Indian hospitals to offer low-cost neurosurgery in India

Neurosurgery in India is a very good option for abroad patients seeking low cost and safe surgical treatment for the correction of their disorders. Medical tourism in India provides very good assistance to international patients for their comfortable treatment in India. For neurosurgery, patients must find surgeons who are appropriately trained. Another factor to consider is cost and reimbursement. And finally, patients need to be aware that like any new medical technology, this surgery carries with it a certain level of unknown technical risks. SinceNeurosurgery  in india it is still a relatively new procedure in India with a certain level of risks. The cost of Neurosurgery in India is very less compared to that of its cost in other developed countries. Most advanced surgery hospitals for Neurosurgery  in India are in most prominent cities of India.

The large number of neurosurgeries in India enables Indian hospitals to offer low-cost neurosurgery in India. Further, cost of neurosurgery in India is amongst the lowest in the world.

The neurosurgeries performed at hospitals in India include the following

• ·         Surgery of the Skull Base
• ·         Micro Vascular Surgery
• ·         Brain Surgery for Epilepsy
• ·         Interventional Neuroradiology
• ·         Neurological Endoscopy
• ·         Non-Invasive Stereotactic Radiosurgery
• ·         Craniotomy
• ·         Surgery for DBS (Deep Brain Stimulation)
• ·         Spine Decompression Surgery
• ·         Spine Decompression with Fusion
• ·         Laminectomy
• ·         Spine Disc Replacement
• ·         Scoliosis Surgery
• ·         Endoscopic Discectomy
• ·         Spina Bifida

Neurosurgeons in India gravitate towards super specialisation in focus areas such as interventional neuroradiology, skull base surgeries, paediatric neurosurgery, etc. Unlike in the past when orthopaedic surgeons used to perform some spine surgeries, spine surgeries are now performed at leading hospitals in India exclusively by surgeons specially trained in spine surgery.

Success rates of Neurosurgery in India very often exceed international standards. Further, neurosurgery cost in India, is amongst the lowest in the world.

Cost of Neurosurgery in India

The cost of neurosurgery in India is truly economical. Some examples:

·         Neurosurgery cost in India for the removal of Pituitary Gland Tumour : Cost of Neurosurgery in India for the excision of pituitary tumour will involve an expenditure of US dollars three thousand to six thousand. The comparable cost of neurosurgery in the USA would be approximately 5 times as much.

·         Neurosurgery cost in India for Lumbar Spine Fusion: Cost of Neurosurgery in India for this procedure will be approximately US dollars 5000. The comparable cost of neurosurgery in the USA would be US dollars 20,000 at least

·         

Neurosurgery cost in India for spine decompression: Cost of Neurosurgery in India for this procedure would be between US dollars 6000; the cost of neurosurgery in the USA would be at least four times as much

Leading neurosurgery hospitals in India rank amongst the finest in the world. They combine the best of human resources in terms of highly qualified neurosurgeons, neurologists, interventional radiologists, interventional neuroradiologists and the best of material resources in terms of hospital infrastructure and medical equipment.

Why should you choose to get Neurology & Endovascular Neurosurgery in India?

Neurosurgery in India's top hospitals is extremely successful on account of the world class operation theatres and cutting edge technology that is available to neurosurgeons in India. For example:

·        

Indian doctors are known all over the world for their skill and knowledge and have the experience of studying and working at the best neuron surgery hospitals in the world.

·         Most advanced Technology Infrastructure - Blood Bank with 24 hour apharesis facility, advanced laboratory and microbiology (infection control) support, advanced cardiology, DSA and interventional radiology, portable and colour ultra-sonology, Liver Fibro-scan, 64 slice CT scanner, 3 T MRI, PET-CT and nephrology (including 24 hour dialysis and CVVHD).

·         Neurosurgery Hospitals in India are equipped with the latest and high end technology.

·         Cost of epilepsy surgery in India at best brain surgery hospitals in India is very low as compared to the cost at best hospitals in America or UK with the same level of care and services.

