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Dr. Sujit Kumar Vidiyala

88 (11 ratings)
MBBS, MCh - Neuro Surgery

Neurosurgeon, Hyderabad

24 Years Experience  ·  250 - 500 at clinic
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Dr. Sujit Kumar Vidiyala 88% (11 ratings) MBBS, MCh - Neuro Surgery Neurosurgeon, Hyderabad
24 Years Experience  ·  250 - 500 at clinic
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Sujit Kumar Vidiyala
Dr. Sujit Kumar Vidiyala is a trusted Neurosurgeon in Secunderabad, Hyderabad. Doctor has over 24 years of experience as a Neurosurgeon. Doctor is a MBBS, MCh - Neuro Surgery . You can visit him/her at KIMS HOSPITAL in Secunderabad, Hyderabad. Don’t wait in a queue, book an instant appointment online with Dr. Sujit Kumar Vidiyala on Lybrate.com.

Find numerous Neurosurgeons in India from the comfort of your home on Lybrate.com. You will find Neurosurgeons with more than 25 years of experience on Lybrate.com. Find the best Neurosurgeons online in Hyderabad. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Specialty
Education
MBBS - Mysore Medical College - 1993
MCh - Neuro Surgery - Nizam's Institute of Medical Sciences - 1997
Awards and Recognitions
Winner Of Divisional Round Of Quiz By The Indian Academy Of Paediatrics
Professional Memberships
Neurological Society of India
Skull Base Surgery Soceity of India (SBSSI)
AP and Telangana Neurological Society

Location

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KIMS HOSPITAL

Minister road .Secunderabad.Hyderabad Get Directions
  4.4  (11 ratings)
400 at clinic
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OMNI Hospitals

Plot Number 20, 21, 22A, 22B, 22C, 23 and 24, Balaji Nagar Landmark : Beside Kalyan Jewellers and Opposite Big BazaarHyderabad Get Directions
  4.3  (11 ratings)
400 at clinic
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Krishna Institute of Medical Sciences (KIMS)

#1-8-31/1, Minister Road, Krishna Nagar Colony, Begumpet Landmark : Near Krishna Nagar ColonyHyderabad Get Directions
  4.3  (16 ratings)
500 at clinic
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St. Theresa Hospital

Jet Colony, Sanath Nagar Landmark : Opposite to Erragadda Rithu BazarHyderabad Get Directions
  4.3  (15 ratings)
250 at clinic
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My bro suffering from parkinson treatment ie going on doctor gave celemetrol injection ,what more treatment can give him.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
My bro suffering from parkinson treatment ie going on doctor gave celemetrol injection ,what more treatment can give ...
Do have proper follow proper follow up with neuro physican and neuro physiotherapist and take appropriate therapy and management best wishes.
1 person found this helpful
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Purpose and Types of Brain Tumor Surgery

MCh - Neurosurgery, MBBS
Neurosurgeon, Chennai
Purpose and Types of Brain Tumor Surgery

Although surgery is considered to be the first step of treatment in any form of tumor but its feasibility depends upon the type, size and location of the tumor. It is not necessary that every kind of brain tumor might require surgery.

Indications of Brain Tumor Surgery

  • Diagnosis of the type of tumor by taking a sample of the tumor for laboratory examination
  • Complete resection of tumor
  • Removal of the tumor as much as possible to slow down its growth and improve the symptoms.
  • Remove the tumor in order to help other treatment
  • Provide direct access for other forms of treatment like chemotherapy, radiotherapy etc.
  • To relieve pressure caused by tumor on surrounding structures

Types of Brain Tumor Surgery

The different types of surgery that are performed in cases of brain tumor include the following:

Craniotomy: Craniotomy is the most commonly performed procedure to remove brain tumor along with a piece of bone. The removed bone is replaced and the tumor is sent for histopathology (biopsy). The surgery is performed using a high end microscope by any of the following techniques:

  • Extended bifrontal craniotomy
  • "Eyebrow" craniotomy (supra-orbital craniotomy)
  • "Keyhole" craniotomy (retro-sigmoid craniotomy)
  • Orbitozygomatic craniotomy
  • Translabyrinthine craniotomy

Shunt: A narrow piece of flexible tube with a pressure regulated valve in between is called a shunt. This is used to relieve the intracranial pressure caused by obstruction of the natural brain fluid (CSF) pathway by tumor mass. The procedure involves insertion of a drainage system into the brain to remove or drain excess of blocked fluid into the peritoneal cavity.

