HEADACHES ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT (PPE)

HEADACHES ASSOCIATED WITH PERSONAL PROTECTIVE EQUIPMENT

Dr Sudhir Kumar MD DM

Consultant Neurologist, Apollo Hospitals, Hyderabad

drsudhirkumar@yahoo.com

Introduction

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV2 is a global pandemic, which has already affected about 2.6 million people belonging to about 200 countries. Healthcare workers (HCW) working in high-risk areas (such as emergency room, isolation wards, ICU, etc) are mandated to wear personal protective equipment (PPE), including close-fitting N95 face mask and protective eyewear (mainly goggles) while attending to the patients.

Aims of the Study

A recent study was conducted at Singapore (Reference: Headache, 30 March, 2020) to study the effects of PPE in development of de novo (new onset) headaches as well as their impact on personal health and work performance. The impact of COVID 19 on pre-existing headache disorders was also investigated.

Participants in the Study

158 healthcare workers participated in the study. 78% of them were in 21-35 year age group. 70% were females. Majority were either nurses (65%) or doctors (32%). 29% had pre-existing headache disorders (19% had migraine and 10% had tension-type headache).

Main Findings of the Study

Out of 158 healthcare workers, 128 (81%) developed de novo PPE-associated headaches. Persons with pre-existing primary headaches were 4.2 times more likely to develop de novo PPE-associated headaches. People using PPE for more than 4 hours per day had a 3.9 fold higher risk of developing PPE-associated headaches.  HCW working in emergency department had a 2.4 times higher risk of developing PPE-associated headaches.

Clinical Characteristics of PPE-associated Headaches

Headaches were bilateral in location. The location of discomfort corresponded to the areas of contact from the face mask or goggles and their corresponding head straps. Discomfort was described as a sensation of pressure or heaviness of affected sites in 87% and throbbing or pulling pain in 12%.

The time interval between donning of face mask or protective eyewear and onset of headache was less than 60 minutes in most people. After removal of PPE, the headache resolved within 30 minutes.

Most people reported an attack frequency of 1-4 days in a 30-day period. The intensity of headache was mild in most. 23% reported accompanying symptoms of nausea, vomiting, phonophobia or photophobia.

Various types of Face mask and Protective eye gear

 Location of headache in association with N95 facemask and protective eyewear

About 70% did not take any painkillers. 30% took either paracetamol or NSAIDs.

83% opined that PPE-associated headaches resulted in a slight decrease in work performance.

Pathogenesis of de novo PPE-associated headaches

The proposed mechanisms care mechanical compression, hypoxemia, hypercarbia and stress.

What could mitigate the risks of PPE-associated headaches?

1.     Shorter duty shifts and resultant shorter duration PPE usage could be a better strategy, 2. Better cushioning of head straps to minimize mechanical compression over scalp, 3. Reducing stress levels among HCWs.

Key points

1.     New-onset headaches are common after using PPE (N95 mask and protective eye gears),

2.     Healthcare workers in ED and those using PPE for more than 4 hours daily have a higher chance of developing headaches.

3.     People with pre-existing headaches have a higher chance of getting headaches.

4.     Headaches begin within 60 minutes of donning PPE and subside within 30 minutes of removing PPE,

5.     Headaches affect both sides of head and are usually mild in nature,

6.     Headaches respond to paracetamol and NSAIDs,

7.     Headaches decrease the work performance,

8.     Shorter shift duration (resulting in shorter duration use of PPE) could be the way forward,

9.     Though the primary aim of PPE is to reduce the risk of virus spread and transmission, we also need to make them user friendly in future.

Dr Sudhir Kumar MD DM

COVID 19 RELATED ANXIETY DISORDER

Corona (Covid 19) Related Anxiety Disorder

Corona virus infection, better known as Covid 19 infection, which started in China about three months ago, has rapidly spread to about 150 countries. So far, about 1,50,000 people have been infected with Covid 19, out of whom about 5,500 people have died.

Various forms of media (including TV, newspaper) and social media (facebook, whatsapp, etc) are full of news and information about Covid 19 infection. Various government agencies too have started awareness campaigns about Covid 19 infections and methods to limit its spread. Countries across the world have initiated partial to total shutdown. WHO has declared Covid 19 infection as a pandemic.

