Patient gets new lease of life following deep brain stimulation implantation

A 46-year-old patient with abnormal movements (dystonia) affecting her eyes, face, jaw, and neck, got a new lease of life after undergoing Deep Brain Stimulation (DBS) implantation at Amrita Hospital.

This is the first time in Kerala that advanced brain sensing technology is used in DBS surgery, the hospital said.

DBS is a neurosurgical procedure that was first introduced in the US in 1987 and involves the implantation of a neuro-stimulator (brain pacemaker) in the patient's body which, through wires connected to the head, sends electrical impulses to specific areas in the brain.

The hospital said the patient was directed to its Movement Disorder Clinic and doctors suggested DBS.

''This technology allows capturing of brain signals from the implanted leads and can help in adjusting settings for the best response,'' the hospital said in a release.

The hospital said the Amrita Institute was the first centre in Kochi to start a regular DBS program in 2017 and the only one in India routinely doing robotics-assisted DBS surgery.

''The neurosurgical robotic assistant (ROSA) allows for more rapid guidance in the DBS electrode placement with high precision. With these latest advancements in DBS surgery, Amrita has become a leading international referral centre for DBS therapy,'' the release said.

Explaining the condition from which the patient was suffering, Dr Saraf Udit Umesh, an Assistant Professor with the Department of Neurology at Amrita Hospital, said dystonia is a movement disorder which is characterised by abnormal twisting movements of limbs, trunk or the whole body.

''It can occur due to different causes and in most cases, it is not very responsive to medical management. Botulinum toxin treatment is usually advised, but it has its own limitations. And hence, DBS is a good option for medically refractory dystonia,'' Umesh said.

He said life was very difficult for the patient as she was unable to even walk without any support.

''She was having the illness for almost five to six years. Initially, she only had neck pain, and even underwent a cervical spine surgery considering it as a spondylosis issue. However, her symptoms worsened gradually over the last one year and then she developed forceful eye closure and jaw closure, along with abnormal neck posturing,'' the doctor said.

The hospital said she was unable to open her eyes and had difficulty in chewing and difficulty in keeping her neck straight.

The surgery lasted for about three hours and the patient responded well within one week and now can lead a more normal life, the hospital said.

 

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All You Need to Know About Botox

Perhaps you have been considering Botox for some time and would like to know if it's safe, what the benefits are and how much it costs. More importantly, is it right for you? These are questions more than 7 million Americans who received Botox in 2017 had. The truth is that the effects of Botox can be very subtle.A  dermatologist says “My patients know they’re going to leave with a natural look." 

A good dermatologist takes the time to see how your face moves—and injects accordingly. In fact, the Dr. says “I’m observing the way you speak, laugh, frown—we go through all your emotions, so I know which muscles to inject and how much. And you should never feel pressured to get more than you’re comfortable with.” Another dermatologist confirms: “Over-treatment and improper placement are the two biggest causes of ‘bad Botox.’”
Of course, it is recommended that you start slow. A great place to start is to see an experienced dermatologist. But, if this is your first time you're considering Botox, you likely have more questions. So, before your first appointment, read on for everything you should know:
What is Botox? 
Botox is made from a protein called botulinum toxin which freezes your muscles. Dr. says “In simple terms, Botox binds to the receptors on the muscles, so that they don’t receive the signal to contract.” And as Dr.  puts it, “Botox essentially acts as a mute button between the nerve and muscle.”
This so-called mute button means you won't be able to make the movements associated with wrinkles between your eyebrows, crow's feet, and forehead lines. These three areas for cosmetic treatment are approved by the FDA. Dr. says “Botox won’t help with static wrinkles, the wrinkles that are there when you aren’t making an expression. The goal is to prevent dynamic wrinkles from becoming permanent static wrinkles.”
What are the benefits of Botox beyond reducing wrinkles?
Botox is also used to treat non-cosmetic issues like excessive sweating or eyelid twitching. Dr. says “Botox blocks the signal of the nerve telling the sweat gland to secrete sweat and relaxes the muscles around the eyes to help with twitching eyelids.”
But how did doctors come about this knowledge? Dr. notes that they did so through therapeutic observations. In addition to this, the muscle-relaxing effects also help to treat chronic migraines, overactive bladder, strabismus (crossed eyes), and maybe also depression. In fact, treatments that prevent frowning correlate with reduced negative mood, according to a study published.
Is Botox expensive, and how long does it last?
Prices vary depending on your provider. A Dr. charges patients around $150-$400 per area, such as the forehead, or around the eyes. As for what you can claim from your insurance? Botox isn't typically covered for cosmetic procedures. 
Once you've had your Botox procedure, it usually takes about five to 14 days to fully activate, and the results last anywhere from three to four months. 
Does Botox hurt?
Botox is an injection, so expect to feel a few quick pricks. If you really can't stand needles, ask your dermatologist to use numbing cream. Overall, the process is short and sweet and you can move on with your day, with just a little, mild redness. 

Is Botox safe? What are the side effects?

According to the FDA, there is a chance that the toxin can move beyond the site of injection, causing muscle weakness, double vision, urinary incontinence, and even difficulty breathing, swallowing or speaking. If any of these symptoms occur, seek medical attention ASAP, particularly in relation to swallowing and breathing difficulties which can be life-threatening. 
Still, severe side effects have never been definitively linked to dermatological use, where the doses are low. According to research conducted in this area, research shows adverse effects are more likely in therapeutic cases, where doses are much higher, and other diseases are also at play. 
According to Dr., “Botox is safe and efficacious as long as you’re in the hands of someone who’s licensed and trained.” Of course, as with any other drug, side effects are possible, albeit minor ones. Dr. says “Side effects are uncommon but include a headache, bruising, and a drooping brow or eyelid.” So, if you're one of the few people stuck with one of the latter, according to Dr., your doctor can prescribe eye drops to stimulate the eyelid muscle and raise the lid. “Or, if the brow is drooped, you can inject Botox into the muscles that pull the brow down to get some brow elevation.” This is a rare occurrence, but to be on the safe side, you can reduce your risk by seeing an experienced provider. 
So, the bottom line is that Botox is a popular treatment that comes with limited side effects when performed by an experienced dermatologist. It is not a painful treatment, and in total lasts for up to four months, however, in terms of cosmetic purposes, it is pricey.

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