Deep brain stimulation

Dr Khondaker A Mamun writes about a method that can be a light of hope for patients suffering from Parkinson’s disease

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The human brain is a scientific wonder and a perplexing mystery at the same time. Even with amazing advancement of medical sciences, the level of knowledge about this vital organ is inadequate and scientists still don’t seem to have a good handle on neurological disorders that stem from it. Since the brain plays the role of the master controller of the whole human body, it is hardly surprising that the slightest amount of disorder occurring in it can have serious physical consequences. The commonly experienced neurological disorders span from migraines to strokes, dementia and Parkinson’s disease among others.

Among these, the Parkinson’s disease attracted great attention when Mohammad Ali, the greatest sports person of last century, suffered from it for a prolonged period of time. Well before that, this special kind of neurological disorder has been known to affect the lives of thousands.

Parkinson’s disease is a form of progressive movement disorder that has a wide range of debilitating effect on the patients including tremors, lack of balance and coordination to name a few. The root cause of this disease lies in the malfunction of neurons in a specific location of the brain. More than 10 million people worldwide are living with Parkinson’s disease. In Bangladesh, every year, approximately 1,600 patients die from this disease while many more suffering from it.

Currently there is no cure for Parkinson’s disease. Treatment of Parkinson’s disease is therefore mainly concerned with controlling the symptoms, which is initially achieved via medication. However, the most prevalent treatment, lepadova therapy, causes the patient to suffer from long term complications.

The next step is surgery. There are two options with regards to surgery. The first one is Lesion therapy. With recent advances in imaging technology and electrophysiological techniques, we can accurately identify and destroy target structures host to the disorder deep in the brain. The most advanced option now is Deep Brain Stimulation, where electrodes are placed deep inside the brain connected to an external device and used to stimulate the brain with an aim of stabilising its output.

Functionally, it is similar to a pacemaker that regulates electrical impulses for the heart. An electrode is placed surgically deep inside the brain around the Thalamus region. The electrode is connected to an external stimulator called Neuro-stimulator through an extension wire. The stimulator is placed under the skin around the shoulder and collarbone region. The electrical impulses from the stimulator are transmitted to the electrode that then distributes the impulses to diminish the electrical signals from the neurons to the target area giving rise to Parkinson’s disease symptoms.

In South Asia, Bangladesh in particular, DBS is still a relatively unexplored path. The complicated procedure means that sufficient skill training is required before a surgeon can attempt this procedure. This has caused a gap in the demand and supply dynamic, resulting in patients from Bangladesh going to Singapore or India to perform this procedure.

Fortunately, times are changing, and some of the most renowned people in the field of DBS are going to be in Bangladesh this September, to attend International Brain Research Organisation- Associate School of Translational Neuroscience and Research (IBRO-APRC Bangladesh) which will be organized at the United International University from September 23-27. IBRO, the premier organisation in the world for research on human brain, is the sponsor of this workshop, and participants have been chosen from the Asia Pacific region through a highly competitive selection process. Brain researchers will intermingle with surgeons, and academicians in order to form an interdisciplinary expert body, to jump start the DBS scene in Bangladesh. As a part of the workshop, world renowned neurosurgeon Professor Tipu Aziz of Oxford University, one of the top neurosurgeons for Lesion and DBS with more than 25 years of experiences, will interact with neurologists, neurosurgeons of Bangladesh at NINS, BSMMU and DMC to explain lesion and DBS.

Our health sector has already experienced many pioneering medical treatment innovations, and hopefully the transfer of knowledge from such luminaries will motivate the highly talented neurosurgeons and neurologists in Bangladesh to embrace and improve DBS techniques. With increasing life expectancy, the number of Parkinson’s disease patients is also increasing steadily. Success of this venture to bring cutting edge medical services to these patients will certainly be another defining moment in this sector.

The author is the director of AIMS Lab and associate professor at United International University