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Dr. Selvin Gnanaraj James

MBBS, MD - General Medicine, DM - Neurology

Neurologist, Chennai

9 Years Experience  ·  500 at clinic
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Dr. Selvin Gnanaraj James MBBS, MD - General Medicine, DM - Neurology Neurologist, Chennai
9 Years Experience  ·  500 at clinic
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Personal Statement

I want all my patients to be informed and knowledgeable about their health care, from treatment plans and services, to insurance coverage....more
I want all my patients to be informed and knowledgeable about their health care, from treatment plans and services, to insurance coverage.
More about Dr. Selvin Gnanaraj James
Doctor has over 9 years of experience as a Neurologist. Doctor studied and completed MBBS, MD - General Medicine, DM - Neurology. Book an appointment online with Dr. Selvin Gnanaraj James and consult privately on Lybrate.com.

Find numerous Neurologists in India from the comfort of your home on Lybrate.com. You will find Neurologists with more than 38 years of experience on Lybrate.com. Find the best Neurologists online in chennai . View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Education
MBBS - Vinayaka Mission's Kirupananda Variyar Medical College, Salem - 2008
MD - General Medicine - Annamalai University - 2012
DM - Neurology - Sri ramachandra medical college and research institute - 2015
Languages spoken
English
Tamil

Location

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Dr. ravindran's hospital

Old Number 96, New Number 212, MTH Road Landmark : Near OT Bus Stop Depo Ambattur, Chennai Tamil Nadu,Chennai Get Directions
500 at clinic
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My dad suffers from epilepsy, what medications or remedies can help him get rid of or deal with this?

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
There is no absolute cure for epilepsy if there is no identifiable cause for it. Most of the epilepsy are idiopathic - i. E. Without any known cause. Anti epileptics given in a optimum dose and number can keep check on epilepsy.
1 person found this helpful
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Today morning I did some squat exercises bit after doing it I couldn't even walk properly today while walking today I fell down many times when I sat down I couldn't stand up on my foot for a long time I got two people to lift me up what may be the problem?

Diploma in Cardiology
General Physician, Kolkata
If you are a v. beginner then it may happen for the first few days, do any exercise under supervision of a technical person.
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I'm epilepsy patient my Dr. said after delivery I vl allri8, is dis truth. Nd this disorder is dangours for me? Life ka khtra hai? Pls explain.

MBBS, MD, DM - Neurology
Neurologist, Chennai
If you have been diagnosed with epilepsy before your pregnancy itself, it is possible to control your epilepsy with proper medications so that you do not get any fits (which may pose danger to both of you). However there is a small possibility of your child developing few problems either due to your epilepsy or your medications. It will be monitored with regular scans and blood tests if needed by your obstetrician. Have a frank talk with your obstetrician and neurologist. Please do not stop your epilepsy medications without consulting your doctor.
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May I know the symptoms of migraine. The patient have been suffering from a severe headache all the tym.

PGDHHM, MBBS
General Physician, Delhi
May I know the symptoms of migraine. The patient have been suffering from a severe headache all the tym.
Common symptoms of migraine are -- feeling dizzy or faint , increased sensitivity to light and sound ,nausea , headache ,pulsing / throbbing pain, vomiting sometimes blackouts. Take over-the-counter painkiller medicine for headache if intolerable pain. Drink plenty of liquids. Eat healthy diet. Avoid stress. .do deep breathing exercises. If still symptoms persists, consult
1 person found this helpful
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I suffered from Brain tumor in December-13, after operation Doctor suggest me for radiotherapy, I took 30 days radiotherapy treatment, After that doctor prescribed me Levetiracet Levugress 500 (3 dosage in a day ). Still I am taking this tablet, I want to know the side effect from this tablet, also please suggest what should I do to reduce it's side-effect. Thanks

MD - Homeopathy, BHMS
Homeopath, Vadodara
I suffered from Brain tumor in December-13, after operation Doctor suggest me for radiotherapy, I took 30 days radiot...
Side Effects: Cough; decreased appetite; diarrhea; dizziness; drowsiness; headache; irritability; nausea; nose or throat irritation; stomach pain; stuffy nose; tiredness; trouble sleeping; vomiting; weakness. But it is not always the case...
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How can you describe a scar epilepsy? Very confused with this variant! Please can anyone help!

