11 th Indian National Stroke Conference in Taj Swarna, Amritsar dated 17-19 March 2017.
Talk on the role of surgery in National Epilepsy day held at VHS hospital by Dr.Ghosh Charitable trust.
Mr Anbu (name changed) was a 25 year old who met with a road traffic accident near Tindivanam. He was groggy by the time he reached home after receiving first aid nearby. Since he had consumed alcohol, the family members believed he was asleep when he couldn’t be woken up. The next day, finding him unable to walk, they feared that he had a fracture in his leg.
He was admitted to a local hospital, where an X ray was done. There was no fracture! He had also not woken up fully and they know the alcohol could not be blamed for so long. A CT Scan was done for the brain and a huge blood clot compressing the brain was found. Now realising that he was in a near coma stage, and that the clot was responsible for the paralysis. They rushed him to a bigger hospital.
They finally reached SRMC close to midnight having realised that specialised brain surgery facilities were not available in some places. All family members were anxious and worried since they had been worried about the risk to the young man’s life. He was rushed to the operation theatre immediately and the clot evacuated.
He was back in the ICU in a couple of hours and was well on his way to a speedy recovery. He was discharged home in less than a week, fully cured and able to walk well without support.
Take home messages:
- Don’t drink and drive
- Wear a helmet at all times when riding a 2 wheeler or riding pillion
- One doesn’t need to have an external injury to have a severe blood clot on the brain
Pre-op CT Scan of brain showing a large extradural haematoma
Per-op picture showing a large clot under the skull compressing the brain
Post-operative scan showing total evacuation of the clot with relief in the pressure on the brain
Worldwide, seven to 10 million people are affected by Parkinson’s Disease (PD) 1. If reports are to be in believed, these numbers will continue to grow, especially in the Asian subcontinent as a result of 10a rapidly ageing population and increasing life expectancy2.
Commonly known to affect people above 50 years of age, PD is second only to Alzheimer’s in terms of global prevalence of neurodegenerative disorders. With World Parkinson’s Day round the corner, the need of the hour is to train the spotlight on risk factors, symptoms and available treatment options for PD, say experts. Dr.K.Viswanathan, Consultant Neurosurgeon, MIOT International Hospitals says, “Parkinson’s disease is a progressive disorder of the nervous system that affects one’s normal movement. It develops gradually, at times with a barely noticeable tremor in one hand. The alarming rise in the number of people with PD can mainly be attributed to changing lifestyles and environment. Not just the elderly, its prevalence is increasing among younger people as well. Considering the debilitating nature of PD, it is important for people to understand risk factors and take measures to thwart its progression”. It is estimated that about one percent of population above the age of 65 years and about five percent above the age of 80 years suffer from PD3 with higher incidence in men than women. Now, studies have found that in 10 percent out of a million cases, PD can set in as early as 40 years. When an individual is diagnosed with PD before the age of 50, the disorder is called Young-Onset Parkinson’s disease. In the Indian scenario, unfortunately, there is still a dearth of sufficient data to identity the exact prevalence in spite of the rising incidence, say experts. While some studies quote the incidence as 328 per 10,000 populations, these figures are not up to date.
‘People should understand risk factors, take early treatment’
With seven to ten million people affected by Parkinson’s Disease (PD), doctors caution people on the risk factors, symptoms and urge them to make use of the available treatment.
While observing World Parkinson’s Disease toda, experts say that this disease is common among people above the age of 50 years. This is also second disease after Alzheimers in terms of global prevalence of neurodegenerative disorder.
MIOT International Hospitals, consultant neurosurgeon Dr.K.Visvanathan says, ‘This disease is a progressive disorder of the nervous system that affects one’s normal movement. It develops gradually at times with a barely unnoticeable tremor in one hand’.
‘The alarming rise int the number of people with PD can mainly be attributed to changing lifestyles and environment. Off late we are seeing its prevalence increasing among younger people as well. Considering the debilitating nature of PD, it is important for people to understand risk factors and take measures to thwart its progression’, he says.
‘It is estimated that about one per cent of population above the age of 65 years and five per cent above the age of 80 years suffer from PD with higher incidence in men than women’, he adds.
Studies have found that in 10 per cent out of a million cases, PD can set in as early as 40 years. When an individual is diagnosed with PD before the age of 50, the disease is called Young-Onset Parkinson’s disease.
While further explaining the disease, Visvanathan says certain nerve cells in the brain known as neurons die, causing symptoms of PD to develop.
Research studies have shown that many of the symptoms are due to loss of neurons that produce a chemical messenger in the brain called dopamine. When dopamine levels decrease, it leads to abnormal brain activity, leading to signs of PD. Although the early signs of PD may be mild and even go unnoticed, experts have identified the most common symptoms of PD to be tremors, slow movements (brady kinesia), muscle rigidity, loss of automatic movements like blinking and smiling, speech problems and difficulty in writing.
The classic symptom of PD is resting tremor, although 20 per cent of patients do not have it. Thought to be incurable earlier, treatment modalities have improved over a period of time and have come up as effective ways of managing symptoms of Parkinson’s Disease.
Of late, Deep Brain Stimulation (DBS) has come up as a well-recognized non-pharmacologic treatment, known to significantly improve the motor symptoms of patients with early and advanced Parkinson’s Disease.
According to NCBI (National Center for Biotechnology Information), DBS has been established as a highly effective therapy for advanced Parkinson’s Disease. The NCBI also states that DBS has led to better functional outcomes with fewer side effects in PD patients.
