Deep Brain Stimulation
What is Deep Brain Stimulation ?
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Why do you need Deep Brain Stimulation ?
DBS is indicated for:
- Parkinson’s disease (PD): To manage tremors, rigidity, bradykinesia, and dyskinesia in patients with suboptimal response to medications (e.g., levodopa).
- Essential tremor (ET): Severe, medication-resistant tremors affecting daily activities (e.g., writing, eating).
- Dystonia: Involuntary muscle contractions causing abnormal postures, often genetic (e.g., DYT1 mutation) or idiopathic.
- Obsessive-Compulsive Disorder (OCD): In severe, treatment-resistant cases (approved in some regions, less common in India).
- Epilepsy: To reduce seizure frequency in drug-resistant cases (emerging indication, often targeting the anterior nucleus of the thalamus).
- Other (investigational): Tourette syndrome, chronic pain, or depression (not widely available in India).
The procedure aims to improve symptoms, reduce medication dependence, and enhance quality of life by targeting specific brain areas, such as the subthalamic nucleus (STN) or globus pallidus interna (GPi) for PD, or the ventral intermediate nucleus (VIM) for ET.
Why Do Deep Brain Stimulation Costs Vary in Philippines?
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Deep Brain Stimulation Procedure
- Before Surgery Evaluation:
- Diagnosis:
- Neurological assessment: Confirms diagnosis and symptom severity (e.g., Unified Parkinson’s Disease Rating Scale for PD).
- MRI/CT: Maps brain anatomy to identify target areas.
- Neuropsychological testing: Screens for cognitive or psychiatric issues (e.g., dementia, severe depression) that may contraindicate DBS.
- Medication trials: Ensures symptoms are not adequately controlled by drugs.
- Medications: Adjusted pre-surgery (e.g., PD patients may stop levodopa to assess baseline symptoms).
- Consent: Risks, including infection or hardware failure, are explained.
- Diagnosis:
- Surgical Techniques:
- Stage 1: Electrode Implantation:
- Performed under local anesthesia with sedation (or general anesthesia for dystonia/anxiety), lasting 3–6 hours.
- A stereotactic frame is fixed to the skull, or frameless neuronavigation is used for precision.
- MRI/CT data guides electrode placement; microelectrode recording (MER) maps brain activity to confirm the target (e.g., STN, GPi, VIM).
- Electrodes are inserted through small burr holes (1–2 cm) in the skull, one per side for bilateral DBS (common in PD).
- Intraoperative testing: Stimulation is applied to confirm symptom improvement (e.g., reduced tremor) and check for side effects (e.g., speech issues).
- Stage 2: Pulse Generator Implantation:
- Performed under general anesthesia, often 1–2 days after Stage 1, lasting 1–2 hours.
- A pulse generator (battery-powered device) is implanted under the skin, typically below the collarbone.
- Extension wires connect the electrodes to the generator through subcutaneous tunneling.
- Programming:
- Starts 2–4 weeks post-surgery to allow brain swelling to subside.
- A neurologist adjusts stimulation settings (e.g., voltage, frequency) using a handheld device to optimize symptom control and minimize side effects.
- Stage 1: Electrode Implantation:
- After Surgery:
- ICU or ward monitoring for 1–3 days; hospital stay of 3–5 days.
- Pain management: Analgesics (e.g., paracetamol) for scalp/chest discomfort.
- Antibiotics (e.g., cefazolin) for 1–3 days to prevent infection.
- Follow-up MRI/CT confirms electrode placement.
- Programming sessions: Multiple visits over 1–3 months to fine-tune settings.
Recovery After Deep Brain Stimulation
- Hospital Stay: 3–5 days; longer (5–7 days) if complications.
- Post-Surgery Care:
- Pain: Scalp/chest discomfort for 1–2 weeks, managed with analgesics.
- Activity: Light walking on day 1–2; avoid heavy lifting or arm movements (generator site) for 4–6 weeks.
- Wound care: Keep incision sites dry for 7–10 days; sutures/staples removed at 10–14 days.
- Programming: Initial session at 2–4 weeks; adjustments over 1–3 months to optimize benefits.
- Medications: Gradually reduced (e.g., levodopa in PD) as stimulation takes effect.
- Diet: Normal diet; 2–3 liters water daily.
- Follow-Up:
- Visits at 2 weeks, 1 month, and every 3–6 months for programming and symptom assessment.
- MRI/CT if electrode migration or complications are suspected.
Most resume normal activities in 4–6 weeks. Symptom improvement varies: PD (50–70% reduction in motor symptoms), ET (70–90% tremor reduction), dystonia (40–60% improvement, slower response over months). Benefits can last years, though disease progression may require adjustments.
Risks and Complications
- Surgical Risks: Bleeding (1–3%), infection (2–5%, e.g., at generator site), stroke (0.5–1%).
- Hardware-Related:
- Lead migration (1–3%): Electrodes shift, requiring repositioning.
- Device failure (1–2%): Lead fracture or generator malfunction.
- Stimulation-Related:
- Side effects (5–10%): Speech difficulty, balance issues, or mood changes (e.g., depression, mania); often reversible with reprogramming.
- General Risks: Anesthesia reactions, seizures (1–2%).
- Long-Term: Battery replacement surgery, disease progression (DBS doesn’t halt underlying condition).
Report fever, severe headache, or new neurological symptoms promptly.
Frequently Asked Questions (FAQs)
Who is a candidate for DBS?
Patients with PD, ET, or dystonia who have significant symptoms despite optimal medical therapy, without severe cognitive/psychiatric issues.
Does DBS cure the condition?
No, it manages symptoms but doesn’t stop disease progression; benefits can last years with adjustments.
Is the procedure painful?
Minimal discomfort during electrode implantation (local anesthesia); generator implantation is under general anesthesia.
How soon can I resume activities?
Light activities in 1–2 weeks, normal routines in 4–6 weeks.
Is DBS covered by insurance in India?
Often partially covered for PD, ET, or dystonia; confirm with your provider.
Signs of complications?
Fever, swelling at incision sites, worsening symptoms, or new neurological issues.
Can I undergo MRI after DBS?
Yes, but only with MRI-compatible devices and specific safety protocols; inform your doctor.
Lifestyle changes post-surgery?
Avoid contact sports, attend regular programming sessions, monitor battery life, and continue medications as advised.
Conclusion
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Looking for Best Hospitals for Deep Brain Stimulation
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.