New hope for patients of Parkinson disease

It is news that would gladden the hearts of the world’s most notable Parkinson disease (PD) sufferers – actor Michael J Fox and boxing champion Muhammad Ali.

Two weeks ago Deep Brain Stimulation (DBS) surgery was performed on a 71-year-old woman at Wockhardt Hospitals in Mumbai, providing much needed relief to the patient and her family members.

The elderly woman was suffering from Parkinson’s for the last 10 years. During the operation, an electrode was implanted in her brain to selectively inhibit a group of cells responsible for the symptoms.

Dr. Paresh Doshi, 43, who performed the crucial operation said, “Surgery should be considered in patients of Parkinson disease when they have uncontrolled tremors and have drug related side effects as seen in advanced Parkinson disease. It is also helpful for patients who have either left their jobs or who are at the risk of leaving their job due to the disease.”

According to Dr Doshi, though the selection of the right patient is extremely important there is no age limit to perform the surgery. He also points out that the surgery is safe and has virtually no side effects. In fact, the risks of complications are less than two per cent.

The elderly woman (name withheld) who underwent surgery is recovering well. “She suffered from severe hallucinations and altered sleep patterns as well as extreme stiffness of limbs. Now she has started walking. But the psychological impact of the disease is still there and it takes a while for the patient to adjust,” says Dr Doshi.

The patient is discharged from hospital ten days after surgery. The follow-up examination is conducted once in three months and then once at the end of the year. After that, once a year is enough. “I have overseas patients who have not come to me for the last 2-3 years and they are doing well,” informs Dr Doshi.

The post-operative care is minimal except that at airports, the patient needs to avoid the metal detectors as they have pace makers installed that sends current to the brain. The pace makers last for 5-6 years.

The surgery is still out of bounds for the common man because it costs around Rs 6.5 lakh inclusive of the implants.

Till date there is no cure found for Parkinsons. Blood samples and laboratory tests have failed to detect the disease. The diagnosis is almost purely based on medical history and neurological examination. Since the doctors don’t know what causes the disease, they are helpless in providing cure. “It’s like diabetes and hypertension. We still don’t have the cure for them,” laments the doctor.

As for the belief that the disease is caused because a parent might have it, the doctors believes that there are only 4 to 5 percent chances of such a possibility.

There is hope for those who have suffered very deeply from the disease. “We have even operated upon 10 doctors in the past. And they have all gone back to work. There is no permanent cure but the surgery controls the degeneration and the patient can perform normal functions majority of the time. However, they continue to remain highly dependent on their caretakers, as they cannot become fully normal,” according to the doctors.

The world is still looking for cure though it can at least be controlled now. “The cure could come from stem cell,” hopes Dr Doshi, who is the only Asian in the International Task Force for Movement Disorders Surgery.

The disease afflicts persons within the age of 50-70 years. But Dr Doshi says he knows of patients who are as young as 40-year-old, which is nearly 25 per cent of people who have fallen prey to the disease.

Once afflicted with this disease, the doctors cannot prevent it from progressing. In extreme cases, one has to go for expensive surgery. But the medicines are not life threatening. If medicines do not suit a patient, doctors can discontinue it and switch to another line of treatment.

Even abroad very few centres perform the surgery. Among the developed countries, England has around 50 centres but only six or seven have the facility to perform this surgery. France which has the most advanced centres, only one-fifth of neurosurgical centres have the expertise, informs Dr Doshi.

Explaining the reason for such a dismal picture Dr Doshi responds, “A doctor has got to be young, requires huge amount of dedication, patience and training. And there can be very few who will have that kind of time. The kind of care and adequate attention required in this disease is normally not needed in treating other ailments.”

Dr Doshi learnt about this surgery from Professor Benabid. Now he is confident that in India DBS has reached an advance level of precision.

“Three years ago even the Food and Drug Administration of the US gave its approval,” he claims.

Since 1998, Dr Doshi has taken up as many as 110 cases, which by now, seems to be the largest in the world. However in India, there are not too many centers performing DBS, just one or two in India namely in Trivandrum and Delhi.

In India, about 8-10 patients per 10,000 fall to prey to the disease. Among Parsis the number is 350. But now there is more awareness about the disease. In Mumbai, the doctor has encountered quite a large number of cases of Parkinsons.

The disease is characterised by lack of movement, tremors, unsteady gait and stiffness. The disease hits the central nervous system that often impairs the sufferer’s motor skills and speech.

Source:The Times Of India

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