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Dr. Preeti Batra

BHMS

Homeopath, Ghaziabad

13 Years Experience  ·  500 at clinic
Dr. Preeti Batra BHMS Homeopath, Ghaziabad
13 Years Experience  ·  500 at clinic
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I believe in health care that is based on a personal commitment to meet patient needs with compassion and care. Doctor is an active member of Council of Homoeopathic System of Medicines, ......more
I believe in health care that is based on a personal commitment to meet patient needs with compassion and care. Doctor is an active member of Council of Homoeopathic System of Medicines, Punjab, Punjab
More about Dr. Preeti Batra
Dr. Preeti Batra is a popular Homeopath in Indirapuram, Ghaziabad. She has been a successful Homeopath for the last 13 years. She is a BHMS . You can meet Dr. Preeti Batra personally at The Homeo Corner in Indirapuram, Ghaziabad. You can book an instant appointment online with Dr. Preeti Batra on Lybrate.com.

Lybrate.com has a nexus of the most experienced Homeopaths in India. You will find Homeopaths with more than 40 years of experience on Lybrate.com. You can find Homeopaths online in Ghaziabad and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Education
BHMS - Baba Farid University of Health sciences - 2004
Languages spoken
English
Hindi
Professional Memberships
Council of Homoeopathic System of Medicines
Punjab
Punjab

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The Homeo Corner

#B-405, Ashiana Upvan, Ahinsa Khand - II, Indirapuram. Landmark: Near Shanti Gopal Hospital.Ghaziabad Get Directions
500 at clinic
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During summers, is it okk to have 3-4 eggs everyday? I want to gain weight. Will it will be ok to have eggs in summer?

Ph.D - Ayurveda, FFAM-Post Graduate Fellowship, MD - Ayurveda
Ayurveda, Delhi
Better to take one egg, there are other food items and herbal supplements to increase weight, if interested let us know.
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My HPLC is 6.7/ ABG is 146 serum cholesterol is 259 s triglycerides. Is 193.

MBBS, MD - Internal Medicine
Internal Medicine Specialist, Faridabad
My HPLC is 6.7/
       ABG is 146
serum cholesterol is 259


s triglycerides. Is 193.
take cap..ecosprin gold 10 1hs after meal. take low fat diet.low salt diet. Lifestyle changes are essential to improve your cholesterol level. To bring your numbers down, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit. Lose extra pounds Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss — and ways to overcome them. Set long-term, sustainable goals. Eat heart-healthy foods What you eat has a direct impact on your cholesterol level. In fact, a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people. Choose healthier fats. Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more than 10 percent of your daily calories from saturated fat. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Almonds and walnuts are other sources of healthy fat. Eliminate trans fats. Trans fats, which are often found in margarines and commercially baked cookies, crackers and snack cakes, are particularly bad for your cholesterol levels. Not only do trans fats increase your total LDL ("bad") cholesterol, but they also lower your HDL ("good") cholesterol. You may have noticed more food labels now market their products as "trans fat-free." But don't rely only on this label. In the United States, if a food contains less than 0.5 grams of trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the ingredients list. If a food contains a partially hydrogenated oil, that's a trans fat, and you should look for an alternative. Limit your dietary cholesterol. Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include organ meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead. Select whole grains. Various nutrients found in whole grains promote heart health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices. Stock up on fruits and vegetables. Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on seasonal fruits. Experiment with vegetable-based casseroles, soups and stir-fries. Eat heart-healthy fish. Some types of fish — such as cod, tuna and halibut — have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote heart health. Drink alcohol only in moderation. Moderate use of alcohol may increase your levels of HDL cholesterol — but the benefits aren't strong enough to recommend alcohol for anyone who doesn't drink already. If you choose to drink, do so in moderation. This means no more than one drink a day for women and one to two drinks a day for men. Exercise regularly Regular exercise can help improve your cholesterol levels. With your doctor's OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group. And, you don't need to get all 30 to 60 minutes in one exercise session. If you can squeeze in three to six 10-minute intervals of exercise, you'll still get some cholesterol-lowering benefits. Don't smoke If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don't end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker's. Within 15 years, your risk of heart disease is similar to that of someone who's never smoked.
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Hiii dctr m 20 years boy can you suggest me please dctr I have lite brown colour dark patches on fore head n pimple red n black spots n my nose sides are dark in colour which tube I should use kojivit plus or melanorm lite plzz suggest me n my skin is sensitive suggest me dctr which cream I used kojivit plus or melanorm lite n when I use wrong tube my skin getting red bciz skin is sensitive so tell me which you used melanorm lite or kojivit plus.