A problem of this magnitude, affecting the entire world is rare and many people have not faced a similar situation in their lifetime. This has resulted in anxiety and fear of varying magnitude. Recently, pulmonologist Dr Chandrakant Tarke encountered two patients with extreme anxiety.

Both patients were women, aged 23 and 30 years respectively, from Hyderabad, India. They presented with mild cold and no other significant symptoms. They had no risk factors to develop Covid 19 infection (no history of travel to Covid 19 affected countries or exposure to a Covid 19 infected patient). They had extreme fear that they were suffering from corona virus infection. They had developed obsessive trait of washing their hands multiple times with sanitizers despite staying at home and no exposure to outside. Clinical examination was normal except for hyperventilation. The fear had started after the news about Covid 19 infection in India started flashing on Indian TV channels. The fear became extreme on listening to Covid 19 awareness caller tune initiated by Government of India (which started with coughing sounds, followed by steps to prevent Covid 19 spread).
A diagnosis of anxiety disorder induced by fear of having contracted Covid 19 infection was made. Women were counselled and referred to psychiatrist for further management.

With increase in the number of Covid 19 cases across the world and the disruption resulting due to it, we are likely to come across many more people suffering from Covid 19 related anxiety disorder. As a health care professional we need to be aware of it, promptly diagnose it (clinical diagnosis suffices) and advise appropriate treatment (counselling, referral to psychiatrist/psychologist).

Steps to prevent Covid 19 related anxiety

1 .Avoid seeking constant updates about Covid 19 from TV channels or social media (updating twice a day- morning and evening- should be sufficient),

2. Do not constantly discuss about Covid 19 with your family, friends and colleagues,

3. Focus on the positive aspects of Covid 19- more than 80% have mild infections and more than 90% survive this infection,

4. Take steps to prevent Covid 19 (as already outlined across various media platforms)

5. Go for walks, exercise and engage in leisure activities (music, gardening, etc)

6. Consult a healthcare professional if you develop anxiety or fear related to Covid 19

Dr Sudhir Kumar MD DM (Neurologist), Apollo Hospitals, Jubilee Hills, Hyderabad
Dr Chandrakant Tarke MD DM (Pulmonologist), Apollo Hospitals, Jubilee Hills, Hyderabad

Headache After Ischemic Stroke

Headache after Ischemic Stroke

How common is headache after ischemic stroke?

Headache is common in people with ischemic strokes. It can occur at onset of stroke symptoms or following stroke. It affects 6-44% of people suffering from ischemic stroke.

What is the type of headache in this group of people?

Headache is similar to tension-type headache. It is located in back of head and neck regions. It is not very severe. There is no nausea or vomiting. There is no photophobia (increased sensitivity to lights) or phonophobia (increased sensitivity to sounds) either. 

Who have a higher risk of getting headaches after ischemic stroke?

1. Females have a higher risk than males.

2. Those suffering from posterior circulation stroke have a higher risk. 

3. Prevalence is higher in North America and Europe, as compared to Middle East and Asia. 

How can this be treated?

Medicines used for treating tension-type headache can be effective. These include amitriptyline or dothiepin (dosulepin) tablets. 

(Source: Neurology, Jan 7, 2020 issue)

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com

MANAGING MULTIPLE SCLEROSIS IN PREGNANCY

Managing Multiple Sclerosis (MS) in Pregnancy

How common is this situation- pregnancy in women with MS?

MS is most often diagnosed between the ages of 20 to 40 years. This is the age when most women plan their pregnancies. Therefore, it is very common to find women with MS, who are pregnant or those who are planning pregnancy.

Which is a better option- starting MS treatment and then planning pregnancy or delaying MS treatments until after completing family?

MS is characterized by multiple relapses (when new symptoms occur). With each relapse, the disability increases. These relapses are often more frequent in the initial years after diagnosis of MS. Disease modifying drugs (DMD) can reduce relapses and disability. Therefore, it is always better to start DMD and then plan pregnancy. One should not postpone starting DMD after pregnancy/delivery.

How does pregnancy affect MS?

Pregnancy does not affect MS in the first trimester.

The MS relapses are lesser in 2^nd and 3^rd trimesters, which is good news.

However, the relapses become more frequent in the post partum period (after delivery) and this higher risk persists until 6 months after delivery.

How does MS affect pregnancy?

By and large, there are no adverse effects of MS on pregnancy. Women with MS have no extra risk of miscarriage or birth defects in their babies; as compared to women without MS. The mode of delivery too need not be altered just because the patient has MS.      

