine nasal drops 2 drops to each nostril 3 time a day. You can undergo panchakarma treatment like nasya or shirodhara after checking with an ayurvedic doctor.
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My daughter age is 30 years, Has a severe pain on the back side of her head and cough, fever, and breathing problem. Doctor has informed me as it is a migraine problem. Kindly guide me for the same.

MBBS, MD - Internal Medicine
Internal Medicine Specialist, Faridabad
My daughter age is 30 years, Has a severe pain on the back side of her head and cough, fever, and breathing problem. ...
now a days is season of viral fever..pl. go for tests ns1,cbc,mp,blood sugar, till then you can give her tab. combiflaim twice a day. syp. zeet expectorant 10 ml thrice a day. tab. lcz once a day after meal. after tests give her antibiotic by doctor.
1 person found this helpful
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My Father is paralysis patient so which is the best treatment medically or ayurvedic & allopathy?

MD - Psychiatry, MBBS
Psychiatrist, Patna
Paralysis occurs due to hampered blood supply to brain, either due to hemorrhage or thrombosis of blood in vessels. Hemorrhage occurs due to hypertension. Thrombosis occurs due to hypercoagulable blood state. Both condition if not controlled may give rise to recurrence of stroke hence paralysis. Allopathy has a scientific and reliable history of controling such factors and thus preventing relapse.
1 person found this helpful
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Do Juvenile Myclonic epilepsy has anything to do with memory problems? I have this disease and facing too much memory problems and confusion.

MD - General Medicine, MBBS
General Physician, Karimnagar
Hello, most of the patients with jme have normal memory and cognitive function, but some people might suffer from these. In addition these problems may also be due to anti epileptic drugs the effect of which cannot be separated. Kindly let me know what drugs you are using for jme.
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I am suffering from insomnia lately, am at times restless on bed and my sleep gets interrupted, please provide me with some help?

PG Diploma in Emergency Medicine Services (PGDEMS), Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine
Ayurveda, Ghaziabad
Hi 1-1 drop of cow ghee in both nostrils at night time before sleep. Take sarpgandha vati 1-1 tab twice a day. Take pranacharya no tens capsule 1-1 twice a day. Avoid spicy food. Junk food. Fermented food. Tea. Coffee. Do pranayama early in the morning.
1 person found this helpful
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I am suffering from parkinson's since 4 years and taking allopathic medicine. There is no marked improvement in my daily routine. Slowness and stiffness and pain in spinal cord and legs knees etc has become order of day constipation and insomnia are long enemy. Is there any cure?

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
Do take proper follow up with neuro physican and neuro physiotherapist and take appropriate therapy best wishes.
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My left hand was trembling since 4 years. I take various types of medicine for it but the result is zero. What can I do pls help me.

MBBS
General Physician, Mumbai
Take Tablet folvite 5mg once a day for six months and tablet vitamin D3 60000iu once a week for six months
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Please help me, mere pati gadi se gir gaye ab wo kisiko nhi pehchante right pair bhi kam nhi kar raha.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Please help me, mere pati gadi se gir gaye ab wo kisiko nhi pehchante right pair bhi kam nhi kar raha.
I think you should go for an immediate MRI BRAIN,only then we can come to a diagnosis.In the mean time start giving below given homoeopathic medicine ARNICA MONTANA 30 ( Dr Reckeweg) Drink 1 drops every 1 hrly direct on tongue.
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Parkinson s Disease

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Parkinson s Disease

Deep brain stimulation in Parkinson’s disease

Abstract: Deep brain stimulation (DBS) is a widely accepted therapy for medically refractory Parkinson’s disease (PD). Both globus pallidus internus (GPi) and subthalamic nucleus (STN) stimulation are safe and effective in improving the symptoms of PD and reducing dyskinesias. STN DBS is the most commonly performed surgery for PD as compared to GPi DBS. Ventral intermediate nucleus (Vim) DBS is infrequently used as an alternative for tremor predominant PD patients.

Patient selection is critical in achieving good outcomes. Differential diagnosis should be emphasized as well as neurological and nonneurological comorbidities. Good response to a levodopa challenge is an important predictor of favorable long-term outcomes. The DBS surgery is typically performed in an awake patient and involves stereotactic frame application, CT/MRI imaging, anatomical targeting, physiological confirmation, and implantation of the DBS lead and pulse generator. Anatomical targeting consists of direct visualization of the target in MR images, formula-derived coordinates based on the anterior and posterior commissures, and reformatted anatomical stereotactic atlases. Physiological verification is achieved most commonly via microelectrode recording followed by implantation of the DBS lead and intraoperative test stimulation to assess benefits and side effects. The various aspects of DBS surgery will be discussed.

