Deep Brain Stimulation therapy offers hope for those unresponsive to medication
Epilepsy has long been a neurological condition in which the person afflicted has been looked upon in a different light. Long back when medical research was in its infancy, epileptic seizures were looked as demonic possession. As it later emerged, epilepsy is caused by sudden surges in the electrical signals in the brain. Epilepsy happens to be the fourth most common disorder which affects people of all ages. Characterized by unpredictable seizures, epilepsy seizures manifests itself with varying intensity and types among people.
Asha, 23, has been living with epilepsy for the past 4 years and feels insecure to venture out to parties late in the night. Even her parents are worried to send her unaccompanied to educational tours or even to a friend’s place. Diagnosed when she was in her second year of Mass Media Graduate program, she missed an exam due to violent seizures. “We saw Asha’s personality withering right in front of us. She transformed from a happy-go-lucky girl to being extremely careful and under confident. She even fared badly in her campus interviews”, says a disheartened Mercy Agnes, Asha’s mother. The seizures may result due to hereditary tendency, brain injury,
congenital brain injury, brain tumours among many but mostly it is unexplained. Many a times, the condition is termed as seizure disorders as the epilepsy sounds foreboding and being diagnosed as
epilepsy is stigmatized .
Asha was put on antiepileptic medication almost immediately considering she was just a student However, she faced serious problems after consuming the medications. Despite multiple medicines, she continues to have seizures on a regular basis. On another occasion, her mother says, “She started complaining of stomach ache and dizziness almost every day. Considering it was a part of the treatment, we ignored it. Then she contracted malaria and had to be hospitalized”. Upon investigation it was revealed that Asha’s white blood cell count had drastically reduced which made her susceptible to infection and delayed recovery. Asha’s doctor immediately stopped her medication and her condition improved .
Dr. Aditya Gupta, Head of Functional Neurosurgery with Medanta hospital says, “Some of the antiepileptic drugs are associated with certain level of toxicity and adverse reactions are often encountered. Since seizure medications lower excitability of nerve cells in the brain, it can also affect the normal brain activity. Cognitive functions like thinking, memory and attention span are likely to be affected when multiple antiepilepsy drugs are used” .
When her doctor introduced deep brain stimulation as a solution, they gave it serious thought. The medications on one hand were toxic, and on the other, were not making her free from seizures. Their confidence was boosted when Asha was free of epileptic fits six months after the surgery. It has been a year now and Asha leads a normal life.
Talking of this novel surgery, Dr Aditya Gupta of Medanta hospital says, “Those who have not gained control of seizures with multiple medications, and are not suitable for the usual kind of epilepsy surgery wherein the seizure focus is removed from the brain, have tremendous hope of a normal life with deep brain stimulation surgery. With stellar success rates in UK and US, many can benefit from this highly effective and safe treatment option”.
Deep Brain Stimulation (DBS) therapy involves placing electrodes in the anterior thalamus of the brain. These electrodes block the pathway of signals that causes epileptic seizures in hands and feet. DBS surgery involves fitting a DBS system in the brain which has mainly three parts:
A lead – It is a thin, insulated wire which is inserted through a small opening in the skull, and placed in the part of brain where the epileptic activity happens.
An extension – it is an insulated wire that passes under the skin of the head, neck, and shoulder, and connects the lead to the neuro-stimulator.
A neuro-stimulator/pulse generator – It is a small device, similar to a heart pacemaker and is usually placed under the skin near the collarbone. It contains a small battery and computer chip programmed to send electrical pulses to control symptoms. Depending on use, the stimulators may last three to five years and their replacement procedure is relatively simple. An MRI or CT scan is done before the surgery to guide the placement of electrodes. The doctor then places the DBS system in that part of the brain. Once in place, electrical impulses are transmitted from the neuro-stimulator, along the extension wire and lead to stimulate the part of the brain.
Dr Aditya Gupta adds, “DBS surgery is a safe and highly effective therapy which has benefitted all my patients that were chosen for this modality. The awareness regarding this new procedure in india is very poor. Novel treatment modalities are now available to
improve an epilepsy patient’s quality of life and must be explored”.
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