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Dr. Naajin

MBBS

Psychiatrist, Mumbai

500 at clinic
Dr. Naajin MBBS Psychiatrist, Mumbai
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.
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Dr. Naajin is a trusted Psychiatrist in Mumbai, Mumbai. He has completed MBBS . He is currently associated with Hamzah Multispeciality Hospital in Mumbai, Mumbai. Don’t wait in a queue, book an instant appointment online with Dr. Naajin on Lybrate.com.

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Hamzah Multispeciality Hospital

1st & 2nd Floor Nilkanth Apartment, Masacha Pada, Kashigoan, Kashimira-Mira Road,Landmark: Near Western Park, MumbaiMumbai Get Directions
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Hamzah Multispeciality Hospital

1st & 2nd Floor Nilkanth Apartment, Masacha Pada, Kashigoan, Kashimira-Mira Road,Landmark: Near Western Park.Mumbai Get Directions
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What are symptoms of depression and anxiety? And is it possible to get back to these things after some incident.

PDDM, MHA, MBBS
General Physician, Nashik
Hello, There are many aspects of depression, the more of them you have the more likely you are to have a clinical depression. Some patients feel severely depressed and suicidal. If you have these feelings you should go to the emergency department immediately. Other things that people with depression can feel are sadness, low energy, lack of motivation, poor sleep, irritability, weight gain or loss, poor self image and sometimes even a lack of touch with reality. The more of these symptoms you have the more likely it is that you have serious depression. Treatments for depression include medications, counseling and exercise. Again the more of these you do the better your chance for a successful treatment. Good luck to you,
2 people found this helpful
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Hi. I am suffering from depression and sumwhat tension headaches. I am taking medicines but not fully recovered. Shud I consult psychologist as well. please help.

MD - Psychiatry
Psychiatrist, Chennai
The word depressed is a common everyday word. People might say" i'm depressed" when in fact they mean" i'm fed up because i've had a row, or failed an exam, or lost my job" etc. These ups and downs of life are common and normal. Most people recover quite quickly. With true depression, you have a low mood and other symptoms each day for at least two weeks The common symptoms are (few might be present in a person with depression) Feelings of sadness, tearfulness, emptiness or hopelessness Angry outbursts, irritability or frustration, even over small matters Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports Sleep disturbances, including insomnia or sleeping too much Tiredness and lack of energy, so even small tasks take extra effort Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people Anxiety, agitation or restlessness Slowed thinking, speaking or body movements Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren't your responsibility Trouble thinking, concentrating, making decisions and remembering things Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide Unexplained physical problems, such as back pain or headaches consult a psychiatrist and get evaluated.
1 person found this helpful
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Hello sir, I have fever and cold for so many days and body pain also. What to do please tell me?

MBBS
General Physician, Faridabad
take 1 tab sinarest at night , steam inhalation. saline garggles, it will help you. welcome for further help
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She suffers from frequent head ache mostly near the forehead. Her age is 42. A forcefully vomiting relieves her form headache sometimes. We are sure that she is not feeling stressed. She takes adequate sleep. Good dite Yet she is suffering with this problem. Please HELP!

MBBS, MD - Psychiatry
Psychiatrist, Mumbai
It is possible she is having migraine, as the symptoms like one sided headache and nausea/vomiting are going towards that. I suggest you consult a psychiatrist for further management. Consider getting a CT or MRI brain done to rule out other things.
1 person found this helpful
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My wife age 60years suffering from Parkinson. Is there any medicine on this. As per our doctors there is no medicine on this. Pl advise.

DHMS (Diploma in Homeopathic Medicine and Surgery)
Homeopath, Ludhiana
Homoeopathic Medicine-------------------- LOLIUM TEMULENTUM 30 ( SBL) Drink 2 drops in 1 spoon fresh water 3 times daily for 3 months------------------------------ Thereafter consult me with any changes.
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My brother is suffering from schizophrenia, he is taking heloperidol which rarely available in chemist shop, so would you please tell a substitute medicine for heloperidol ?

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Dear, heloperidol is commonly used anti-psychotic medication. I don't know from where you got the prescription of this drug. You have to consult the psychiatrist who prescribed this medicine if you want to change it. That is healthy practice. As anti-psychotic drugs are scheduled, you may not get it with chemist unless you produce a written and signed prescription. Consult a psychiatrist. Take care.
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I want to leave smoking. But I falls every time to leave. I have a bad habit to smoke in toilet at morning and evening. And that's the main reason for my addiction.