Worldwide, 7 to 10 million people are affected by Parkinson’s Disease and this is expected to increase rapidlyy due to ageing population and increasing life expectancy. Commonly known to affect people above 50 years, PD is second only to Alzheimer’s in terms of global prevalence of neuro-degenerative disorders. With World Parkinson’s Day being observed on April 11, the need of the hour is to bestow attention on ascertaining risk factors, symptoms and available treatment options. Says Dr.K.Visvanathan, consultant neurosurgeon, MIOT International Hospitals, “Parkinson’s Disease is a progressive disorder of the nervous system that affects one’s normal movement. It develops gradually, at times with a barely noticeable tremor in one hand. The alarming rise in the number of people with PD can mainly be attributed to changing lifestyles and environment. Not just the elderly, its prevalence is increasing among younger poeople as well”. Considering the debilitating nature of PD, it is important for people to understand risk factors and take measures to thwart its progression. It is estimated that about 1 per cent of population above the age of 65 years and about 5 per cent above the age of 80 years suffer from PD with higher incidence in men than women. Now, studies have found that in 10 per cent out of a million cases, PD can set in as early as 40 years. When an individual is diagnosed with PD before the age of 50, the disorder is called Young-Onset Parkinson’s Disease.
Although the symptoms of Parkinson’s Disease (PD) is often mistaken or confused with old age-related problems of tremor, difficulty in turning, this degenerative disroder can be treated if diagnosed early, says city doctors.
“There are four stages of Parkinson’s Disease. It leads to difficulty in walking, turning and causes a loss of balance, making one fall. Any early diagnosis can help to treat this malady through medicines”, says Dr.Satish Kumar, consultant neurologist, Fortis Malar Hospital, here. There are no risk factors involved in such patients, he adds.
“Effective treatment makes the symptoms decline within 7 or 8 years. We call this honey-moon period as the PD patients respond to medicines. We resort to surgery viz., ddep brain simulation (by fixing a programmer with batter inside) to correct the disorder”, says Dr. D.S. Halprashanth, consultant neurologist, Global Hospitals, here.
Speaking to this correspondent, he said PD pre-dominantly affects those above 60 years of age, though younger people, especially those in 45-50 years of age, too are showing similar symptoms.
“It is a malady similar to diabetes or hypertension. There is no sure cure, but it can be controlled“, Dr.Halprashanth says.
Basic awareness on PD is lacking among the people as many tend to regard these as age-related problems. It will take about two or three years to discern that the person is sufferning from PD and only then people seek neurologists’ help, he said.
“Stroke is not a risk factor for Parkinson’s Disease but certain conditions like depending on anti-psychiatric medicines could also lead to secondary PD”, claims Dr.Satish Kumar. People should learn to differentiate PD from old age problems.
Parkinson’s diseas (PD) is a degenerative condition affecting the brain. There is an imbalance of chemicals in the brain because an important area in the brain called “substantia nigra” is damaged. Why this occurs is usually not known and such patients are labeled as “Idiopathic Parkinson’s disease”. Such patients are ideal candidates for the procedure called deep brain stimulation.
Surgical treatment for Parkinson’s disease is not new. It was being done decades before the medicines used to treat PD were discovered. Using stereotactic techniques, deep areas in the brain were targeted and small holes were made in parts of the basal ganglia. It was presumed that by such “lesioning” techniques, the imbalance in the chemical circuitry was restored. However, lesioning is essentially destroying a small area in the brain and this will be permanent. As science developed and medicines to treat PD evolved, principally levo Dopa, the use of such lesioning techniques rapidly declined.
However medicines bring with them their own set of problems. The first few years with medicines are really good. The patient has excellent control of the symptoms and his quality of life improves greatly. Later, the side effects of medicines start to appear gradually and the effect of the medicines also start wearing off. The patient is in the “on” state immediately after taking the drugs and soon thereafter as the blood levels of l-Dopa drop he gets into the “off” state. He is practically frozen and immobile.
It is at this stage that Deep Brain stimulation(DBS) evolved. The technique involves placing an electrode stereotactically into both the subthalamic nuclei and connecting it by wires under the skin to a pacemaker. By electrically stimulating this area, the electrical circuit which was out of balance can be brought back into balance. Currently, the best target for DBS is in an area called Subthalamic Nucleus. This is because, we can reduce the dose of Dopa needed following the surgery, thereby reducing the drug related side effects.
Since DBS is a reversible procedure, the technique is better than the lesioning procedure done previously and works as long as the pacemaker is active. Over the years, the technology has evolved significantly whereby the newer devices are much slimmer and last much longer than the first generation DBS implants.
DBS is a definite option for patients suffering from Parkinson’s disease if they want to improve their quality of life.
When one thinks of “surgery” or an “operation” I would guess the next word that comes into their mind is “pain”. I’m about to describe an operation that comes to the rescue of a particularly unfortunate group of patients who have severe pain that has continued despite many surgeries in the back or neck.
The conditions are called “Failed back surgery syndrome” (FBSS) and “Failed neck surgery syndrome” (FNSS). You may know many friends, relatives or acquaintances who have had operations to remove discs in the neck or back and have had plates and screws fixed. Even after the surgery, a few of them have their symptoms continuing – in some cases the pain is more worse than before. Further visits to the doctor and many scans later, they are told that there is nothing wrong on the scans and the nerves are free. They find themselves in a situation where no further surgery on their back or neck is deemed necessary and no painkiller works well. Pushed to a corner, most become depressed, unable to get back to work or to lead a normal life.
It is for such patients that a surgery called “Spinal Cord Stmulation” can potentially work well. A flat plate of electrode is placed on the back and is connected to a battery under the skin. Using this, electrical current is sent to the spinal cord to trick the spinal cord from sending the pain impulses up to the brain. Instead, the patient feels a warm buzz in the area he or she used to feel the pain. While it may not completely wipe out the pain, it will certainly enable them to restart their normal life which was crippled because of the pain.
Such modern surgical techniques are now available in Chennai and can be performed in a safe and successful manner.