Treatment of brain and spine disorders are becoming less invasive with the advent of better imaging and interventional technologies. Interventional neuroradiologists in India now offer a wide range of minimally invasive neurosurgeries through angioplasty, placement of stents, treatment of vascular tumors, large aneurysm, embolization for resolution of arteriovenous malformations, etc

Rehabilitation care at hospitals for neurosurgery in India:

In the aftermath of complex neurosurgery, several patients will require intense physical and neuro rehabilitation. Leading hospitals for neurosurgery in Indiahave specialised equipment as well as rehabilitation specialists. Rehabilitation post neurosurgery is targeted in the following areas:

• ·        Functional Therapy
• ·         Mobility of Patients
• ·         Enhanced Movement Therapy
  
  
  
  

  
  

  
  

  
  

  
  

  
  

  For more information visit:          http://www.medworldindia.com      
                      https://www.facebook.com/medworld.india
  
  
  Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.
  
  
  Call Us : +91-9811058159
  Mail Us : care@medworldindia.com

Tips for Your Best Stroke Recovery : Rehabilitation is a crucial component of care following a stroke

Survivors have an increased risk for long-term disability and face challenges completing daily activities.

Rehabilitation is a crucial component of care following a stroke. At top stroke centers some form of rehabilitation begins virtually immediately after a patient is admitted to the hospital — to get them on the right path to the best possible outcomes.

However, there are several things patients can do to ensure they are maximizing their recovery starting the second they suspect a stroke. Here are 10 tips:

1. Seek urgent care immediately.

It is absolutely critical to seek emergent care when a stroke is suspected. Patients who arrive at the emergency department within 3 hours of their first symptoms tend to have less disability months after a stroke than those who received delayed care.  A stroke alert prompts a team of experts from our center to come to a patient’s bedside within minutes to confirm or rule out a stroke, allowing treatment and rehabilitation to begin as soon as possible.

If you’re worried about clogging the emergency room or just want to wait things out, you could be delaying life-saving care.

2. Keep your medical information handy.

A stroke can affect parts of the brain responsible for cognition and communication, leaving a patient unable to tell a doctor their medical history. That can be worrisome, because some stroke treatments can’t’ be given with other medications.

I urge people to carry with them a patient health profile that lists their medical conditions and any medications they’re taking. This piece of paper carried in your wallet might contain vital information that doctors can use to ensure you’re on your way to an optimal recovery.

3. Choose a top care center for your rehabilitation.

Whenever possible, you want a patient to be involved in acute inpatient rehabilitation following a stroke. Data suggest the more acute, intensive rehabilitation you get after a stroke, the better the outcomes.

4. Eat well.

A healthy and consistent diet is crucial when recovering from a stroke, from the hospital bed to your outpatient care at home.

One reason food choice is important is because patients in early stages of recovery may experience weakness or incoordination of the swallowing muscles. A care team might recommend soft foods or thicker liquids, because swallowing problems can lead to fluid aspiration which might lead to pneumonia.

Also, certain medications may interact with certain foods, so a rehabilitation specialist can direct you to the best choices.

5. Compliance is key.

I tell my patients if you don’t remember anything in the weeks you’ve been here as an inpatient, the one thing I want you to remember is to see your primary care doctor for regular follow-ups and checkups. Your primary care doctor is essential to your recovery from a stroke, and can make sure your medication needs and health issues are being attended to properly.

Some people may be in denial after a stroke and instead avoid their doctors. But poor compliance with physicians and medications may have got them into these health problems in the first place.

6. Exercise, but within your limits.

Safe levels of physical activity as prescribed by a physical or occupational therapist can go a long way when rehabilitating from a stroke.

What’s important though is you don’t overdo it. People may be excited by improvements in their ability to exercise, but falls are a very real risk following a stroke. That’s why it’s important to stick to your prescribed routine.

7. Limit stress.

I urge patients to keep their lives as stress-free as possible after a stroke. This is not meant to imply that leading a stressed life in some way contributed to their stroke in the first place, but keeping your life more balanced without undue psychological pressures is associated with better outcomes.

8. Stay positive.

It’s very common to have a negative attitude after a serious illness, and some patients experience depression after a stroke — sometimes weeks or months later. However, it is absolutely critical to keep a realistic or positive attitude during rehabilitation to maximize results. Psychologists, psychiatrists and other therapists, who are part of your care team, may recommend therapy and/or medication.

9. Do your homework.

For every stroke patient, treatment at a rehabilitation center eventually comes to an end. When you continue onto the outpatient setting, it is essential you do any homework — otherwise known as a home exercise program — assigned to you by one of your rehabilitation care specialists.

I can’t tell you how many times a patient comes back with a family member or partner to report they’re not getting better, only for a loved one to point out they’re not following their assignments.