MBBS, DPM
Psychiatrist, Bangalore
Dear Himanshu, Congratulations for your decision of leaving smoking. Nicotine in cigarettes make the bowels move. So, if you leave smoking, you maynot pass motion freely or constipated. It is a common withdrawal symptom. If you persist not to smoke for 12 weeks, it will disappear and you will be able to pass motion freely. Till then take some purgative daily at night. Luckily you don't have other withdrawal symptoms to keep using cigarettes. All the best.
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My wife is 27, she is very aggressive in nature and negative thinker. When she is angry she starts blaming me for she not being happy. She starts the work and leaves half way and she get bored of things very fast. If she is tense she just doesn't do anything except for sleeping. When she is angry she gets violent. She doesn't even come to doctor. What should I do.

Hypnotherapist, DCS, BSIC, Advanced Trainee of Transactional Analysis, Advanced Skills in Counselling
Psychologist,
Looks like you both are going through a difficult time in your marriage. Since you have only written about what she does but not about your behaviour, I sense that you either withdraw and remain quiet or both of you argue and it leads to fights between the 2 of you. In either case you will benefit with couple counselling so that you are able to talk to each other openly and transparently so that the actual problems can be spoken about openly. Communications styles differ in all people which leads to many misunderstandings and differences. A succesful marriage requires both parties to understand each other and participate in a manner to support the relationship, as well as personal goals and interests. A visit to the doctor will not be wrong either. Maybe both of you can go as a couple instead of making her as the" identified patient" (she seems to be feeling blamed and cornered hence refusing to cooperate). You could suggest to her that you want to see a doctor" for both of us" so that we can work out the differences between us. Say what you mean and do it genuinely.
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Unable to put concentrate on study's my mind automatically diverted to do some unnecessary works how to turn my mind towards study.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
Dear user, You must be able to understand Concentration, attention span, recollection and distraction. If you are able to watch a movie for two hours continuously, if you are able to play a game for an hour, then you do not have any concentration problems. You can't be attentive towards your studies because you are not interested in it. You are able to watch movie and play game because you are interested in it. Human cannot be attentive towards anything for more than 10 minutes. Then you should study in such a way that your attention is continued and make the subjects are interesting to you. Effective learning techniques should help you. Recollection depends on anxiety, stress and other physical and circumstantial factors. Distractions while studying are plentiful. You should be able to overcome distractions or avoid distractions. Please understand the above. Change your study style and attitude accordingly. Please post a private question to me and I will help you with "effective learning" techniques. Avocados, Beetroots, Blueberries, Broccoli. Celery, Coconut Oil, Dark Chocolate etc are good for improving concentration. Take care.
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I have exams after few days but I didn't study anything when I try to read my mind goes somewhere else and I feel sleepy, tired what should I do please suggest something helpful.

M.Sc Applied Psychology, Advanced Diploma Child Guidance & Counselling
Psychologist, Delhi
Hello try to modify your schedule. Start your day with morning walk and exercise. This will help you to feel fresh. Take good healthy diet. Form a study time table. You can take help of study organizers. You can write number of chapters to be learnin one column and then make adjacent column naming them learn, then revised 1, then revised 2. Whenever you finished learning 1 chapter put a tick. When you are finished with revision 1 put another tick. This will help you to get an idea about your preparation and will increase your confidence. Goal setting can also be another technique, you can set goals like need to complete 1chapter within 1 hour. Tell yourself that you will not leave your preparation between. After achievement of your goal reinforce yourself by engaging into likeable activity. All the best. Please feel free to give your feedback. Take care.
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Hai. I can't control my mind. Example I see the one things or humans or any one, I imagination go to negative thought's (100 out off 60). So how to control my mind. How to learn positive thinking. But normally my friends bad or sad time all are they call or meet to me and told his or her problem's and ask solution for me. That time I give some words they are told now I'm fell like free. I can't understand to me. My words give better fell for others. What is my problem?