MBBS
General Physician, Faridabad
Sometimes, epilepsy can be caused by scar tissue or a brain infection that can interfere with the brain's electrical signaling. Scar tissue in the brain can be caused by head injury, tumor, stroke or surgery.
1 person found this helpful
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My mother is suffering from meningioma diagnosed before 1 week through MRI. But doctors said that it is not a problem because it is small and found in mri sometimes in everyone. Is it a serious case? Or need consulting another neuro surgeon? Thanks in advance She has severe headache frequently now a days Is this happening due to meningioma? Mri report as follows Extra axial mass lesion in the right occipital convexity and a broad base towards dura Subtle hyperintensity in the left putamen ischemic or metabolic etiosy.

Neurologist,
My mother is suffering from meningioma diagnosed before 1 week through MRI. But doctors said that it is not a problem...
Hi, Yes sometimes it so happens that a meningoma may be found incidentally which Imaging brain - which means it is not related to her headaches. If the meningioma is small and not causing any mass effects- there is no reason to worry. Perhaps get a follow up MRI brain in a year to see if it's size is stable. From the information you shared, I concur with her doctor's opinion- her headaches could be migraines, which are the most common headache type or tension type headaches- but that cannot be said with certainty without specific questioning about her headaches. PS- the other MRI finding in putamen also is unrelated to headaches, but without looking at the scan I cannot confirm what it actually means.
1 person found this helpful
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I m 31 year old male. I sometimes have chronic headache. migraine. What should I do.

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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Is seizure at the age of 17 can be due to brain tumor (non-cancerous) or brain cancer (cancerous)?

MBBS, DNB, Fellowship in Neurosurgery
Neurosurgeon, Kolkata
Dear lybrate-user, It could be because of brain tumor. To exclude please do an MRI brain plain and if required contrast by 1.5/3 Tesla machine. You will be sure. Thanks,
1 person found this helpful
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What are the causes of facial nerve problem and bell's palsy and what is the solution cure from these?

COMT, MPTh/MPT
Physiotherapist, Surat
Facial and bell's paralysis is loss of facial movement because of nerve damage. There can be many reasons for it. It can be due to any infection in nerve, any head injury, tumor, stroke, high bp leading to hemorrhage, any auto immune diease, the most common is ear infection or inflammation directly affecting your facial nerve as it passes through your ear. In physio we have very good treatment plan include: muscle stimulator - stimulate / strength the weak muscles those are paralysed. Facial soft tissue manipulation, facial exercises, pnf, etc so in general I would advice you to go for some treatment if possible visit some neurophysio who will guide you your treatment plan according to your problem. Please follow: 1. Facial exercises like eyebrow raising, drawing, wrinkling, deep breath from nose, smiling, ballon filling, jaw moments etc 2. Using your fingers massage the entire area of massage with applying any cream or talcum. Guidance required from physio. 3. If not that weak then you can apply hot pack also for 10 mins. Precautions: 1. Take eye care. Wash properly. 2. Use goggles when moving out from home. 3. Take mouth care. 4. While drinking or eating take care. 5. Guidance from neurophysio for life styl modifications. 6. If speech disturbed take opinion from speech therapist. Please consult me if you do not understand any point. Get well soon. Take care.

I am 26 years old nd I am suffering from migraine from last 2 years nd had consulted with doc he given me medicines for the first time nd told me that take this for next 3 months I did same what he told now I am feeling some relaxation. Now I want to know that how should I will get perfect solution for this Thanks.

MD - Homeopathy
Homeopath, Aurangabad
Migrane yes migraine headache can be cured by homeopathy take natrum mur 30 30 ml liquid sbl 1 drop daily on tongue for x 7 days and revert me back you may contact me on this site. And check my package and get customized medicines.
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I had cervical laminectomy 1 and half month ago. Suddenly today my left arm which is weak previously, is feeling numb and current type sensation is there. Also same is there in left leg's three fingers. Why is it? What to do? Please help.

