Lourdes Hospital is the only mission hospital that performs Deep Brain Stimulation: Dr. Sreeram Prasad, HOD, Neurology, Lourdes Hospital, Health News, ET HealthWorld
ETHealthWorld
Updated: March 30, 2023, 09:10 IST
Shahid Akhter, editor, ETHealthworld, spoke to Dr. Sreeram Prasad, HOD, Neurology, Lourdes Hospital, Kochi, to know more about the mission hospital and the advanced surgeries that they perform.
Deep Brain Stimulation (DBS): Journey so far & emerging indications
The DBS treatment was started in the late 1990s on a patient in France who had Parkinson's disease with motor fluctuations and disability. Since then, the indications for and technology of DBS have advanced. As far as the indications are concerned, DBS was approved for other movement disorders like dystonia, tremor disorders, tardive dyskinesia, and tic disorders. Later, many psychiatric indications also came into the picture, the most common being obsessive-compulsive disorders (OCDs). DBS is also done in some patients with depression as well. Regarding technology, the DBS started with a non-rechargeable device. Later, rechargeable devices came into the picture, which have a longer life. That is one change in technology, and later technology also changed with many new devices, reaching even adaptive DBS.
The concept of adaptive DBS is that we can record the brain recordings of these patients, which are called the local field potentials, and the stimulation can be adapted according to the local field potentials. The adaptive DBS has not developed into its full existence. At present, we don't have the technology by which we can give minute-to-minute or time-to-time stimulation changes depending on the local field potential change. But at present, we can record local field potentials in patients. And we can also use these local field potentials to know when the patient was having the effect of medication, which we call the 'on state' in Parkinson's disease, and when the patient was not having the effect of medication, which we call the 'off state' in Parkinson's disease. We can also know whether the patient has missed their medication or whether the patient is regularly taking medications or not. And we can plan our programming depending on these parameters.
Deep Brain Stimulation at Lourdes Hospital
Deep Brain Stimulation was started in our hospital in December 2020, when we did our first case. And ours is the only mission hospital in Kerala and probably in the country to do DBS. In Kerala, all other hospitals are either central government institutes like Sri Chithra or private hospitals in different parts of the state. Because we are a mission hospital, we have tried to reduce the cost to the minimum. We are doing DBS at the lowest cost in Kerala and may be in India, except for some government hospitals that are funded by the government. Otherwise, in the private sector, we can always say that we are one of the hospitals that do DBS at the lowest cost. Secondly, we have performed 29 DBS till now, within around 27 months. And we are the fastest centre to reach 25 cases in Kerala. While other centres took at least three to four years to reach 25 cases, we reached that number in just a matter of two years, which is probably among the fastest in India itself.
Regarding DBS technology, we are doing two types of DBS for Parkinson's disease. For Parkinson's disease, we can find deviants in two places in the brain. One is called the Subthalamic Nucleus, and the other is called the Globus Pallidus Internus Nucleus. In India, all the cases were being done in the subthalamic nucleus alone, and because DBS started with the subthalamic nucleus around the world, later people started adding the second site as well, which is the Globus Pallidus Internus Nucleus. The Globus Pallidus Internus Nucleus DBS was almost never done for Parkinson's disease in our country. After my training in Toronto, where DBS is done in both the subthalamic nucleus and the Globus Pallidus Internus Nucleus, I started the DBS programme here. Naturally, I started doing Globus Pallidus Internus Nucleus as well. This was followed by a lot of discussion in the medical fraternity, and there was a debate over the efficacy of GPA versus Subthalamic Nucleus DBS in Parkinson's disease. After we started doing GPA DBS, awareness about GPA DBS increased among the medical fraternity in our country. And there are now more and more centres doing GPA DBS, so we could actually contribute to the growth of DBS and its technology in the country.
Neurology Department at Lourdes Hospital
The neurology department in our hospital has almost all the treatment facilities for different types of patients, and we do it at an affordable cost. We have two specialties. We have a momentary disorder specialty here as well as an epilepsy specialty. We have an epilepsy specialist. We have a sleep lab to treat patients with sleep-related disorders as well. We have all these programmes running. In addition, we have all the facilities needed for a basic neurology setup, such as a stroke programme, state-of-the-art ICUs, neurology labs, and everything else needed to support a good neurology programme.
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Thursday, March 30, 2023 at 3:08 am