MBBS
General Physician, Jalgaon
Hiii dctr m 20 years boy can you suggest me please dctr I have lite brown colour dark patches on fore head n pimple r...
Please Alone medicine, creams etc won't work permanently Wake up early go for morning walk in greenery daily Do yogasanas and pranayam daily Do facial exercises daily Take carrots and beet root juice daily Take Tab purim by Himalaya 2 2 for 3 mths Mahamnjishtadi kadha 20 ml twice a day for 3 months Use herbal face wash regularly Apply acne and pimple cream by Himalaya regularly
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There are many scars on my face and they are looking so bad .How we can removes scars from face.

MBBS, DNB (Dermatology)
Dermatologist, Mumbai
There are many scars on my face and they are looking so bad .How we can removes scars from face.
Acne can cause red or brown discoloration and uneven skin contour. Usually multiple types of treatments are needed for maximum improvement. Patience is key since the full effect is often not seen for several months. Skin discoloration and texture can be improved with topical treatments like hydroquinone and Retin-A, but for deeper scars and more significant discoloration, other techniques like resurfacing are needed.
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I'm 20 year old I have headache last four month. I used many pills but that pills give no great response and I can not got the satisfied. What can I do for my best . Answer please eeeeeee.

MBBS
General Physician, Cuttack
I'm 20 year old I have headache last four month. I used many pills but that pills give no great response and I can no...
If you have recurrent attack of headache1. It could be a tension headache due to anxiety/stress, depression inadequate sleep, low bp/high bp, migraine, prolonged use of cell phone/computer, chronic anaemia, refractive error, chronic sinusitis, organic brain lesion 2. Avoid stress, physical and mental exertion, have adequate sound sleep for 7-8 hours daily in the night 3. Go for regular exercise 4. Practice yoga, meditation and deep breathing exercise to calm your mind, control your emotion and relieve stress 5. Check for refractive error, sinusitis hemoglobin, bp 6. Avoid prolonged use of cell phone/computer 7. Consult neurologist to rule out other causes of headache, if required take a ct scan /mri of brain to exclude any brain lesion 8. If it is migraine you have to take migraine prophylactic drug after consulting neurologist.
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I am 31 year old male and I have allergic rhinitis and I have to take cetirizine table once in three days. And also my immune system is very low. Some doctors told me to operate but I do not want to operate. Please guide me.

MS - ENT,MBBS
Ear-Nose-Throat (ENT) Specialist, Kolkata
I am 31 year old male and I have allergic rhinitis and I have to take cetirizine table once in three days. And also m...
Regular cold may be due to Allergies or due to decreased immunity repeated episodes of viral infection. *Steam inhalation  twice a day. *Have fruits 5 portions  every day  *A course of vitamin B complex and vitamin C to improve  immunity. *Avoid  allergic stimuli like dust ,pollens. If you remain in AC room either ensure AC FILTER is cleaned every 2 weeks  or use a mask *Steroid nasal  sprays may be needed for a prolonged duration Anti allergic  drugs may also be needed Hope this helps.
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I am a 42 years old man. I am having arsenic in my body beyond the limit. I do not know know how did it happen. Can you please help me to remove arsenic from my blood.

C.S.C, D.C.H, M.B.B.S
General Physician,
I am a 42 years old man. I am having arsenic in my body beyond the limit. I do not know know how did it happen. Can y...
Drink plenty of water. Your kidneys need it to move waste through your system. Get plenty of antioxidants. Fruits and vegetables rich in antioxidants can help protect your cells from the damage heavy metals can cause. Vitamin C and E are especially powerful antioxidants for protecting against the oxidative damage from heavy metals. Get enough fiber. Fiber helps move food through your system, reducing the risk that you’ll absorb the heavy metals. Get enough glutathione. It’s an antioxidant that helps protect against heavy metal toxicity. A 2004 study showed that it glutathione (GSH) protected the liver when exposed to things like mercury and chromium. Good sources of this nutrient include fresh (not cooked) fruits and vegetables, particularly asparagus, broccoli, avocados, squash, and spinach. You can also try supplements of N-Acetyl Cystein (NAC) and alpha lipoic acid.
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I have a problem of acne, due to oily skin, they keep on coming, also they have left black scars on my face. what should I do?