MS has no direct effect on fertility. Women with MS may have sexual dysfunction resulting in lesser libido. Male partners who have MS may suffer from erectile dysfunction.  

What MS medications are safe in pregnancy?

No DMD has yet been tested in pregnancy and hence none can be declared safe. However, recent evidence suggests that some DMDs are less risky than others. Less risky DMDs in pregnant women with MS include beta interferons (Avonex, Rebif, Betaseron) and Glatiramer acetate.

For prospective fathers, beta interferon and Glatiramer acetate as DMD showed no risk to baby’s health. Teriflunomide is detected in semen and it should be discontinued before trying to conceive.

Steroids can be safely used to treat MS relapses during pregnancy.

Will babies born to women with MS have a higher risk of getting MS themselves?

Most cases of MS are sporadic and most women with MS do not have a history of MS in their family members. However, having a relative with MS does slightly increase the risk of being diagnosed with MS.

In UK, the lifetime risk of being diagnosed with MS in general population in 1 in 330. The risk increases to 1 in 48, if one of the first degree relatives has MS. If one of the second-degree relatives has MS, the risk of being diagnosed with MS is 1 in 100.

an women with MS breastfeed?

Breastfeeding is safe and can be continued as usual.

What impact does pregnancy have on the course of MS?

There is limited data on this topic. However, in one study, pregnancy and childbirth were associated with lesser chances of developing severe disability. Women who gave birth at any time (either before or after the onset of MS) were 34% less likely to develop severe disability (as defined by need to use walking aid).

(For more reading, Multiple sclerosis Trust, UK)

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com

MIGRAINE IN CHILDREN

MIGRAINE IN CHILDREN

What is migraine?

Migraine refers to a condition where the sufferer gets repeated headaches.

What are the other symptoms of migraine?

People may have nausea or vomiting associated with headaches. They also do not like noise or light during the headache episodes. Some children with migraine may not have headache and they may present with only repeated abdominal pain. 

Do children suffer from migraine?

Yes, children do suffer from migraine. 10-25% of children may suffer from migraines. Before puberty, migraine is more common in boys. After puberty, it becomes more common in girls.

What is the earliest age when migraine can affect children?

Migraine has been reported in children as early as 18 months old. About half of the children with migraine have their first attack before the age of 12 years.

What is the cause of migraine in children?

In most cases, there is a combination of genetic and environmental factors. Children with one parent with migraine has 50% chance of getting it, whereas children whose both parents have migraine have 75% chance of getting migraine. Most children with migraine have at least one close family member suffering from it.

How does migraine affect children’s quality of life?

Migraine in children can be as disabling as in adults. Children with migraine miss school twice as often as compared to those without migraine. They also suffer from anxiety, depression, and mood swings, and may not be able to focus in studies. They may also not enjoy sports and other recreational activities.

How is the diagnosis of migraine confirmed in children?

In most cases, the patient’s history and clinical examination are enough to make a diagnosis of migraine. However, in some cases, a brain scan may be needed to exclude other causes.

How is migraine treated in children?

Migraine can be effectively treated in children with medications.

For acute severe headaches, helpful medicines include paracetamol, ibuprofen and triptans (such as sumatriptan, zolmitriptan and rizatriptan).

To prevent headache episodes in future (migraine prophylaxis), propranolol, Flunarizine, topiramate or valproic acid may be used.

What measures can the children take to reduce the headache episodes?

1. Sleep adequately,

2. Eat food on time,

3. Avoid stress,

4. Certain triggers such as cakes, chocolates, Chinese food, too much TV/phone use, can be avoided/reduced. 

DR SUDHIR KUMAR MD DM

Senior Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777

drsudhirkumar@yahoo.com

https://www.facebook.com/bestneurologist

FREQUENTLY ASKED QUESTIONS ABOUT HEADACHE

FREQUENTLY ASKED QUESTIONS ABOUT HEADACHES

Headache is a common disorder. A large number of people suffer from headaches. Migraine and tension headaches are the commonest causes of headaches. They are not life-threatening, however, they cause significant disability, as pain impairs the quality of life. In some cases, headaches can be caused by serious causes, such as brain tumor, brain hemorrhage, brain fever, etc. 