Reparenting Technique, BA, BEd
Psychologist, Bangalore
That only means that you are good for others but not good enough to take care of yourself. When you listen to and help too many other people and do not take care of yourself adequately, you will experience something like a burnout i.e. you will feel the exhaustion of taking care of others and may even collapse from it. so the solution is to meet with a counselor and take personal care of yourself. This can happen to professionals like us too and so we always have a confidante to talk to. You will need to find such a person either in a counselor or a good friend who could be older and wiser to you. In the meantime, do regular exercise, eat healthily, and make sure you have good rest int eh form of sleep. You could do with a little training in handling emotions too. You can give only what you have so build up reserves of strength emotionally and psychologically if you want to continue to help others. Otherwise, just stop being there for others for some​ time.
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Do all antidripesents have side effects? Does all are bad for health, I have depression, do I take these or not, please help.

MBBS, MD Psychiatry, DNB Psychiatry
Psychiatrist, Nagpur
Antidepressants are used for treatment of depression. Just like any other medications every antidepressant has some documented side effects which may not occur in every person. Antidepressants are devised to improve depression and for well being of a person and hence are used according to the risk benefit ratio. For sure, depression has much worse and dreadful side effects on human health than antidepressants alone. Hence it would be inappropriate to call them good or bad. So, if you have depression you should go ahead and treat it. Choice of antidepressants should be made according to your clinical profile and should be taken under strict supervision of the treating psychiatrist.
1 person found this helpful
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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 suffering from 2 days weakness and full body pain and pain my head my eyes is week.

MBBS
General Physician, Mumbai
For pain take tablet paracetamol 650 mg and Eat nutritious food and have adequate fluid intake and take physical rest
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Sir I am 37 year old, my problem is I don't remember any thing even name of a person, sir it is affecting my professional life, please help me to come this problem.

MD- Ayurveda
Ayurveda, Ujjain
Dear lybrate-user ji, Use BRIHAT BRAHAMI BATI 1-1, twice a day with milk, Sy Coagnium (Charak co.) 15-15-15, three times a day. Jyotish Mati Malkangani tail- use it in 3 ways 1. 10-10 drops twice a day with milk (Internal use) 2. 4-4 drops in both nostrils (As nasal drops) 3. Massage with same oil on head before going to bed. Continue this at least three months & do regularly Exercise – YOGA you will get rid your all problem surely.
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I lost somebody very close to me and I fell very depressed from last year if you have any suggest please help me.

B.A PSYCHOLOGY HONOURS, M.A PSYCHOLOGY, M.Phil - Psychology, PhD PSYCHOLOGY
Psychologist, Delhi
Best tribute to departed person is not to dive into depression but to move above your personal loss and show it to the departed soul--you love and remember the guidance given and will become the person they wanted you to be when alive! put all energy at becoming a more stronger person and aim to be successful, just as your loved one had always wanted you to be. Best wishes! happy diwali.
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Hello , I am having periods and I suffer from very head pain, my body starts paining a lot, bleeding is not an issue but pain is the problem please suggest me some thing can not bear pain any more.

DHMS (Diploma in Homeopathic Medicine and Surgery), BHMS
Homeopath, Delhi
Take mag phos 6x disolve 4 tab in luke warm water little bit water than drink it take 4 tab 1 hrly your pain will be subside.
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Meri age 40 years hai and mere do children hai mere husband ko last four months say waham ho gaya hai ki mera kisi kay sath affair hai or woh jyada pareshan bhi ho rahe hai and sath he har baat may unko sak(doubt) kane ki addat ho rahi hai please help me thank you

DNB (Psychiatry), MD - Psychiatry
Psychiatrist, Navi Mumbai
The symptom of suspiciousness needs to be evaluated in detail in person before coming to a conclusion. This problem can be treated with medications and counselling after complete assessment by a psychiatrist.
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I have started smoking since 2004 now I feel weak and lethargic till time had a smoke. I want to quit please suggest a solution?

PGDAP, MBBS
Psychiatrist, Gurgaon
Motivation and will power are the two weapons to quit smoking. There are many nicotine containing patches which slowly help you in weaning away as well.
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Hello doctor my brother age is 10 years old. He is really aggressive and hyper child. He is good in studies but he get hyper very fast and start beating or throwing thing to other. He always play games on tv and moreover he always used to fight in school. Nowdays I am really fedup with his behavior. Every teacher complain about him. Please suggest me how to tackle him and how to counsel him.

Masters in counseling psychology, Counseling psychologist, Rational Emotive Behavioral Therapist
Psychologist, Mumbai
He may be emotionally disturbed due to some reason, or may be going through some other problem, emotional or developmental. Please consult a professional as he needs to be evaluated properly.
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