Key words: deep brain stimulation (DBS); Parkinson’s disease(PD),  stereotaxis

Introduction

Parkinson's disease is a slowly progressive, neurodegenerative disease characterized by tremor, rigidity, bradykinesia and postural instability. It is the most common movement disorder in middle or late life with a prevalence of about 0.3% of the general population, rising to 1% in people over 60 years of age. Approximately 130 000 people suffer from it in the UK and it presents an increasing burden in our ageing population. Pathological findings in Parkinson's disease demonstrate greatly diminished neuromelanin pigmented neurons in the substantia nigra of the basal ganglia with associated gliosis, and Lewy bodies present in many remaining neurons.

James Parkinson, in his original 1817 Essay on The Shaking Palsy, gave an account of six patients in which he noted signs of tremor, festinating gait and flexed posture.  Nearly two centuries from Parkinson's observations, and almost four decades after Cotzias' dramatic demonstration of levodopa's efficacy, the limitations and complications of levodopa treatment for Parkinson's disease have become well documented Five years after initiation of therapy, a majority of patients develop medication related motor complications, namely levodopa induced dyskinesias (LID) and motor fluctuations. Deep brain stimulation (DBS) has been developed primarily to address these treatment related motor complications and therapeutic failures.

Pathophysiology of PD

The loss of dopaminergic neurons in the substantia nigra, the main functional characteristic of PD, affects the circuit described above and leads to the cardinal motor symptoms of PD. While the exact mechanism of this process is unknown, animal research as well as human recordings have provided functional and biochemical evidence that bradykinesia in PD results from excessive activity in the STN and the GPi. This leads to an exaggerated beta (10-30 Hz) synchronization within and between structures in the basal ganglia circuitry  that could also contribute to rigidity and akinesia.

The pathophysiology of rest tremor in PD is less clear and probably more complicated. This symptom most likely results from a dysfunction of both the striato-pallidal-thalamocortical and the cerebellodentato-thalamocortical circuits, with hyperactivity and hypersynchronization between central oscillators.

Possible mechanism of action of DBS

DBS acts through delivering an electrical current in a specific target area of the brain. This current can be modulated through modification of voltage, frequency and duration of each electrical pulse delivered. The delivered energy creates an electrical field of variable size and shape according to the parameters used for stimulation. Although initially believed to stimulate the target, thus the name of the whole process, it seems that

DBS actually excites the neuronal fibers, but inhibits the neural cells. In fact, GPi DBS decreases the GPi mean firing rate back to a normal range in animal models as well as PD patients, and high frequency DBS has a similar effect as dopamine replacement therapies, and promotes faster (about 70 Hz) nonhypersynchronous activity in the basal ganglia, correlated with clinical improvement. This might be achieved through stimulation of bypassing inhibitory pathways, synaptic inhibition, depolarizing blockade, synaptic depression, and simulation-induced disruption of pathological network activity. Overall, this leads to modifications of the firing rate and pattern of neurons in the basal ganglia, as well as local release of neurotransmitters such as glutamate and adenosine. In addition, it seems that DBS also increases blood flow and stimulates neurogenesis. Over the last few years, functional imaging, specifically functional magnetic resonance imaging (fMRI), positron emission tomography (PET) and single-photon emission computed tomography (SPECT), has been used in an attempt to clarify the mechanism of action of DBS. In fMRI, blood-oxygen-level-dependent (BOLD) signals are acquired, and oxygenated blood marks areas of neural stimulation or inhibition. On the other hand, PET and SPECT allow for imaging of multiple activity markers, such as blood flow, glucose and oxygen metabolism. While fMRI is less powerful than nuclear medicine techniques, it provides a much better spatial and temporal resolution. Because of the suspected inhibitory DBS effects in electrophysiological studies, reduced STN blood flow or glucose metabolism would have been expected on functional imaging. However, the opposite has been found to be true in an overwhelming majority of imaging studies to date. In addition, BOLD activation in the area surrounding the electrode has been reported, despite the electrode imaging artifact preventing direct observation of the STN around the electrode. This discrepancy between apparent STN inhibition in single-cell studies and activation in imaging studies might be explained by a few hypotheses. First, electrophysiological recordings identify short neuronal modulation (in the order of milliseconds) while neuroimaging methods may reflect the summed activity changes over seconds to minutes. Second, non-neuronal contributions to the change in blood flow and/or glucose metabolism cannot be excluded, and could confound the results of neuroimaging.