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
I have a problem of acne, due to oily skin, they keep on coming, also they have left black scars on my face. what sho...
Homoeopathic treatment SKIN AID PLUS ( BAKSON) This pack of skin aid plus contains SKIN AID DROPS nd DERM AID TABLETS SKIN AID DROPS-10 drops in 1 spoon water twice daily DERM AIDTABS-Chew 1 tab twice daily SEAFOLIUM CREAM Apply twice daily 6-8 glass water daily 2 glasss milk daily Take nutritious diet nd exercise regularily
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I have done a blood test yesterday. My HB % was 10 %. Doc said boys don't have complaint of anemia often.

BHMS
Homeopath, Delhi
Yes it's unusual for males having anemia unless there is profound malnutrition and malabsorption. Of if there is blood loss. Pls elaborate your case.
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Kindly give suggestion to get rid from anxiety and depression via changing life style. Regards.

C.S.C, D.C.H, M.B.B.S
General Physician,
Kindly give suggestion to get rid from anxiety and depression via changing life style. Regards.
5 Ways to Fight Depression and anxiety. These are both related intricately and these steps will control both feelings If you feel depressed, it's best to do something about it — depression doesn't just go away on its own. In addition to getting help from a doctor or therapist, here are 5 things you can do to feel better. 1.Exercise. Take a 15- to 30-minute brisk walk every day — or dance, jog, or bike if you prefer. People who are depressed may not feel much like being active. In addition to getting aerobic exercise, some yoga poses can help relieve feelings of depression. Two other aspects of yoga — breathing exercises and meditation — can also help people with depression feel better. 2.Nurture yourself with good nutrition. Depression can affect appetite. One person may not feel like eating at all, but another might overeat. Proper nutrition can influence a person's mood and energy. So eat plenty of fruits and vegetables and get regular meals (even if you don't feel hungry, try to eat something light, like a piece of fruit, to keep you going). 3.Identify troubles, but don't dwell on them. Try to identify any situations that have contributed to your depression. When you know what's got you feeling blue and why, talk about it with a caring friend. Talking is a way to release the feelings and to receive some understanding. 4. Express yourself. With depression, a person's creativity and sense of fun may seem blocked. Exercise your imagination (painting, drawing, doodling, sewing, writing, dancing, composing music, etc.) and you not only get those creative juices flowing, you also loosen up some positive emotions. Take time to play with a friend or a pet, or do something fun for yourself. Find something to laugh about — a funny movie, perhaps. Laughter helps lighten your mood. 5. Try to notice good things. Depression affects a person's thoughts, making everything seem dismal, negative, and hopeless. If depression has you noticing only the negative, make an effort to notice the good things in life. Try to notice one thing, then try to think of one more. Consider your strengths, gifts, or blessings. Most of all, don't forget to be patient with yourself. Depression takes time to heal. If you are happy with these answers please click on "useful” link so that I can know my efforts are not wasted. If you want more clarifications or prescription for medicines consult me on this site to ask me directly and not in open questions session It's not easy to say exactly what causes depression and anxiety – it's different for everyone. Sometimes a difficult time in you or your mates' life can set off depression or anxiety, sometimes it's caused by a combination of things that has built up over time and sometimes, there's just no obvious cause at all.
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I am 19 now, n my height is 5'6" How to increase my height quickly n at least another 2" will be very good. Is there any medicines for growth? Or naturally.

