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Best-Quality Deep Brain Stimulation Surgery Cost in India [2020]

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What is the Deep Brain Stimulation surgery cost In India?

[Many potential patients for surgery are a concern to Know about Deep Brain Stimulation surgery cost In India? The estimated cost of Deep Brain Stimulation Surgery In India usually starts $28000 however, it may go up to as much as $35000. it depends on the hospital charges and the fee charged by the surgeon. This price usually does not cover the post-operational therapy and medicine. Additional costs also involve the diagnostics before the surgery and pre-operational consultations.]

[Verified by:- Dr Sandeep Vaishya, Director , MBBS, MS, MCh, Fellowship 20 Years of Experience Gurgaon, India. (Updated On 16/ July/2020)]

Deep Brain Stimulation Surgery is a surgery that is done to implant a device for sending electrical signals direct to brain areas that are mainly responsible for the movement of the entire body. In this surgery, electrodes are used to be placed inside the brain, which is connected to a stimulator.

DBS Surgery doesn’t damage the brain tissue; it blocks abnormal signals that cause impaired motor control. Most candidates for deep brain stimulations are patients whose symptoms cannot be controlled by medication.

What is deep brain stimulation?

DBS is a surgical procedure that implants electrodes into specific areas of your brain. A pacemaker-like device is then placed under the skin of the chest, which emits electrical impulses that regulate or block electrical signals within the targeted area.

DBS doesn’t damage the brain tissue; it blocks abnormal signals that cause impaired motor control. Most candidates for deep brain stimulations are patients whose symptoms cannot be controlled by medication.

When Doctors Suggests DBS Surgery

DBS is suggested for reducing the symptoms like stiffness, walking movement problems and tremor for several treatments. Once it is done, patients get back to a healthy life once again.

Risk of Deep brain stimulation Surgery

Deep brain stimulation involves creating small holes in the skull to implant the electrodes, and surgery to implant the device that contains the batteries under the skin in the chest. Complications of surgery may include:

Temporary tingling in the face or limbs
Temporary pain/swelling at implantation site
Allergic reaction to the implant
Slight paralysis
Speech or vision problems
Jolting or shocking sensation
Loss of balance
Dizziness
Reduced coordination
Concentration difficulties.

Deep brain stimulation is hence a cost vs. benefits problem. For many patients with treatment-resistant forms of Parkinson’s disease and other movement disorders, DBS can help them return to a normal life and regain quality of life.

Deep brain stimulation is not a cure, it is a way to manage unmanageable symptoms that interfere with normal functions.

Symptoms Of Deep brain stimulation Surgery

You may have some soreness in the head, neck and chest.
You may develop painless puffy swelling around the eyes for a few days after surgery, particularly the eye under the incision(s).
You may experience a micro-effect after surgery. This means that some of your symptoms may be better for a few days. This will fade away and you can expect to return back to your previous level of functioning.
If you have Parkinsons’ disease and experience more dyskinesias, you may have to decrease your Parkinson’s disease medications. Unless it is severe, it is usually best to wait as this generally improves with resolution of the micro-effect.

Criteria for Deep Brain Stimulation Surgery

An ideal candidate for DBS surgery is under 70 years old and is in good health. Patients who fluctuate between “on” and “off” medication states are usually good surgical candidates, as are those who have troublesome dyskinesias.

a movement disorder with worsening symptoms (tremor, stiffness) and your medications have begun to lose effectiveness.
troubling “off” periods when your medication wears off before the next dose can be taken.
troubling “on” periods when you develop medication-induced dyskinesias (excessive wiggling of the torso, head, and/or limbs).

How does Deep Brain Stimulation Surgery work?

DBS is a surgical procedure that delivers high-frequency electrical stimulation to precise areas of the brain. This is done by implanting a thin wire with electrodes at the tip. The electrodes are precisely placed into a brain site that carries the abnormal signals producing the symptoms. High frequency stimulation will alter these abnormal signals, thereby leading to symptom improvement. The location of electrode placement varies based on the illness being treated.