It’s never fun to have a stroke or disabling illness, but even if it feels like it’s a grind, do whatever you can to stay up-to-date with your homework.

10. Stay vigilant.

Patients following a stroke face an increased risk of second stroke compared with the general population. Your brain helps you recover from a stroke by asking the unaffected brain regions to do double duty, which means a second stroke can cause far more dangerous effects.

If heaven forbid something gets worse again or you suspect you’re having another stroke, seek out medical attention immediately.

Brain Tumors That Cause Epilepsy : Best Neurosurgery Hospital in India

Brain Tumors That Cause Epilepsy

Some brain tumors can cause seizures over many years without causing any other symptoms. These tumors are generally very slow growing, benign tumors. The goals of surgery in such a situation are to cure both the epilepsy and the tumor. As it turns out, these goals have an extremely high likelihood of success.


Glial Tumors

Astrocytomas and oligodendrogliomas arise from cells in the brain called glia. These cells surround the neurons and support their metabolic and physiologic functions. Glial tumors come in two varieties, fast-growing and slow-growing.

Fast-growing glial tumors often come to the patient's attention because of a neurological symptom, such as weakness or loss of vision. This type of tumor may also cause seizures, but because of the onset of the neurological symptoms, the tumor is generally discovered early on, perhaps after only one or two seizures. Faster-growing tumors, called anaplastic astrocytomas or glioblastomas, often come back after surgery.

Patients who have had multiple seizures for 3 years or more generally have the slow-growing type of tumor. Slow-growing glial tumors represent as many as 70% of tumors that cause epilepsy in the general population. These tumors are more common in adults with epilepsy; they may not be seen on a CT scan if the tumor is very small. Experience has shown that a complete surgical removal of these tumors can lead to excellent seizure control with a good chance of a cure. As a rule, the longer the patient has had seizures, the slower the growth rate of the tumor, and the greater the chance for a cure. Depending on the type of surgery performed, as many as 80-90% of patients stop having seizures after surgery. A recurrence of seizures, even many years after the surgery, may indicate a re-growth of the tumor. For this reason, patients with glial tumors should have an MRI scan on a yearly basis to ensure that their tumor has not returned.

Glioneuronal tumors

Gangliogliomas and dysembryoplastic neuroepithelial tumors (DNT) are tumors composed of a combination of glial cells and neuronal cells. They are more common in children and are often found in the temporal lobe of the brain. The most common symptom of these tumors is partial seizures, which are often present for several years before the diagnosis is made. These tumors may not appear on CT scan, which contributes to the delay in diagnosis. Gangliogliomas and DNTs are extremely benign tumors and are generally cured with surgery. As opposed to the glial tumors described above, the goal of surgery for glioneuronal tumors is predominantly seizure-control. These tumors are often located next to areas of cortical dysplasia (areas of the brain's cortex that contain tissue abnormalities). Cortical dysplasia occurs as a result of abnormal neuronal development that can cause hyperexcitability in a population of neurons. This area of hyperexcitable neurons is the site of origin of the adjacent seizures. Surgery that removes the tumor tissue but not the adjacent areas of abnormal cortical tissue may not cure the seizures. For this reason, the surgical treatment of epilepsy caused by presumed glioneuronal tumors often requires the use of a technique called electrocorticography.

Electrocorticography
Epileptic seizures in patients with brain tumors do not originate in the tumors themselves, but from the area of the brain next to the tumor. Electrocorticography, or ECoG, is currently the most sensitive method for localizing the area in the brain where the epilepsy starts. This technique must be performed by a neurosurgeon, preferably an epilepsy surgeon. A grid or strip of electrodes is placed on the surface of the brain. Occasionally, a depth electrode can also be placed deep into the brain to record from structures that are difficult to reach with grids and strips. Electrical recordings are then made directly from the brain in the operating room. The surgeon can also leave the electrodes in contact with the brain and thereby monitor the patient for several days in the hospital until a few seizures occur. The recordings are interpreted by a neurologist with the knowledge and experience in distinguishing between normal and abnormal cortical activity.