The current interview focuses on the common causes of headache. How should we diagnose migraine? It can be diagnosed based on symptoms in most cases. When should one consult a doctor for headache? When should one do a brain scan? How do we treat headaches? To get answers to these and other questions, please watch this interview. The link of the youtube video with the interview is:

https://youtu.be/VgBvamY5kS0

Feel free to post your comments or ask any queries.


Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist,
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/

FREQUENTLY ASKED QUESTIONS ABOUT EPILEPSY (HINDI)

FREQUENTLY ASKED QUESTIONS ABOUT EPILEPSY

Epilepsy is a common neurological illness. It can be easily diagnosed and treated. People suffering from epilepsy can lead normal lives after treatment. Despite this, there are lot of misconceptions about this disease. There is a social stigma attached to epilepsy and epileptic patients. 

In this interview (in Hindi language), I have discussed the symptoms, diagnostic techniques and treatment options for people suffering from epilepsy. The link to youtube video is given below:


https://youtu.be/BzAzkOxecJs


Please go through this video interview to learn more about epilepsy. Feel free to post your comments and queries.

Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/

TEST YOUR KNOWLEDGE ABOUT STROKE

TEST YOUR KNOWLEDGE ABOUT STROKE

1. STROKE is a disease that affects:

A. Heart
B. Brain
C. Kidney
D. Lungs

2. Common symptoms of stroke include:

A. severe chest pain
B. Fits or convulsions
C. Paralysis of face, arms, legs, slurred speech
D. Breathing difficulty

3. If someone suffers from stroke at 9 PM,

A. He can go to OPD the next day
B. He should rush to the nearest general physician
C. He should rush to a hospital with 24X7 CT scan and neurologist on call
D. He can try home remedies for the night.

4. Is there a treatment available for patients with stroke, which would minimise disability

A. Yes
B. No

5. Common risk factors for stroke include all the following EXCEPT

A. Diabetes mellitus
B. Hypertension
C. Running on treadmill
D. Smoking

6. Which of the following measures is NOT helpful in preventing a recurrence of stroke in a person who has suffered stroke?

A. Taking Aspirin
B. Controlling BP and sugars,
C. Quitting smoking,
D. Skipping breakfast, if overweight

7. Physiotherapy helps in better and faster recovery of stroke survivors.
A. True
B. False

8. Stroke affects only older people
A. True
B. False

9. Proportion of population that may suffer a stroke in their lifetime

A. 1 in 10
B. 1 in 8
C. 1 in 6
D. 1 in 4

10. Stroke is treated by
A. Neurologist
B. Cardiologist
C. Nephrologist
D. Chest physician

Please go through these questions and answer them. Answers are posted below

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Thank you for going through the questions. Here are the answers:

1. B
Stroke affects brain. It most commonly occurs due to blockage of blood supply to a part of the brain. In some cases, it can also occur due to rupture of a blood vessel.

2. C 
Common symptoms of stroke include sudden onset facial weakness, weakness of arm or leg, slurred speech, loss of vision on one side, imbalance while walking or severe headache.

3. C
Stroke is a medical emergency. The brain tissue can suffer irreversible damage, if not treated within the first four hours. Therefore, the patient should be rushed to a hospital with 24X7 CT scan facility. The treatment is administration of clot-buster therapy under the guidance of a neurologist.

4. A
Clot-buster therapy with tissue plasminogen activator or tenecteplase within the first four and a half hours after stroke onset can minimise disability.

5. C
Running on treadmill is a healthy exercise and protects from stroke.

6. C
Skipping breakfast is an unhealthy habit. Moreover, it does not help in reducing weight.

7. A
Physiotherapy is very helpful in faster recovery of stroke survivors. It should be started as early as possible.

8. B

Stroke predominantly affects older people, however, it can affect all ages, including children.

9. C

Stroke is a common cause of death and disability (along with heart attacks and cancer) in the world, and affects i in 6 people in their lifetime.

10. A
Stroke is a disease of brain and is treated by neurologist.

I hope you enjoyed this mini-quiz. I would love to hear your comments or any further queries.

Dr Sudhir Kumar MD DM
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
drsudhirkumar@yahoo.com
04023607777/60601066

https://www.facebook.com/bestneurologist/

STROKE: RISK FACTORS, SYMPTOMS, TREATMENT AND PREVENTION (Times of India article)

On the occasion of World Stroke Day (29th October), an article published in Times of India newspaper, to raise awareness about the diagnosis, treatment options and prevention of stroke. 

