Before delving on what is DBS, I would at the outset cover what I gained from DBS lest you may lose interest in going through ‘what is DBS’ first.

‘DBS is life changing’ and it is true.

I list out below the tangible gains I achieved by undergoing DBS

• My medicine reduced by at least 70 to 75%
• The Bradykinesia (slowness of movement) is gone
• The stiffness (neck pain etc.) is no more a bother
• Rigidity is almost gone

Apart from the above the following indirect or mostly medicine related issues are corrected

• With reduction in use of Sinemet the painful ‘protein effect’ is gone. This one of the biggest gains.
• Constipation (which is non motor symptom) is eased

In fact, the daily worry of handling the disease is not there anymore.

 I expected the regular end of dose tingling on the foot and the calf muscles will also reduce as with every dose Sinemet it goes off, but it didn’t reduce. But then, I agreed with Dr. Shivam that this could be a non-motor symptom and it would be asking too much of DBS to correct this.

The main issue is to keep one’s expectation from DBS ‘realistic’. Then you would be taken aback by the benefits achieved from DBS.

It is equally important to be in the hands of a good Neurologist and Neurosurgeon. I was extremely lucky to have Dr. Shivam and Dr. Tanmoy for me, both of whom are very passionate about the work they do, and both have a genuine intent to help patients

What is DBS

Deep Brain Stimulation or DBS is an advanced surgical therapy for Parkinson’s Disease. In a lay man’s language, this is a surgery by which one or two electrode leads are surgically implanted in the patient’s brain, and the electrode(s) are then connected through a wire to the Internal Pulse Generator (IPG) which is placed under the skin below the collarbone. The connecting lead is routed under the skin. The battery operated IPG send constant low voltage current to the brain through the electrodes. The current is used to correct the rouge signals that the brain generates due to PD. DBS mostly works for Motor symptoms like – tremor, Bradykinesia, stiffness and rigidity.

Apart from being used as a treatment method for PD, DBS is also used for treating Dystonia, Epilepsy, compulsive disorders, and Depression. There are two distinct areas in the brain namely subthalamic nucleus (STN) and the globus pallidus internus (GPi) where the electrodes are placed.

The size of the STN with in the brain is around 8mm in length and 6mm in width. In this a specific point in an area within the STN which controls the motor symptoms is to targeted for placement of the leads. ‘The more accurate is the electrode placement the better is the effectiveness of DBS.

The following few companies manufacture the DBS equipment in the entire world

• Medtronic, USA: They IPGs both with rechargeable battery and non-rechargeable battery. Their latest device is Percept with Brain Sense Technology. The device, implanted in me is Active PC
• Abbott Labs USA: Their infinity DBS device can be controlled through IOS
• Boston Scientific USA: they have Vercise range of DBS systems which include ‘directional lead’ technology
• Scene Ray, China: they manufacture devices which can be programmed remotely through WiFi.

Who Can Have DBS

Not everyone who has Parkinson’s’ disease can have a DBS surgery. There are certain requirements which a patient must fulfil to have a DBS surgery. Some of them are

• The patient is under medication for PD for at least 4 years
• The patient is being treated with Levodopa and Levodopa works on him/her
• The patient experiences increased ‘off’ period (off period is the time when the medicine levodopa does not work). This mostly happens at the ‘end of dose’ of the medicine, i.e., every two to three hours
• The doses of Sinemet can not be increased further as it leads to dyskinesia (a side effect of levodopa)

There is an inter- disciplinary evaluation of the patient to establish that he is fit to undergo DBS surgery.

It involves a ‘levodopa challenge’ whereby one is asked to stop taking the medicine say 10-12 hours before the doctor sees him/her.  In my case, I stopped the medicine from the afternoon of the previous day but could not manage without the medicine after 10pm and had to take a dose of levodopa in the night.

The doctor will evaluate and video graph the patient’s condition without levodopa and thereafter will usually administer a double dose of levodopa and once the medicine takes effect, the doctor will again evaluate the condition. This required to arrive at UPDRS rating.

Then the patient will have to go for a neuropsychological evaluation in order to set the base line data before the operation.

All the above information is reviewed by a team of doctors to arrive at the eligibility of the patient to undergo DBS.