The use of ECoG in the treatment of low-grade tumors that cause epilepsy is controversial. Some surgeons do not feel that ECoG is necessary to treat epilepsy caused by tumors. It has been demonstrated that removal of the tumor without EcoG guidance can cure epilepsy in as many as 60% of patients. There is mounting evidence, however, that the use of ECoG may help the surgeon cure as many as 80-90% of patients. ECoG allows the surgeon to identify the site of onset of the epilepsy, usually adjacent to the tumor, and remove this area as well. These areas of brain that initiate epilepsy can be normal tissue or, as in glioneuronal tumors, may be areas of cortical dysplasia. Extensive 'mapping' of the brain may also be performed in order to ensure that these epilepsy-producing areas of the brain are not important for other functions such as movement, language, or memory.


Tumors Located in the Temporal Lobe

The temporal lobe is a unique part of the brain. Structures called the "hippocampus" and "amygdala" on one side of the temporal lobe, are important for memory and emotion while structures on the other side, called the "neocortex, are important for language. For reasons that are not well-understood, the hippocampus and amygdala have a very high likelihood of producing seizures, even if the tumor is not contained in these structures. In many circumstances, the greatest chance of curing the seizures will require removal of the hippocampus and amygdala in addition to the tumor. This is a controversial idea since the hippocampus and amygdala may appear to be normal. For this reason, epilepsy doctors have tried to identify which patients would be helped the most if the hippocampus and amygdala were removed.

Probably the most important factor in making the decision to remove these tissues is whether the hippocampus is working and how its removal would affect the patient. This decision requires the aid of a neuropsychologist who can perform a number of psychological tests, including a Wada test. The Wada test uses a drug to put the hippocampus 'to sleep' for a few minutes to simulate the effects of the proposed surgery and thereby helps to predict the effect of the surgery on the patient. It appears that if someone has had seizures for many years, has had seizures since a very young age, has a tumor located very close to the hippocampus, or has evidence that the hippocampus is not functioning, the chance of curing seizures with surgery is much greater if the hippocampus and amygdala are removed in addition to the tumor. Microscopic analysis of the tissue removed at surgery under the above-mentioned circumstances often shows that the hippocampus is, in fact, abnormal.


Closing Thoughts

Tumors that cause epilepsy are some of the most benign tumors found in the brain. The majority can be cured with surgery. In addition, epilepsy caused by tumors has the highest rate of cure after surgery, assuming the proper procedure is performed with ECoG, neuropsychological testing, Wada testing and stimulation mapping. In some cases of temporal lobe epilepsy, removal of the hippocampus may be necessary. For this reason, patients with epilepsy who learn that they may have a brain tumor must realize that this is not necessarily bad news. The prognosis is generally excellent.

Different Types of Surgery for Parkinson's disease - Parkinson's Disease Surgery in India

Surgery

Surgical procedures are recommended for specific patients with advanced Parkinson’s disease who no longer respond to drug treatments. Surgical treatment cannot cure Parkinson's disease, but it may help control symptoms such as motor fluctuations and dyskinesia. Pallidotomy and thalamotomy are older procedures that destroy tissue in certain parts of the brain. Deep brain stimulation, the current standard surgical practice for Parkinson’s disease, has largely replaced the older operations.

DEEP BRAIN STIMULATION

In deep brain stimulation (DBS), also called neurostimulation, an electric pulse generator controls symptoms. The generator is similar to a heart pacemaker. It sends electrical pulses to specific regions of the brain. Candidates for surgery are generally patients who have responded well to levodopa drug treatment. Patients who have had PD for fewer than 16 years may experience greater benefit from DBS than patients who have had the disease longer.

Evidence indicates that DBS improves motor function and reduces dyskinesia best when the procedure targets the subthalamic nucleus (STN) of the brain. Many studies demonstrate the effectiveness of STN stimulation. Procedures that target the globus pallidus interna or ventral intermediate nucleus of the thalamus can also sometimes treat rigidity and tremors. However, there is not yet enough evidence to support stimulation of these parts of the brain.

The procedure is performed as follows:

• The surgeon implants a tiny pulse generator near the collarbone, which is connected to four electrodes that have been implanted in the target area in the brain.
• The generator delivers programmed pulses to this area, which the patient can turn on and off using a magnet held over the skin.
• When on, the pulses suppress symptoms. Complications occur in 2 - 4% of operations. The most serious ones are bleeding in the brain and infection. Depression is common.

When compared to drug therapy, many patients who receive DBS show better improvement in symptoms and quality of life. However, patients who receive neurostimulation may have more serious side effects than those who are treated only with medications. These side effects include infection at the surgical site and nervous system, psychiatric, and heart disorders. Researchers are also studying whether DBS can benefit patients with earlier-stage Parkinson's disease.