Finally, it is possible that PET and fMRI actually detect the increased activity in the axons, rather than in the cell bodies. Complicating matters further, some imaging studies after STN DBS have showed increased

activity in the GPi while others reported decreased activity in that nucleus. In summary, it is still unclear how exactly DBS affects the firing rate and pattern of neurons and how these changes actually modify the symptoms of Parkinson’s disease. DBS is presently more of an empirically proven treatment in search of physiological explanation.

The effect of DBS on the cardinal symptoms of PD have been established in three randomized controlled clinical trials --- 

TABLE 1

Author, year

 

No of patients

Follow up

Target

Results

Deuschl et al., 2006

156

6 months

BL STN

QOL better with DBS, motor symptom better with DBS

 

Weaver et al., 2009

255

6 months

BL STN or GPi

Dyskinesia free ON time better with DBS

 

Williams et al., 2010

366

12 months

BL STN  or GPi

QOL better with DBS

 

 

PATIENT SELECTION for DBS in PD

Patient selection is a critical first step as poorly chosen candidates may not have optimal benefits and have increased morbidity. Several factors must be considered before determining if a patient is an appropriate candidate for DBS surgery. A multidisciplinary approach involving the neurosurgeon, neurologist, and neuropsychologist is important to determine the appropriate surgical candidate. It is also important that the diagnosis of idiopathic PD be confirmed prior to proceeding with DBS surgery. Key to this assessment is evaluating the surgical candidate in both the on and off medication states with a corroborating levodopa challenge. Perhaps the best prognostic indicator of a patient’s suitability for DBS surgery is their response to levodopa.In general, a levodopa challenge following a 12-hour medication withdrawal should provide at least a 33% improvement in the motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS).

                     In our institute, we follow a simple chart(below) for screening of patients for DBS in PD.

 

 

  1.  

Age<75 years

 

  •  

No

  1.  

Idiopathic PD ( No PSP/MSA/NSD etc)

 

  •  

No

  1.  

Levodopa responsive  

                      

  •  

No

  1.  

Poor/adverse response to drug          

 

  1.  Increased off period                                                              

 

  1. Disabling dyskinesia                                                              

 

 

  1. Disabling motor fluctuations                 

 

 

Yes

 

Yes

 

 

Yes

 

 

No

 

No

 

 

No

  1.  

Degree of disability(UPDRS part III score)>25

 

  •  

No

  1.  

Neuropsychology, MMSE>24

 

  •  

No

  1.  

LEVODOPA CHALLENGE RESPONSE POSITIVE                                                   

 

(30% improvement in UPDRS after 12-hours off medication)

 

  •  

No

  1.  

Advanced  co-morbidity

 

Yes

  •  
  1.  

long term anticoagulation

 

Yes

  •  
  1.  

Willing for surgery and programming

 

  •  

No

 

 

PREOPERATIVE MANAGEMENT

A full medical assessment is a necessary part of the preoperative evaluation, as advanced PD patients tend to be elderly with significant comorbidities. Major issues are---

 

Anticoagulation/antiplatelets--- The risk of discontinuing medications that affect anticoagulation and

platelet aggregation should be weighed against the potential benefits in the quality of life offered by DBS surgery. However, timely discontinuation of these latter medications is mandatory for stereotactic surgery since intracerebral hematomas are the most serious of all potential complications from DBS. Any anticlotting medications, including aspirin, ticlopidine, clopidogrel, and all nonsteroidal anti-inflammatory drugs should be discontinued at least 7 to 10 days preoperatively to ensure the return of normal blood clotting function.

Arterial hypertension can also increase the risk of intracranial bleeding during stereotactic procedures and must be controlled in the weeks prior to surgery.

A prolonged discussion on the short- and long-term effects of DBS on Parkinson’s disease should be carried out with the patient, family, and caregivers.

The night prior to DBS surgery, the antiparkinsonian medications are typically held to pronounce the Parkinson’s symptoms at the time of surgery to see the clinical effects on symptoms during surgery and the families must be counselled regarding their role in facilitating the patient.