MBBS, PG Diploma In Emergency Trauma Care, Fellowship in Diabetology
General Physician, Bangalore
I had cervical laminectomy 1 and half month ago.
Suddenly today my left arm which is weak previously, is feeling numb...
Numbness and tingling sensation is very common post operation on spine. Since its cervical both upper and lower limbs bound to get involved. please relax, if weakness detoriates please go back to the Dr. who did operation n get MRI of cervical spine again.
1 person found this helpful
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My father is suffering from Parkinson's disease from last 4 years is there any permanent cure for this disease his right hand and right leg shaking too much please guide me.

BHMS
Homeopath, Delhi
My father is suffering from Parkinson's disease from last 4 years is there any permanent cure for this disease his ri...
permanent cure will take a lot of time, but yes he will be very much improved and progression of disease will stop with homeopathic treatment
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I am 22 years old and some times my body parts become numb in the still state it happens often and I also get exhausted while doing light work so please tell me what should I do?

Dip. SICOT (Belgium), MNAMS, DNB (Orthopedics), MBBS
Orthopedist, Delhi
I am 22 years old and some times my body parts become numb in the still state it happens often and I also get exhaust...
Hi thanks for your query and welcome to lybrate. I am Dr. Akshay from fortis hospital, new delhi. You actually require a detailed conversation including clinical examination. What I can advise you is that you will have to elaborate in detail your symptoms especially numbness etc. Also you will have to get a complete workup of your blood investigations which from my side will include: cbc, esr, crp, serum electrolytes, serum vitamin d and serum vitamin b 12 levels, thyroid profile get these tests done empty stomach from a good lab like srl or Dr. Lal's and send reports across to me. Do not hesitate to contact me if you need any further assistance. You can also discuss your case and treatment plans with me in a greater detail in a private consultation.
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My blood pressure normally has been 130 /90 From last 15 days it has come down to 115 /65. What could be cause of the same. Remedy I suffer from sleep apnea I also take.

Bachelor of Ayurveda, Medicine and Surgery (BAMS)
Ayurveda, Navi Mumbai
My blood pressure normally has been 130 /90 From last 15 days it has come down to 115 /65.
What could be cause of the...
Take following remedies 1. Triphala kadha 4 tsp before lunch and dinner 2. Amala juice 4 tsp + 2tsp sugar + 2tsp honey in the morning empty stomach 3. Have 1 cup pomegranate juice at evening 4.1cup milk+ 1 tsp ashwagandha powder after dinner before sleep.
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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

Sir, I have a problem in my hands. My fingers will shake and so what precautions should I take to handle this problem.

MBBS
General Physician, Mumbai
I will suggest you to take injection vitcofol 2cc intramuscularly every alternate days for five pricks and revert back
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I recently asked about the problem of shivering hands nd the doc suggested meh to take injection of vitcofol 2cc please tell meh how much amount of it per injection should be taken nd after how many days next injection should be taken nd if possible then plzz take meh the reason behind this problem.

Diploma in Child Health (DCH), MBBS
General Physician, Bangalore
Sir, get your blood tested for hb, tc, dc, esr, t3, t4, tsh, fbs, serum creatine, b12 levels, on empty stomach, after over night fasting. Get back to me with reports.
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Getting mild tingling sensation for sometime on the left side of lips. Not going away. What could it be ?

MBBS,J.R. Neurology
General Physician,
This can be a simple nutritional deficiency. Start multvitamins. It will help. Consult a general physician though. Take care.
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Hi, am 18 years old male, I have been having insomnia, but I tried all remedies-exercise, honey,milk, curd,banana but no, Please give me any advise of no side effects sleeping pills?

MD, Fellowship in Intergrative Medicine, MBBS
Integrated Medicine Specialist, Kochi
Hi, am 18 years old male, I have been having insomnia, but I tried all remedies-exercise, honey,milk, curd,banana but...
Sleep should be natural and not be induced by medicines. All these sleep medicines will cause addiction and it will be difficult to sleep without medicines. First a detailed history is needed to find out the trigger factor for insomnia. Cut down tea and coffee in the evenings sleep at the same time daily restrict fluids at night. Then I can suggest you sleep hygiene methods to get natural sleep without medicines. Take a consult to sleep like a baby without medicines. Edit Answer.
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