PALLIDOTOMY AND THALAMOTOMY

Pallidotomy and thalamotomy are surgical procedures that destroy brain tissue in regions of the brain associated with Parkinson’s symptoms, such as dyskinesia, rigidity, and tremor. In these procedures, a surgeon drills a small hole in the patient’s skull and inserts an electrode to destroy brain tissue. Pallidotomy targets the global pallidus area. Thalamotomy targets the thalamus. Because these procedures permanently eliminate brain tissue, most doctors now recommend deep brain stimulation instead of pallidotomy or thalamotomy.

Surgical complications may include behavioral or personality changes, trouble speaking and swallowing, facial paralysis, and vision problems. Weight gain after surgery is also common.

STEM CELL IMPLANTATION

Scientists are investigating whether stem cells may eventually help treat Parkinson disease. Experimental surgery has shown promise using fetal brain cells rich in dopamine implanted in the substantia nigra area of the brain. Because the use of embryonic stem cells is controversial, researchers are studying alternative types of cells, including stem cells from adult brains and cells from human placentas or umbilical cords. All of this research is still preliminary.

What causes Epilepsy? - Low Cost Epilepsy Treatment in India

What causes epilepsy?

Causes of epilepsy vary by age of the person. Some people with no clear cause of epilepsy may have a genetic cause. But what's true for every age is that the cause is unknown for about half of everyone with epilepsy.

• Some people with no known cause of epilepsy may have a genetic form of epilepsy. One or more genes may cause the epilepsy or epilepsy may be caused by the way some genes work in the brain. The relationship between genes and seizures can be very complex and genetic testing is not available yet for many forms of epilepsy. 
• About 3 out of 10 people have a change in the structure of their brains that causes the electrical storms of seizures.
• Some young children may be born with a structural change in an area of the brain that gives rise to seizures. 
• About 3 out of 10 children with autism spectrum disorder may also have seizures. The exact cause and relationship is still not clear. 
• Infections of the brain are also common causes of epilepsy. The initial infections are treated with medication, but the infection can leave scarring on the brain that causes seizures at a later time. 
• People of all ages can have head injuries, though severe head injuries happen most often in young adults.
• In middle age, strokes, tumors and injuries are more frequent.
• In people over 65, stroke is the most common cause of new onset seizures. Other conditions such as Alzheimer’s disease or other conditions that affect brain function can also cause seizures.

Common causes of seizures by age:

In Newborns: 

• Brain malformations
• Lack of oxygen during birth
• Low levels of blood sugar, blood calcium, blookd magnesium or other eletrolyte disturbances
• Inborn errors of metabolism
• Intercranial hemorrage
• Maternal drug use 

In Infants and Children: 

• Fever (febrile seizures)
• Brain tumor (rarely)
• Infections

In Children and Adults:

• Congenital conditions (Down's syndrome; Angelman's syndrome; tuberous sclerosis and neurofibromatosis)
• Genetic factors
• Progressive brain disease (rare)
• Head trauma

In Seniors:

• Stroke
• Alzheimer's disease
• Trauma
  
  
  When a disorder is defined by a characteristic group of features that usually occur together, it is called a syndrome. These features may include symptoms, which are problems that the patient will notice. They also may include signs, which are things that the doctor will find during the examination or with laboratory tests. Doctors and other health care professionals often use syndromes to describe a person's epilepsy.
  Epilepsy syndromes are defined by a cluster of features. These features may include:
  • The type or types of seizures
  • The age at which the seizures begin
  • The causes of the seizures
  • Whether the seizures are inherited
  • The part of the brain involved
  • Factors that provoke seizures
  • How severe and how frequent the seizures are
  • A pattern of seizures by time of day
  • Certain patterns on the EEG, during and between seizures
  • Brain imaging findings, for example, MRI or CT scan
  • Genetic information
  • Other disorders in addition to seizures
  • The prospects for recovery or worsening
  
  
  Not every syndrome will be defined by all these features, but most syndromes will be defined by a number of them. Classifying a person's epilepsy as belonging to a certain syndrome often provides information on what medications or other treatments will be most helpful. It also may help the doctor to predict whether the seizures will go into remission (lessen or disappear).
  