Prior to the procedure, a pre-operative evaluation is performed in order to maximize the success of DBS surgery. The evaluation may include brain MRI scan, neuropsychological testing, videotaped evaluation of movement both on and off medication, and others if indicated.

The precise placement of the electrodes is achieved both by MRI measurement as well as intraoperative microelectrode mapping. Once the electrodes are placed, the wire is connected to the neurostimulator power supply (a battery-operated generator), which is placed under the skin near the collarbone. The system, often called a brain pacemaker, regulates the abnormal signals resulting from the disease process.

Once the electrodes and the impulse generator are securely in place, the electrodes send electrical impulses that help normalize abnormal impulses. In other words, it will help block faulty signals within the brain that cause tremors or other movement symptoms to occur. No healthy tissue is destroyed with this procedure.

What happens before Deep Brain Stimulation Surgery?

You will typically undergo tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. An MRI scan of your brain will be performed. In the doctors office you will sign consent forms and complete paperwork to inform the surgeon about your medical history, including allergies, medicines, anesthesia reactions, and previous surgeries.

Stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) 1 week before surgery. Stop smoking, chewing tobacco, and drinking alcohol 1 week before and 2 weeks after surgery because these activities can cause bleeding problems. You may also need to have clearance from your primary care physician or cardiologist if you have a history of other medical or heart conditions. No food or drink, including your Parkinson’s medication, is permitted after midnight the night before surgery.

Try to get a good night’s sleep. The DBS surgery involves multiple steps and lasts most of the day, during which you will be awake and off medication.

Morning of surgery

Shower using antibacterial soap. Dress in freshly washed, loose-fitting clothing.
Wear flat-heeled shoes with closed backs.
If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
Leave all valuables and jewelry at home (including wedding bands).
Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
Bring a list of allergies to medication or foods.

Arrive at the hospital 2 hours before your scheduled surgery time to complete the necessary paperwork and pre-procedure work-ups. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks. An intravenous (IV) line will be placed in your arm.

How deep brain stimulation surgery is performed in India?

DBS surgery can be performed while you are awake (with local anaesthesia and mild sedation) or asleep (local anaesthesia). Some people may remain awake for a part of surgery and asleep during the other part.

If the surgery is performed while the patient is awake, a local anaesthesia is used to numb the scalp and no anaesthesia is required for the brain as it does not have any pain receptors.

The doctors may ask the patient to stop taking the medicines that control Parkinson’s symptoms. During the procedure, the patient is asked to perform certain tasks to help guide the surgeon while placing electrode in the accurate part of the brain.

However, remaining awake during a brain surgery or not taking medicine can be unsettling for some people. So using a general anaesthesia is an alternative option as the patient will be unconscious during the surgery.

Following are the steps involved in a Deep Brain Stimulation Surgery in India:

Step: 1 Attaching the stereotactic frame

The surgeon first attaches a stereotactic frame to the head of the patient. A local anaesthesia is applied on the scalp where the four pin sites will be inserted to minimize discomfort. The might patient might feel some pressure as the pins are tightened.

Step 2: MRI or CT scan

You will then have an imaging scan, using either computerized tomography (CT) or magnetic resonance imaging (MRI). A box-shaped localizing device is placed over the top of the frame. Markers in the box show up on the scan and help pinpoint the exact three-dimensional coordinates of the target area within the brain. The surgeon uses the MRI / CT images and special computer software to plan the trajectory of the electrode.

Step 3: skin and skull incision

You will be taken to the operating room. You will lie on the table and the stereotactic head frame will be secured. This prevents any small movements of your head while inserting the electrodes. You will remain awake during surgery. Light sedation is given to make you more comfortable during the initial skin incision, but then stopped so that you can talk to the doctors and perform tasks.

The hair is shaved about an inch wide along the incision line. A skin incision is made across the top of your head to expose the skull. Using a drill, two quarter-sized burr holes are made on the left and right sides of the skull (Fig 3). These holes allow the electrodes to be passed through the brain.

