Movement Disorder Surgeries

Movement Disorder Surgeries

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People who don’t suffer from movement disorders find it difficult to understand how the conditions feel like. So it didn’t surprise Roshan that failed to understand what he was feeling. 

He was in his early forties when the first symptoms of his disease began to surface. Roshan didn’t consult the doctor. Why would he? He didn’t even see it as anything serious. He was a fool to not to realize the importance of the tremor that shook his fingers and limbs sooner. But the time it came to him that something about this tremor was fishy, another sign of the disease made its presence known. 

His movement got slower, making simple tasks difficult and time-consuming. His steps became shorter when he walked. It became difficult for him to get out of a chair. And before he knew it, he was dragging his feet along the floor as he tried to walk. Then stiffness and rigid muscles set in. After that, Roshan didn’t waste any time and consulted a doctor. The doctor told him that his symptoms were similar to that of a person with Parkinson’s disease. The doctor sent him to a neurologist who confirmed the disease. 

The neurologist put him on antidepressants and dopamine promoters. But these drugs proved to be futile. Roshan had lost all hopes when the neurologist told him that there was one door that was still open. The door named surgery. 

What are movement disorders?

Movement disorders mean excessive often repetitive and involuntary movements that interfere with the normal flow of motor activity. The most common movement disorders are:

  • Essential tremor. 
  • Ataxia.
  • Dyskinesia. 
  • Dysphonia. 
  • Dystonia.
  • Parkinson’s disease.
  • Physiological tremor.
  • Tics. 
So do surgeries really help in treating movement related disorder? 

No one can answer this question better than Dr. PareshDoshi. After all, Dr. Doshi and his team perform a wide spectrum of movement disorder surgeries. 

 

His team has performed one hundred and thirty movement disorder surgeries, including forty-nine cases of DBS.

What are the surgeries that work for the Movement Disorder?

DBS Treatment

The deep brain stimulation is a treatment technique in which electrodes are placed in a specific region of the brain. These regions are selected based on the symptoms being treated. The electric terminals are placed on both the left and right sides of the brain through small holes or incisions made at the top of the cranium or skull. The electrodes are connected by long cables that travel under the skin and down the neck to a battery-powered stimulator placed under the skin of the chest.

In the correctly selected patients, DBS is quite safe and efficient but there are some risks. There is an estimated two to three percent risk of brain hemorrhage that may either be of no significance or may cause paralysis, speech impairment, stroke, or other major problems. In fact, such treatments have been performed in massive numbers in Apollo Hospital.

The circuit inside our brains responsible for controlling our movements is called the basal ganglia and is made up of several different groups of brain cells that connect and communicate with each other to fine-tune movement. In Parkinson’s, the key families of brain cells involved in the movement circuit stop working properly as the dopamine-producing cells in the substantianigra slowly stop producing the optimal level of dopamine. 

Without the injection of dopamine, it becomes harder to get moving and to maintain movements, and so, things like stride length can get shorter over time. This is where DBS comes into the picture. Although we still do not fully understand how this electrical stimulation works to improve movement, scientists and doctors now believe that the stimulation may disrupt abnormal electrical activity in the basal ganglia and may help to regain the movement control. Apollo Bangalore has been performing may researches on the same.  If the patient is selected carefully, the DBS can be highly effective and reduce the symptoms by 70% and it is also completely reversible and can be turned off or can be removed if necessary. 

What are the side effects of DBS?

There are a few side effects of DBS, and they may include the following:

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

First introduced in the 1950s, it is a surgical procedure in which an opening is made into the thalamus to primarily treat tremors such as those associated with Parkinson’s disease. But now, focused ultrasound, a completely non-invasive method of thalamotomy, is now employed. It is a procedure in which a predefined small volume of brain tissue containing nerve cells causing the tremor is destroyed using focused ultrasound. 

Unlike DBS, no incision or electrodes are involved, hence if the symptoms are not that severe, this surgery is preferred. 

What are the side effects of Thalamotomy?
  • Weakness
  •  loss of sensation
  •  loss of voluntary movement
  • Temporary confusion.
  • Stroke caused by bleeding in the brain. It sometimes can lead to death.
  • Temporary balance problems.
  • Numbness around the mouth and in the hands.
  • Infection.

Pallidotomy

Pallidotomy is another neurosurgical procedure to treat movement disorders. In this procedure, a tiny electrical probe is placed in the globuspallidus which is one of the basal nuclei of the brain. The electrical probe is then heated to 80 °C for 60 seconds to destroy a small area of brain cells. Neurologists believe Parkinson’s happens when a part of the brain called the globuspallidus starts working too hard

What are the side-effects of pallidotomy?
  • Fatigue and sleepiness 
  • Worsening of memory 
  • Depression 
  • Aphonia
  • Dysarthria 
  • Scotoma
  • Slight facial and leg paresis 
  • Delayed stroke 

 

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