Stereotactic surgery: This surgery is done by creating a three-dimensional image called stereotaxy using computers. It aims to find out the location and position of the tumor. In fact it can also be done to aid tumor removal, implant radiation pellets or for other treatments.

Embolization: It is a procedure used to reduce the amount of blood supply to a tumor by blocking the blood flow in the selected arteries. It is generally performed before the main surgery.

Endoscopy and endoscope assisted surgery: Endoscope is the tool which helps to closely visualize the tissue through small openings in difficult to reach areas. This tool can be used in various brain surgeries to precisely reach the target location without damaging the adjacent structures.

Adjuvant modalities to improve outcome: In addition to above mentioned surgeries, following surgeries may also be performed in relation to brain tumor treatment:

  • Laser surgery
  • Photodynamic laser surgery
  • Ultrasonic aspiration
  • Fluorescent-guided surgery
  • Electrophysiological monitoring 

    If you wish to discuss about any specific problem, you can consult a neurosurgeon.

3223 people found this helpful

What are the symptoms of migraine head ache? What are the remedies of migraine head ache? How to avoid migraine head ache? It's comes once in a week? Is it cause some other affect?

C.S.C, D.C.H, M.B.B.S
General Physician,
Some symptoms may include: feeling dizzy or faint. increased sensitivity to light and sound. nausea. pain on one side of the head. pulsing and/or throbbing pain. vomiting. Treatment is specific migraine drug , form the triptan class of drug
1 person found this helpful
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Iam 37 years male I have migraine I have take medicine but I haven found any positive response please help me.

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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I am 50 years old male. working in an MNC. For the last 2 years I feel severe pain and numbness in low backache. It often radiates to my lower limb. Very painful. What should I do?

BHMS
Homeopath, Delhi
I am 50 years old male. working in an MNC. For the last 2 years I feel severe pain and numbness in low backache. It o...
Hello, there are many causes behind backache *any strain or sprain in the muscles or ligaments of the back during lifting of heavy objects is the main cause of the lower back pain. *sitting in the wrong posture for a very long time is another cause. *people suffering from constipation may also suffer from lower back pain. *sometimes sleeping on wrong type of beds can also cause pain in the back. Follow the tips *take rest or move about once in 1-2 hours in case of working in a constant position. *maintain a good posture while reading or working with computers. *take a high fibre content diet like vegetables, fruits, etc.
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I have a 12 year old boy with klin (chromosome xyx) syndrome. He cannot speak and walk. He can manage a wheel chair. Active to some extent. Only one testis is visible. Head is slight; y bigger. Fair and lovely. Where can I get right treatment for such a child and what is that?

M. Phil Clinical Psychology
Psychologist, Hyderabad
Please identify a multidisciplinary center near your place. They will provide remedial education for your child. If you can tell me the city you're located in, I can try to help.
2 people found this helpful
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I'm 33 years woman experiencing continuous pain on mid left side of my chest which is radiating at my back as well as on my left hand neck a sight numbness on last two fingers moving upwards in the elbow area.