BHMS
Homeopath, Faridabad
I am 19 now, n my height is 5'6" How to increase my height quickly n at least another 2" will be very good. Is there ...
Hi, Follow the following medication and guidelines----Start the treatment with single dose of Tuberculinum 1M. After 1 week of this take the below:- * First week- you should take Baryta carb 1M, 5 drops, single dose, morning empty stomach. *second week- take Thuja 1M, drops, single dose, morning empty stomach. *third week- Again take Baryta carb 1M, 5 drops, single dose, morning empty stomach. *fourth week- take Thuja 1M, 5 drops, single dose, morning empty stomach. *Take Rite -hite tablets from SBL, 2-2 tabs, two times daily. *Bio combination no. 21, 4 -4 tabs daily, two times. *Mix two tablespoons of ashwagandha powder in a glass of warm cow’s milk. 1. Add sugar or jaggery according to your taste and mix well. 2. Drink it every night before going to bed at least for 45 days to increase your height. * plenty of fluids, frequent smaller meals, yoga and exercise regime and adequate sleep is also important. Take a healthy and balanced diet. *Do yoga (especially TADASAN) and stretching exercises regularly. *Revert after 1 month.
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Please suggest fast what should I do it is very much paining for me me tell me fast what should I do I have a back pain from last 15 days what should I do to get rid of it tel me fast what to do?

MPT - Orthopedic Physiotherapy, BPTh/BPT
Physiotherapist, Noida
Please suggest fast what should I do it is very much paining for me me tell me fast what should I do
I have a back pa...
If you want immediate relief then go for physiotherapy treatment best option for you avoid long sitting, standing and toward bending.
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Hii doctor. What are the symptoms of male breast. If it is there what are the steps to reduce?

Advanced Aesthetics, M.Ch - Plastic Surgery, MS - General Surgery, MBBS
Cosmetic/Plastic Surgeon, Indore
Male breast or gynecomastia reduction. Is one of the most frequently performed office surgeries and we are the pioneers in central India since last 30 years. To the best of our knowledge no medicines or creams work to decrease the breast Size. Gynecomastia is treatable by surgery. There is no medical treatment. It is a one day out patient surgery with very gratifying results. It boosts self esteem also. The Dr. Can examine and tell you what is the problem, gynecomastia has a breast tissue and a fat component. No one wants surgery unless it is necessary. There is no medication which can give the results. Surgery is the only answer. The surgery is almost painless because there are enough medications to keep the pain under control. It can be a day care surgery or 1 day hospital stay. There is no bed rest but 3-5 days are required for recovery and 10 days for full recovery.In 3 weeks you can go the the Gym. Gynacomastia is not a disease but excess response to hormones. If it does not bother you you don't have to get it removed. As long as the Breast size is big it is taken as Gynacomastia which could be because of More fat or More Breast tissue or a mixture of the two. Wait till 18 years of age and then if not resolved look for surgical treatment. Hot or cold weather can change the nipple size. You may need 1-2 days rest. Including the day of surgery. It is considered as an office surgery procedure. Normally we do not see a recurrence unless you put on very large amount of weight.
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Home Remedies to Remove Unwanted Hair

BHMS
Homeopath, Raebareli
Home Remedies to Remove Unwanted Hair
Sugar mixed with water and lemon juice will help in exfoliating your face and offer natural bleach to your face. The lemon juice used will help in lightening the color of your facial hair. These three ingredients combine to help effectively remove hair on your face as well as other parts of the body. It is advisable not to use these ingredients on sensitive parts.

Ingredients:
- 2 tablespoons of sugar
- 10 tablespoons of water
- 2 teaspoons of lemon juice
- One small bowl

Method:
Mix sugar and water in the small bowl.
Once the sugar solution is ready, add lemon juice into the bowl and mix well.
Now apply this sugar and lemon mixture on your face in the direction of hair growth on the face.
Allow this mixture to rest on your face for 15 to 20 minutes.
Wash it off with water after 20 minutes, by rubbing the mixture gently with your hands.
Repeat this process two to three times a week to see a reduction in facial hair.
145 people found this helpful

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

My face is so oily and I want oil free skin and glow on my face so what can I do for it?

PG Diploma In Clinical Cosmetology (PGDCC), BHMS
Homeopath, Delhi
My face is so oily and I want oil free skin and glow on my face so what can I do for it?
Dear patinet use an oil free face wash like neutogena and apply miltani mitti once a week as face pack.
1 person found this helpful
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What are the different ways to loose weight can you just me? How to make proper health and what are the different ways for proper diet? What should I do for not being tiered hios to be active everyday every time?