Target selection

The two main targets considered for DBS in PD are the STN and the GPi. current tendency is to prefer targeting the STN because of a greater improvement in the OFF phase motor symptoms as well as a higher chance to decrease the medication dosage and a lower battery consumption linked to the use of lower voltage in the STN compared to the GPi DBS. GPi can be the preferred target if LID is the main complaint. GPi DBS might be preferred for patients with mild cognitive impairment and psychiatric symptoms. Because STN DBS might have a higher rate of cognitive decline and/or depression and worsening of verbal fluency in some studies.

Surgical technique

The basic components of DBS implantation surgery involve frame placement, anatomical targeting, physiological mapping, evaluation of macrostimulation thresholds for improvement in motor symptoms or induction of side effects, implantation of the DBS electrode and implantable pulse generator (IPG).

Head-frame placement

The CRW frame is the most commonly used followed by the Leksell frame. Placement of the frame is done under local anesthesia unless anxiety or uncontrollable movements necessitate the use of sedation or general anesthesia.

Leksell stereotactic frame  placed over the head of a patient showing the correct method for placement of the Leksell head-frame. The frame should be placed parallel to orbito-meatal line in order to approximate the AC-PC plane. It is attached to the patient’s head using four pins under local anesthesia.

Imaging and anatomic targeting

Computerized Tomography (CT) scans and MRI are the two main imaging modalities used for targeting when performing DBS implantations. A thin cut stereotactic CT (_2 mm slices with no gap and no gantry tilt) is obtained after frame placement and is then fused with the stereotactic MRI on a planning station (Stealth station). The advantage of fusing the CT with MRI is the ability to avoid image-distortions inherent to MR imaging adding to the stereotactic accuracy. To better define the STN, T2-weighted images (TR 2800, TE 90, flip angle 90˚, slice thickness 2.0 mm) were obtained.

The AC and the PC were marked and the centre of the AC–PC line determined. The next step is planning the entry point and trajectory. The strategy here is to avoid surface and sub-cortical vessels. After trajectory planning, the patient is placed supine on the operating table and the frame attached to the table using an adaptor. Prophylactic antibiotics are given at least 30 min prior to incision. The head is prepped and draped in a sterile fashion. Under local anesthesia, a burr-hole is placed on the calculated entry point marked on the skull. The entry point is determined by the calculated arc and ring angles. Hemostasis is achieved with bone wax and bipolar cautery.

A Medronic Stim-Loc anchoring device (Medtronic, Minneapolis, MN) burr-hole base ring is then placed on the burr-hole and secured with two screws which are used at the end of the procedure to anchor the DBS electrode.

The dura is then cauterized and opened exposing the underlying surface of the brain. The microdrive is then assembled and cannulae inserted 10 mm above the target to avoid lenticulostriate vessels found deeper. Gel- foam and fibrin glue is applied on dural hole to minimize cerebrospinal fluid (CSF) loss and air entry into the skull. Subsequently, microelectrode recording and stimulation is undertaken.

Microelectrode recording/ Mapping

Microelectrode mapping is used to precisely define the target STN and its boundaries as well as nearby critical structures. We believe microelectrode mapping is crucial in order to give one the best chance for optimal placement of the DBS lead given anatomical inaccuracies due to image distortion and intraoperative brain shifts secondary to CSF loss, and pneumocephalus that can lead to inaccuracies in defining the initial target coordinates and shifts in the target itself once the skull is opened. Microelectrode mapping is performed using platinum-iridium glass coated microelectrodes dipped in platinum black with an impedance of around 0.3–0.5 Mo. These platinum-iridium microelectrodes are capable of recording single unit activity and can also be used for micro-stimulation up to 100 mAwithout significant breakdown in their recording qualities.

As the recording electrode was advanced, entry into the STN was identified by a sudden increase in the density of cellular discharge, with the characteristic irregular pattern of discharge—spikes of different sizes, occurring at random intervals. On coming out of the STN a quiet period (background noise) was seen followed by recording from the substantia nigra if the recording was continued far enough, described as high frequency (50–60 spikes/s) discharge pattern.11 Characteristic STN recordings (visual and audio) were identified and the depth of the STN activity was noted. Identification of STN activity was only based on the visual identification. The centre of the point of best electrical activity was selected as the final target. The microelectrode was replaced with a permanent quadripolar macroelectrode (Medtronic electrode no. 3389) to target the centre of the STN electrical activity. The proximal part of this electrode consists of four nickel conductor wires insulated with a polytetrafluoroethylene jacket tubing. The distal part has four metallic noninsulated contacts of 1.5 mm spaced at 0.5 mm intervals. The diameter of the distal electrode is 1.27 mm. Based on the clinical response any of the four contacts can be used for stimulation. Macrostimulation using the DBS electrode itself is then used to determine benefits and side effects. In most cases lateral skull x rays were obtained at this point with image intensifier carefully positioned to locate the target point in the centre of the Leksell-G frame rings.