MBBS
General Physician, Cuttack
I'm 33 years woman experiencing continuous pain on mid left side of my chest which is radiating at my back as well as...
) chest pain causes 1. Heart disease 2. Stress, anxiety 3. Lack of exercise 4. Sedentary life style 5. Obesity (over weight) 6. Smoking, tobacco and alcohol consumption, excess tea/coffee 7. Excess oily, fatty, cholesterol rich diet, junk food 8. Hyperacidity, musculr pain 9. Heredity and genetic factor prevention follow the advice given below 1. Avoid stress and strain 2. Do regular exercise, yoga, meditation, deep breathing exercise like pranayama etc. It will calm your mind, control your emotion and relieve stress 3 avoid alcohol, smoking and tobacco consumptio, excess tea/coffee. 4. Take bland diet, avoid spicy, oily, fatty and junk food 5. Take paracetamol 500 mg one tablet sos after food up to a maximum of three tablets daily, at the time of chest pain 6. Drink plenty of water and take rest. 7. If you have recurrent attack of chest pain take ecg and consult cardiologist.
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I am 27 year female I have suffering severe neck pain and numbness in head since last 5 month.

FRHS, Ph.D Neuro , MPT - Neurology Physiotherapy, D.Sp.Med, DPHM (Health Management ), BPTh/BPT
Physiotherapist, Chennai
I am 27 year female I have suffering severe neck pain and numbness in head since last 5 month.
Do Take IFT and laser Therapy for pain relief for 12 days followed by strengthening exercise from physiotherapist Best wishes.
1 person found this helpful
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When I stand immidiatly numness occour in my left tigh so I want to know what is the reason, also suffring from acidity, every time I feel that I have to go for toilet, pls help me

MPTh/MPT
Physiotherapist,
Due to dysaesthesia(loss of sensation) you feel numbness. Kindly do bird dog exercises (2 sets-10 counts) regularly for week. This will be help full
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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

I am 36 year male suffering from regular leg pain above ankle and also numbness in feet while walking. The condition goes away when I stop for few minutes and again resurfaces when I start walking again. What should I do?

M S Orthopaedics, MBBS
Orthopedist, Mumbai
I am 36 year male suffering from regular leg pain above ankle and also numbness in feet while walking. The condition ...
Hello lybrate user, the symptoms you are describing are similar to what we call claudication. In common language, it is development of symptoms of pain etc in the lower limbs after one does some previously accustomed activity ie one was able to do those activities easily but are causing symptoms now. It occurs due two causes. Firstly, vascular problem causing decreased blood supply to the muscles of the lower limb which is now inadequate to maintain the demands of the muscle while doing activity. Secondly, neurological problem in which there is stenosis in the spinal canal which transmit the nerves from brain to the lower limbs. This stenosis causes decreased space for the nerves and their vessels causing pain in the lower limbs. With the details you have provided, and your profile, it looks more like a spinal canal stenosis. I would suggest you to see a spine surgeon or an orthopaedician for a detailed assessment. I would also suggest you forward bending exercises and exercises to strengthen your abdominal muscles. Hope this helps.
1 person found this helpful
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21 male .I have sharp pain in right butt cheek ,when I move my leg suddenly ,as if the muscles are being torn apart under my skin, and numbness in my right butt cheek! Pain is only for a short moment.

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
21 male .I have sharp pain in right butt cheek ,when I move my leg suddenly ,as if the muscles are being torn apart u...
1. Lie on your back. ... 2. Cross your left leg over your right so that your left ankle rests on your right knee. 3. Use your hands to grab hold of your left knee and pull it gently toward the opposite shoulder. ... 4. Hold for 15 to 30 seconds. 5. Relax, and then repeat with the other leg. 6. Repeat this cycle 2 to 4 times.
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Hi . My baby, 8 months old behaving like fits by turning hands back and shaking head and hands. We consult doctor and taken ct brain plain and eeg scans and reports came normal. Finally doctor said nothing to worry and will wait and see. May I know the reasons for that and what I should do? please suggest.

Pediatrician, Pune
it is difficult for a 8 month child to behave in such a way , could be some other problem rule out gastroesophageal reflux , some metabolic problem if require get her reevaluated and take a second opinion
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She is having headache problem 2 or 3 tym in a week. So is having migraine problem or something else. Pls help.