The article can be accessed in Times of India (Hyderabad edition), dated 29th October 2017 (Page 31), at the following link: http://epaperbeta.timesofindia.com/Article.aspx?eid=31809&articlexml=WORLD-STROKE-DAY-Avoid-a-brush-with-a-29102017105014

Dr Sudhir Kumar MD DM

Senior Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777/60601066
drsudhirkumar@yahoo.com

EDARAVONE- A NEW HOPE FOR PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS

EDARAVONE- A NEW HOPE FOR PATIENTS SUFFERING FROM AMYOTROPHIC LATERAL SCLEROSIS (ALS)

Amyotrophic lateral sclerosis (ALS) is an uncommon degenerative disease of nervous system, mainly affecting the motor nerves. The common symptoms of ALS include weakness of arms and legs, difficulty in swallowing & speaking and breathing problem. The symptoms of ALS continue to get worse over time and most people die within 3-5 years after diagnosis, often due to respiratory failure.

                                          Stephen Hawkings (suffering from ALS)      AFP

There is no cure available for ALS. There is only one medication, RILUZOLE, which was approved for treating ALS in 1995. Riluzole can be used to slow down the deterioration in muscle strength. However, it has limited benefit in most patients. (In India, riluzole is offered free of cost to patients with ALS by Sun Pharmaceuticals). 

Now, there is a new hope for patients with ALS. A new medicine, EDARAVONE INJECTION, has been approved by US FDA to treat patients with ALS.

What is basis of Edaravone efficacy?

A research was conducted in Japan on more than 100 patients suffering from ALS. Edaravone injections were given for a period of six months. After six months, patients who received edaravone had better functional status and better quality of life (as compared to those who did not receive edaravone). 

Which patients with ALS would benefit from Edaravone injections?

Patients with ALS of less than two years duration, with mild disease severity, would benefit from edaravone. In addition, they should not suffer from any respiratory failure. 

What is the treatment regimen?

Patients are given edaravone injection 60 mg per day as intravenous infusion (given over 60 minutes) for 14 days. Then there is a gap of 14 days. Edaravone injection is supplied as 30 mg/20 ml vials (in India). In US, it is usually supplied as 30 mg in 100 ml. So, two vials would be needed per day. 

In second month, the injection is given on 10 out of 14 days. There is a gap of 14 days. This is continued for five months. 

So, in total, patient receives 64 doses of edaravone injections (60 mg each time) over a period of six months.

How long is the treatment continued?

As of now, there is efficacy and safety data for six months, so, it should be continued for total of six months, as per the schedule mentioned above. 

Is Edaravone treatment safe?

Yes, there are no serious adverse effects with edaravone. Minor side effects are similar to placebo. 

Do we need to reduce the dose of Edaravone in patients with kidney or liver disease?

There is no need to reduce the dose in patients with renal or liver function impairment. 

What is the cost of edaravone injections?

Each 30 mg vial costs about INR 400 (in India). So, the per day cost is about INR 800. The total cost of 64 days course of edaravone would be INR 51,200 (approximately 800 USD). Additional room rent, nursing charges, doctors fees, etc may be incurred. 

How about Riluzole?

Riluzole tablets should be continued together with edaravone injections. 

So, in summary, now we have a new drug for ALS, which is the first drug approved in 22 years for ALS after Riluzole. 

DR SUDHIR KUMAR MD DM

Consultant Neurologist

Apollo Hospitals, Hyderabad

drsudhirkumar@yahoo.com

www.facebook.com/bestneurologist/

04023607777/60601066

DEEP BRAIN STIMULATION (DBS) IN PARKINSON’S DISEASE

DEEP BRAIN STIMULATION (DBS) IN PARKINSON’S DISEASE

Major Symptoms of Parkinson’s disease

Parkinson’s disease (PD) is a progressive neurological disease, characterised by tremors, rigidity, slowness of movements and postural imbalance. Though it is more common after the age of 40, people younger than 40 can also get affected (when it is known as young onset PD).

Other symptoms of PD include low volume speech (sometimes totally incomprehensible), expressionless face, reduced blink rate, reduced arm swing while walking, stooped posture, small handwriting (called micrographia), short-shuffling steps, tendency to fall forwards. Many people also have pain and aches in the affected limbs. Sleep disturbance and restless leg syndrome are common comorbid illnesses in people with PD. Severe memory impairment is NOT a feature of PD, however, in advance PD, mild memory impairment may occur in about 10% of patients. Similarly, loss of bladder control or erectile dysfunction is not a feature of PD. When these features are present, one should suspect multiple system atrophy (MSA).