  
  
  

Epilepsy in Children - Best NeuroSurgery Hospitals in India

Epilepsy is a type of brain disorder which leads to a sudden change in how the brain works. It can cause people to have repeated (several or many) seizures called epileptic fits (convulsions), for short periods of time. The seizures happen because there is an uncontrollable electrical discharge from the nerve cells in the brain. This may create a short term disturbance in the way the brain works and cause odd sensations and abnormal movement or behaviour.

Epiliptic seizures are not usually dangerous. But, a person can be at risk if they are in a dangerous environment (eg swimming in a pool or beach, driving a car), or if they become unconscious. Injuries can happen at school, at work, at home or other places.

One child in every 20 will have a seizure during their childhood, often with a high temperature (febrile convulsion). This is not epilepsy. Most children who have febrile convulsions do not go on to have epilepsy. Only about one in 200 children have epilepsy.

Children with epilepsy can usually lead a normal and active life but will need to take be careful with certain activities.

It is important to know what to do and how to help your child if they have a seizure.

Signs and symptoms

The symptoms of the seizure depend on what parts of the brain are affected. What happens during a seizure lets doctors know what parts of the brain are involved.

Signs and symptoms may include:

• Sensory disturbances - is when you/your child experiences tingling, numbness, changes to what you/your child sees, hears or smells, or unusual feelings that may be hard to describe.
• Abnormal body movements - limp, stiff or jerking movements that may come with loss of consciousness and shallow or jerky breathing
• Abnormal behaviour - is when you/your child may be confused or have automatic movements such as picking at clothing, chewing and swallowing or appearing afraid
• All of the above

Types of seizures

There are many different types of seizures and they can be generally classified into two groups:

Focal seizures

Focal seizures happen when the seizure activity begins in only one part of the brain. It usually affects one side of the body and you/your child may or may not lose consciousness.

These include:

• Simple partial seizures
• Complex partial seizures

Generalised seizures

Generalised seizures happen when the seizure activity begins all over the brain. The person's conscious state is always affected.

These include:

• Tonic-clonic seizures, sometimes called 'grand mal' or major seizures.
• Absence seizures, sometimes called 'petit mal' or starring seizures.
• Myoclonic, atonic and tonic seizures.

Diagnosis of epilepsy

It is important that your/your child's epilepsy is correctly diagnosed and treated by a children's doctor (paediatrician) or a doctor who specialises in childhood disorders of the brain (paediatric neurologist). To diagnose epilepsy the doctor will need a very detailed description of your child's seizures, medical history, development, learning and behaviour. A home video recording of your child's seizures is very helpful if they happen often or are predictable.

Tests

Special test are needed in some children with epilepsy. Your child's doctor will talk to you about the following tests if they are needed.

• Blood tests:to check your child's sugar, calcium, magnesium and salt levels.
• EEG:is a recording of brainwave activity. (More information on EEG factsheet).      
• CT or MRI:gives us pictures of the brain. (More information on MRI or CT factsheets).
• Video EEG monitoring:detailed EEG done in hospital. (More information on Video EEG monitoring factsheet).

What causes epilepsy in children?

Many different disorders of the brain may be associated with epilepsy.

For some patients the epileptic disorder is congenital, that is, the child is born with the predisposition to have epilepsy. In other patients, the epileptic disorder is acquired, as a result of brain damage that occurred after birth.

The congenital epilepsies could be the result of the child having a gene that is responsible for the epileptic disorder; these are the genetic types of epilepsy. Alternatively, congenital epilepsy may be the result of factors that interfere with the development of the brain during gestation, resulting in brain malformations.

In acquired epileptic disorders, the damage might occur at the time of birth, for example the case of newborns that have oxygen deprivation during labor and delivery; or intracranial bleeding, as seen in some children born prematurely. Also, the brain damage may occur any time after birth. For example, epilepsy could be a complication of infections in the brain (meningitis, encephalitis), head injuries with brain damage, brain tumors, or intracranial bleeding.

Are seizures bad for children?

Presently there is no indication that short-lasting seizures will result in any brain damage. However, prolonged seizures, especially generalized tonic-clonic seizures, in some cases could result in brain damage, but this is very unusual.

Although brain damage is not likely, children can be injured at the time of the seizures. For example, in the atonic seizures there is a sudden loss of muscle power and, if this happens when the patient is standing, it is followed by a fall that might result in injuries to the face and/or mouth. Similar types of physical injuries can happen with other seizures.