MBBS
General Physician, Mumbai
Migrane- It is characterised by one sided headache which is pulsatile in nature and with a throbbing pain usually with an aura and we have to rule out sinusitis or refractive error problem
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My sister is 22 years old. She is a CP patient. She is getting fits from 2010. Earlier she used to get fits once or twice in a month. Now a days she is getting fits after almost every 10 days and in a day she gets fits 6-7 times in a day. Please advice what to do. She lives in Bihar and it is difficulty for her to visit any doctor at a far off place regularly. She is regularly taking medicines. Torleva 750 mg, OXETOL 600 mg, Lacosam 100 mg twice a day.

MD - Alternate Medicine, Doctor of Homeopathic Medicine (H.M.D.)
Homeopath, Delhi
Give her a Single dose of 10 drops of Nux Vomica Q in 1/4 Cup lukewarm water only a single dose. Kindly note only a single dose and don't repeat. If it helps you may revert for further consultations on my messenger.
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I have my nerves seen in my hands too big and I too have the shaking problem of my hands everyday and my nerves are like coming out like very bigger. Please someone help me on this. Thank you.

MBBS
General Physician, Chennai
I have my nerves seen in my hands too big and I too have the shaking problem of my hands everyday and my nerves are l...
The nerves you call are veins looks like you no fat in your hands so they are exposed tremors of the hand needs detailed discussion.
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I am getting blood in stool and one nerve is paining a lot. What should I do to avoid in eating and what should I eat?

MD - Psychiatry, MBBS
Psychiatrist, Patna
Blood in stool is a serious symptom. It may be due to piles, anal fissure or lower gi bleeding. Kindly consult a surgeon who may advise you for proctoscopy/colonoscopy to find out the reason behind it. Avoid eating chilly and spicy food. Take more roughage.
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Sir I recently noticed that while doing push ups my left elbow was popping every time I did push ups. It felt like something is rolling up and down the side of elbow. I also noticed some tingling sensation in my fifth finger. Please tell me what should I do.

MBBS, MD - Physical Medicine & Rehabilitation
Pain Management Specialist, Jaipur
Sir I recently noticed that while doing push ups my left elbow was popping every time I did push ups. It felt like so...
Hello lybrate-user As per your symptoms, you are having ligament weakness of left elbow, causing ulnar nerve compression resulting in tingling sensation in 5th finger. Get X-ray Left elbow-AP/Lateral view done. We need to discuss more about your symptoms and find out correct disease so, kindly get these investigations done and review as early as possible. Kindly consult me in private as I can't write medicines here. Thank you. Get well soon.
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Autism: Treat It With Homeopathy

BHMS
Homeopath, Raebareli
Autism: Treat It With Homeopathy

Autism is defined as a neurobiological pervasive development disorder that includes lack of social skills and inability to reciprocate to social interactions. The patient may also have intellectual and cognitive deficits and problems in communication (verbal as well as non-verbal).

Conventional medicine is mostly used to treat some of the symptoms but is never used to cure or provide remedies for autism. A proper professional homeopath will be able to guide you to get the best results for your child and reduce all the problems of autism, if not outright cure it.

Some of the medications that could be used to treat autism are as follows:

  1. Cuprum Metallicum: This works wonders when the child is being very obsessive, angry and is inflexible, tense and is very aggressive towards their parents. Some of these children may even exhibit malicious behaviors and are usually averse to touch or being approached.
  2. Androctonus: A child or a patient who tends to swing wildly from a stable good mood to a destructive mode can be calmed down or evened out by Androctonus. These children also exhibit behaviors of suspiciousness and quickness to act on their compulsion.
  3. Carcinosin: This is very helpful in children affected by autism who are talented, but are obsessive, compulsive, stubborn and also have sleep related issues. These children may also have addictive disorders.
  4. Agaricus: This medication is very good for children who may be mentally and physically awkward and show symptoms like indifference, muttering, talking, shouting or singing but not answering to direct calls or questions. Agaricus is very effective for children who suffer from involuntary jerking when they are awake.
  5. Helleborus: This is a very effective medication when the child is slow and under active and seems to be depressed most of the time. Some of these children may also have muscular weakness and helleborus is very effective in treating them. These are only a few examples of how homeopathy can provide remedies for your autistic child and thus is an effective solution.
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