M.Sc - Dietitics / Nutrition
Dietitian/Nutritionist,
What are the different ways to loose weight can you just me? How to make proper health and what are the different way...
u need to take a balanced diet. do exercise its a very important for this. eat more vegetables and fruits. consume less oil. eat good fats. eat complex carbohydrate. do exercise.
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How to decrease ldl cholesterol levels and increase hdl cholesterol levels naturally? Please advise.

MBBS, MD - Internal Medicine
Internal Medicine Specialist, Faridabad
How to decrease ldl cholesterol levels and increase hdl cholesterol levels naturally? Please advise.
High cholesterol can cause atherosclerotic heart disease or narrowed coronary arteries in the heart can cause the symptoms of angina, when theheart muscle is not provided with enough oxygen to function. Decreased blood supply to the brain may be due to narrowed small arteries in the brain or because the larger carotidarteries in the neck may become blocked. This can result in a transient ischmic attack or stroke. Peripheral artery disease describes gradual narrowing of the arteries that supply the legs. During exercise , if the legs do not get enough blood supply, they can develop pain , called claudication . Other arteries in the body may also be affected by plaque buildup causing them to narrow, including the mesenteric arteries to the intestine and the renal arteries to the kidney. Avoid fast foods,oily foods,junk foods,alcohol,smoking,fatty foods, non-veg.,avoid stress, take omega-3 fatty meal or cap., take .green veg., whole grain.garlic,. Take anti cholesterol medicines .
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My friend is 8months pregnant and she is having legs pain and backache what should she do? And she also want to know in winters now what should she add in hot milk except protein powder n drink?

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
My friend is 8months pregnant and she is having legs pain and backache what should she do? And she also want to know ...
She can take milk. Now some backahe is common but excessive pain needs attention. Do not take drugs without consulting doctors. Maintain correct posture. For leg pain, movement of leg is needed. If severe, consult doctor immediately to make sure that it is not vein thrombosis.
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All About Endometrial Cancer

MD - Obstetrtics & Gynaecology, MBBS, DGO
Gynaecologist, Mumbai
All About Endometrial Cancer

Cancer that originates in the uterus is termed as Endometrial Cancers. The cancer is known to originate in the endometrium i.e. lining as well as the cells of the uterus. Abnormal vaginal bleeding causes the cancer to be detected early and a consultation with the doctor should be done immediately. When other cancers originating from the uterus are considered, endometrial cancer is found to be the most common.

Causes: The exact cause for endometrial cancer is not known clearly. The cells in the endometrium tend to become abnormal due to the occurrence of a genetic mutation, which causes rapid multiplication of cells that ultimately lead to the formation of a tumour like mass. They begin to spread to other parts and proceed to affect the tissues in the surrounding areas.

Symptoms:
The typical symptoms of endometrial cancer include:

  1. 1. Irregular bleeding in between periods
  2. 2. A watery discharge from the vagina
  3. 3. Bleeding from the vagina postmenopausal
  4. 4. Pain in the pelvic floor muscles

Risk factors that might increase the chances of being affected by endometrial cancer include:

  1. 1. Aging increases the chances of this disease, especially post menopause.
  2. 2. Obesity can cause hormonal imbalance.
  3. 3. Certain drugs used in hormone therapy
  4. 4. Early onset of menstruation, especially before 12 years of age

Treatment for Endometrial Cancer Includes:

  1. Radiation therapy: This treatment procedure involves using radiations, such as X-rays to target and destroy the cancer cells. The two forms of radiation therapy are external radiation therapy (external machine is used to direct radiation on the cancer cells) and internal radiation therapy (radioactive substance enclosed within small and consumable items is placed near to or directly at the spot of cancer).
  2. Hormone therapy: Medications are administered to eliminate imbalances in hormone levels and prohibit the growth of cancer cells in the body. This remedy is preferred if the cancer progresses to an advanced stage.
  3. Chemotherapy: This form of treatment uses oral administration or injection of chemicals into the veins so that the growth of cancerous cells is curbed, either by elimination of the cells or by prohibiting cell division.
  4. Surgery: In this surgery, the areas affected by cancer are surgically removed; i.e. the uterus in this case. The surgical procedures that might be used include total hysterectomy (total removal of uterus), radical hysterectomy (removal of the cervix, uterus and part of the vagina) and Bilateral salpingo-oophorectomy (removal of both the ovaries and the fallopian tubes)
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