For more information visit:          http://www.medworldindia.com     
                    https://www.facebook.com/medworld.india

Please scan and email your medical reports  to us at care@medworldindia.com and we shall get you a Free Medical Opinion from India’s Best Doctors.

Call Us : +91-9811058159

Mail Us : care@medworldindia.com

What are the benefits of DBS surgery? - Best Neurosurgery Hospital in India

When should one consider surgical therapy? 
 
For patients with early Parkinson's disease, levodopa (sinemet) and other antiparkinsonian medications are usually effective for maintaining a good quality of life. As the disorder progresses, however, medications can produce disabling side effects. Many patients on long-term levodopa develop troublesome dyskinesias, excessive movements that often cause the limbs and body to writhe or jump. In addition, their dose of levodopa no longer lasts as long as it once did. This may lead to "on-off fluctuations," a condition in which the ability to move changes unpredictably between a mobile ("on"), state when medication seem to work, and an immobile ("off") state in which little effect of medication is apparent and normal movement is very difficult. When patients no longer have an acceptable quality of life due to these shortcomings of medical therapy, surgical treatment should be considered. 
 
What are the different types of surgery for Parkinson's disease? 
 
There are several different types of surgery for Parkinson's disease. The first surgical procedures developed were the ablative, or brain lesioning, procedures. Examples of lesioning surgery include thalamotomy and pallidotomy. Lesioning surgery involves the precisely controlled destruction, using a heat probe, of a small region of brain tissue that is abnormally active. It produces a permanent effect on the brain. In general, it is not safe to perform lesioning on both sides of the brain. 
 
We continue to perform some lesioning surgeries for patients who desire it, although in our practice lesioning has been largely replaced by deep brain stimulation (DBS). DBS surgery involves placing a thin metal electrode (about the diameter of a piece of spaghetti) into one of several possible brain targets and attaching it to a computerized pulse generator, which is implanted under the skin in the chest (much like a heart pacemaker). All parts of the stimulator system are internal; there are no wires coming out through the skin. To achieve maximal relief of symptoms, the stimulation can be adjusted during a routine office visit by a physician or nurse using a programming computer held next to the skin over the pulse generator. Unlike lesioning, DBS does not destroy brain tissue. Instead, it reversibly alters the abnormal function of the brain tissue in the region of the stimulating electrode.

 
Many patients inquire about the "restorative" therapies, a category of procedures which includes transplantation of fetal cells or stem cells, growth factor infusion, or gene therapy. These procedures attempt to correct the basic chemical defect of Parkinson's disease by increasing the production of dopamine in the brain. In the future, restorative therapies will hopefully emerge as effective and possibly curative interventions for Parkinson's disease. Growth factor therapy for Parkinson’s disease

 
What are the possible brain targets for DBS?
 
There are now four possible target sites in the brain that may be selected for placement of stimulating electrodes: the internal segment of the globus pallidus (GPi), the subthalamic nucleus (STN), the pedunculopontine nucleus (PPN), and a subdivision of the thalamus referred to as Vim (ventro-intermediate nucleus). These structures are small clusters of nerve cells that play critical roles in the control of movement. Thalamic (Vim) stimulation is only effective for tremor, not for the other symptoms of PD. Stimulation of the globus pallidus or subthalamic nucleus, in contrast, may benefit not only tremor but also other parkinsonian symptoms such as rigidity (muscle stiffness), bradykinesia (slow movement), gait problems, and dyskinesias 

How does DBS work? 
 
The theoretical basis for DBS of the GPi or STN in PD was worked out in the late 1980's and early 1990's. In Parkinson's disease, loss of dopamine-producing cells leads to excessive and abnormally patterned activity in both the GPi and the STN. "Pacing" of these nuclei with a constant, steady-frequency electrical pulse corrects this excessive and abnormal activity. DBS does not act directly on dopamine producing cells and does not affect brain dopamine levels. Instead, it compensates for one of the major secondary effects of dopamine loss, the excessive and abnormally patterned electrical discharge in the GPi or the STN. The exact mechanism by which the constant frequency stimulation pulse affects nearby brain cells has not been determined. 
 
How is the surgery performed?
 