Diagnosis of PD

The diagnosis of PD is still best made on the basis of clinical examination by an experienced neurologist (preferably trained in movement disorders, though not a must). PET and DaT scans are available to help in the diagnosis of PD, but they are not superior to a good clinical examination by an experienced neurologist.

Treatment of PD

Treatment of PD is still primarily medical and DBS is not the first option.

The most effective medicine is levodopa-carbidopa combination. If a patient does not respond to levodopa treatment, we should doubt the diagnosis (it may not be PD). Even though levodopa is the most effective medication, we should delay starting it by 2-3 years, to avoid side effects and lack of efficacy later on. Other medications in use are pramipexole, ropinirole, trihexiphenydyl, selegiline, rasagiline, amantadine, entacapone, safinamide, etc.

Role of Deep Brain Stimulation (DBS) surgery in PD

DBS was approved for PD in 2002. In the past 15 years, about 1,35,000 patients worldwide have undergone DBS for PD.

What does DBS surgery involve?

A neurosurgeon places the leads (thin wires) that carry electrical signals to specific areas of the brain. Then, the surgeon places a battery-run neurostimulator (like a pacemaker) under the skin of the chest.

The surgeon may use a programming device to adjust the settings. You may have a device, similar to a remote control, which allows you to turn the system on and off and check the battery. You may also be able to adjust the stimulation within options programmed by your doctor.

A neurologist initially evaluates a patient to determine whether he or she is the right candidate for DBS surgery. Then, further evaluations include brain imaging (MRI, CT, PET, etc), neuropsychological testing, UPDRS scoring, etc. Once the patient is found to be suitable for DBS, he is referred to the neurosurgeon.

Which patients are likely to benefit from DBS surgery?

1.     The diagnosis of PD should be definite.

2.     Patient has had PD for five years or more.

3.     Patient continues to respond to levodopa, even though the response may or may not be good.

4.     There are motor fluctuations, such as on-off phenomena, with or without dyskinesia.

5.     Various medical treatments have not had desired benefit.

6.     PD symptoms are severe enough to interfere with activities of daily living.

Which patients are NOT likely to benefit from DBS surgery?

1.     Patients with atypical Parkinsonian symptoms,

2.     Patients with multiple system atrophy (where bladder and sexual dysfunction are prominent symptoms),

3.     Patients with progressive supranuclear palsy,

4.     Patients with dementia or severe cognitive impairment,

5.     Patients with unstable psychiatric illnesses,

6.     Patients with advanced PD, who are confined to bed/wheelchair; despite being on medications,

7.     Patients with NO response to levodopa therapy,

Who are the best candidates for DBS surgery in PD?

1.     Excellent response to levodopa therapy,

2.     Younger age,

3.     Mild or no cognitive impairment,

4.     Few or no axial (affecting neck or trunk) motor symptoms,

5.     Absence of or well controlled psychiatric disease.

Are there any complications of DBS surgery?

DBS surgery is generally safe if performed by a trained group of specialists. However, complications may occur in upto 3% of patients, which include:

1.     Bleeding (hemorrhage) in the brain,

2.     Infection,

3.     Stroke,

4.     Speech impairment

5.     Erosion, migration or fracture of the lead,

6.     Death

What to expect after DBS surgery?

Most patients report a reduction in severity of symptoms after surgery. Tremors, dyskinesia, slowness all respond to the surgery.

PD medications, however, can not be stopped even after DBS. Most patients still need to take medications, however, at much lower doses.

The benefits are seen at five years after surgery, however, the effect tends to wane in later years.

DBS does not alter the disease progerssion, and disease continues to get worse even after DBS.

Is MRI safe after DBS?

Yes, MRI can be safely done after DBS surgery.

What is the cost of DBS surgery ?

The cost of surgery is approximately INR 9,00,000 to 10,00,000.

Dr Sudhir Kumar MD (Med) DM (Neuro)

Senior Consultant Neurologist

Apollo hospitals, Hyderabad

http://www.facebook.com/bestneurologist/

drsudhirkumar@yahoo.com

04023607777/60601066