Initial programming is always refined by using intra-operative macrostimulation data and a mono-polar review to identify the thresholds of stimulation for improvement in parkinsonian motor signs as well as the thresholds for inducing side effects at the level of each contact. The four variables that are used in programming are choice of contacts (0, 1, 2 or 3 used either as the cathode or anode), frequency of stimulation (hertz), pulse-width (ms) and amplitude (voltage).

POSTOPERATIVE MANAGEMENT

In the immediate hours after surgery, it is important to keep arterial blood pressure in the normal range. In addition, the patient’s preoperative drug regimen should be restarted immediately after surgery to avoid problems with dopaminergic withdrawal. Patients should undergo postoperative CT scans and/or MRI scans to assess the electrode location and intracranial status. In addition, plain X-rays are obtained to assess the location and geometry of the leads and hardware. Parkinson’s medications may need to be adjusted depending on the patient’s status. Cognitive and behavioral changes may occur in the postoperative period, particularly in older patients. Patients can be discharged as early as 24 hours after surgery, depending on their neurological and cognitive status.

Conclusion

For the last 50 years, levodopa has been the cornerstone of PD management. However, a majority of patients develop motor fluctuations and/or LID about 5 years after the initiation of therapy. DBS of the STN or the GPI grant to patients with PD improved quality of life and decreased motor complications, and has been approved as such by the Food and Drug Administration in the US in 2002. We reviewed the experience and available literature on DBS for Parkinson’s disease over the last decade and arrive at the following understandings.

The success of DBS surgery depends on the accurate placement of the leads and meticulous programming of the stimulation. Therefore, it is best accomplished by an experienced team of neurosurgeon, neurologist, and support staff dedicated to the treatment.

Reports of surgical complication rates and long-term side-effects of DBS are very variable, so benefits and potential adverse results should not be under- or over-emphasized.

While essentially equal in improving the motor symptoms of PD, STN and GPi might have their own benefits and risks, and the choice of the target should be individualized and adapted to the patient’s situation.

Knowledge to further improve DBS treatment for Parkinson’s disease, such as a more scientific and reliable protocol on programming, strategies to minimize cognitive and psychiatric complications, and the better

long-term maintenance of the implanted device, are still lacking.

Data on the impact of DBS on non-motor symptoms affecting the quality of life of PD patients, such as pain, speech or gastro-intestinal complaints, are still scarce. Further research in these areas will help make this useful treatment even more beneficial.

3 people found this helpful

For my seizure I take medication Twice a day which are following 1.Zenoxa 300 (oxcarbazepine tablets IP 300 mg) 2.Lacotide 150 (Lacosamide Tablets 150 mg) taking twice aday after taking it from 3 days after taking this medicine i feel like i was just drunk 4 bottle of wine what i should have to do just suggest me Doctor.

MD - Psychiatry
Psychiatrist, Udaipur
Because of side effect of Zenoxa u are feeling more sedative. You tell me about ur seizure pattern. I think u should readjust dose and medicine both.
1 person found this helpful
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My father 75 years of age is feeling numbness in toe and below knees. Which doctor we should consult and what should be the problem.

MS - Orthopaedics, MRCS Ed UK, FASM(Fellowship in Arthroscopy and Sports Medicine), DNB (Orthopedics)
Orthopedist, Bangalore
My father 75 years of age is feeling numbness in toe and below knees. Which doctor we should consult and what should ...
Hello Lybrate user, There can be many causes of this problem of your father. It could be due to uncontrolled diabetes mellitus or due to nerve compression (sciatica). I would suggest you take him to a diabetes specialist and an orthopaedic surgeon so that he is properly evaluated.
2 people found this helpful
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My age is 26 I am suffering from cervical lordosis. Elongation of transverse process in C7. Please suggest medication and who is better a ortho or ortho surgeon or neurologist or neural surgeon.

LCPS, BAM&S
General Physician, Pune
This is very rare case and certainly only orthopedic surgeon specialized in neck and shoulder should operate it. But try Yogasans. I know yogasans can relieve you of symptoms and may postpone or avoid surgery if followed meticulously.
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