Step 4: insert electrode in the brain

Through the small hole, a recording electrode is inserted into the brain. Based on calculations from the MRI / CT scans and the planning computer, the electrode is inserted to a precise depth and angle inside the brain (Fig 4). The brain itself does not feel pain, so you should not feel any discomfort.

Step 5. stimulate the brain cells

Once the permanent DBS electrode/lead are placed on the correct nerve, test stimulation will be performed. The surgery team will ask if the patient feels any of their symptoms have lessened or completely gone away.

Step 6: Closure of incision

The surgeon will place a plastic cap over the small hole on the head to hold the lead in place. The incision of the scalp is closed with sutures or staples. Later a bandage is placed on the surgical wounds.

What happens after surgery?

After surgery, you may take your regular dose of Parkinson’s medication immediately. You are kept overnight for monitoring and observation. Most patients are discharged home the next day.

During the recovery time after implanting the electrodes, you may feel better than normal. Brain swelling around the electrode tip causes a lesion effect that lasts a couple days to weeks. This temporary effect is a good predictor of your outcome once the stimulator is implanted and programmed.

About a week later, you will return to the hospital for outpatient surgery to implant the stimulator in the chest/abdomen. This surgery is performed under general anesthesia and takes about an hour. Patients go home the same day.

Step 7:- Implanting the stimulator

In the operation theatre, the surgeon will reopen a portion of incision on the scalp to access the leads. Then a small incision is made near the collarbone where the neurostimulator will be implanted under the skin. The electrode/lead is attached to the extension wire that is passed under the skin down the neck to connect to the stimulator/battery in the chest.

The stimulator might be visible as a small bulge under the skin, but it usually remains hidden under the clothes.

It is advisable to avoid movement of arm over the shoulder or an excessive stretching of the neck as the incision heals.

Step 8: program the stimulator

About 10 days after surgery, you will be scheduled for an office visit. The stimulator will be programmed and your medication dosage will be adjusted. You may be asked to stop taking your medications for up to 12 hours before the programming session. This is done to increase the effectiveness of the programming in reducing your usual symptoms. It is important that you work with the neurologist and nurse to adjust your medications and refine the programming. You will return to the office every 3 weeks for programming. It typically takes 3 to 4 programming sessions to attain maximum symptom control while minimizing side effects.

Most people don’t feel the stimulation as it reduces their symptoms. However, some people may feel a brief tingling sensation when the stimulator is first turned on.

It’s important to remember that Parkinson’s disease is progressive and symptoms get worse over time. You will return to the neurologist’s office periodically to adjust the stimulation settings.

Discharge Instructions Deep brain stimulation Surgery

Continue to take all of your medications for your movement disorder the same way as you did before surgery.
If you are asked to stop blood thinners such as aspirin or Plavix, you may restart these 2 days after the last surgery.
You should take over-the-counter pain medication if the pain is mild.
You will be give a prescription for a narcotic for more severe pain. This medication can cause confusion, constipation, nausea or a rash. If any of these symptoms occur, stop taking the medication.

Results

Deep brain stimulation won’t cure your disease, but it may help lessen your symptoms. If deep brain stimulation works, your symptoms will improve significantly, but they usually don’t go away completely. In some cases, medications may still be needed for certain conditions.

Deep brain stimulation isn’t successful for everyone. There are a number of variables involved in the success of deep brain stimulation Surgery. It’s important to talk with your doctor before surgery about what type of improvement you can expect for your condition.

Frequently asked questions

How long does deep brain stimulation surgery take?

The length of the operation also depends on the technique used by each center, but it often lasts between 3-6 hours from start to finish. As long as the electrodes are accurately placed, without complications, the recovery period usually lasts from between 3 to 5 days.

What is the success rate of deep brain stimulation surgery in India?

Studies report that DBS Surgery can reduce off -periods of PD symptoms by 60% (fluctuations in motor symptoms due to poor response to medicines). By reducing the need for medication, DBS Surgery rapidly decreases medication-induced dyskinesias by 60 to 80% and improves the quality of life in people with advanced PD.