There are several available surgical methods. In the most common method, implantation of the brain electrode is performed with the patient awake, using only local anesthetic and occasional sedation. The basic surgical method is called stereotaxis, a method useful for approaching deep brain targets though a small skull opening. For stereotactic surgery, a rigid frame is attached to the patient's head just before surgery, after the skin is anesthetized with local anesthetic. A brain imaging study (MRI or CT) is obtained with the frame in place. The images of the brain and frame are used to calculate the position of the desired brain target and guide instruments to that target with minimal trauma to the brain. After frame placement, MRI/CT, and calculation of the target coordinates on a computer, the patient is taken to the operating room. At that point an intravenous sedative is given, a Foley catheter is placed in the bladder, the stereotactic frame is rigidly fixed to the operating table, a patch of hair on top of the head is shaved, and the scalp is washed. After giving local anesthetic to the scalp to make it completely numb, an incision is made on top of the head behind the hairline and a small opening (1.5 centimeters, about the size of a nickel) is made in the skull. At this point, all intravenous sedatives are turned off so that the patient becomes fully awake. 
 
To maximize the precision of the surgery, we employ a "brain mapping" procedure in which fine microelectrodes are used to record brain cell activity in the region of the intended target to confirm that it is correct, or to make very fine adjustments of 1 or 2 millimeters in the intended brain target if the initial target is not exactly correct. The brain mapping produces no sensation for the patients, but the patient must be calm, cooperative, and silent during the mapping or else the procedure must be stopped. The brain's electrical signals are played on an audio monitor so that the surgical team can hear the signals and assess their pattern. The electronic equipment is fairly noisy, and the members of the surgical team often discuss the signals being obtained so as to be sure to interpret them correctly. Since each person's brain is different, the time it takes for the mapping varies from about 30 minutes to up to 2 hours for each side of the brain. The neurological status of the patient (such as strength, vision, and improvement of motor function) is monitored frequently during the operation, by the surgeon or by the neurologist. 
 
When the correct target site is confirmed with the microelectrode, the permanent DBS electrode is inserted and tested for about 20 minutes. The testing does not focus on relief of parkinsonian signs but rather on unwanted stimulation-induced side effects. This is because the beneficial effects of stimulation may take hours or days to develop, whereas any unwanted effects will be present immediately. For the testing, we deliberately turn the device up to a higher intensity than is normally used, in order to deliberately produce unwanted stimulation-induced side effects (such as tingling in the arm or leg, difficulty speaking, a pulling sensation in the tongue or face, or flashing lights). The sensations produced at high intensities of stimulation during this testing are experienced as strange but not painful. We thus confirm that the stimulation intensity needed to produce such effects is higher than the intensity normally used during long-term function of the device. 
 
Once the permanent DBS electrode is inserted and tested, intravenous sedation is resumed to make the patient sleepy, the electrode is anchored to the skull with a plastic cap, and the scalp is closed with sutures. The stereotactic headframe is removed. The patient then receives a general anesthetic to be completely asleep for the placement of the pulse generator in the chest and the tunneling of the connector wire between the brain electrode and the pulse generator unit. This part of the procedure takes about 40 minutes. . 
 
 
Why must patients be awake for part of DBS surgery? 
 
Using the standard, microelectrode guided technique for DBS surgery, brain mapping is performed using microelectrodes. The brain mapping procedure is much harder to do if the patient is under a general anesthetic or strong sedative. In addition, the procedure is safer if the patient's neurological function (speech and voluntary movement) can be checked periodically during the procedure, which is only possible in an awake patient. For patients undergoing surgery in our investigational interventional MRI protocol, general anesthesia is used for the whole procedure, as the MR images take the place of electrical mapping and monitoring of neurological function. 
  
What are the benefits of DBS surgery? 
 
The major benefit of DBS surgery for PD is that it makes movement in the off-medication state more like the movement in the on-medication state. In addition, it reduces levodopa-induced dyskinesias, either by a direct suppressive effect or indirectly by allowing some reduction in medication dose. Thus, the procedure is most beneficial for Parkinson's patients who cycle between states of immobility ("off" state) and states of better mobility ("on" state). DBS smoothes out these fluctuations so that there is better function during more of the day. Any symptom that can improve with levodopa (slowness, stiffness, tremor, gait disorder) can also improve with DBS. Symptoms that do not respond at all to levodopa usually do not improve significantly with DBS. Following DBS, there may be a reduction, but not elimination, of anti-Parkinsonian medications. At present, we believe that DBS only suppresses symptoms and does not alter the underlying progression of Parkinson's disease