BWI: BGS Global Hospitals Performs a Complex Deep Brain Stimulation Treatment on a 19 Year Old Iraqi Patient with Dystonia Caused by Bullet Injury to the Brain

Press release from Business Wire India
Source: BGS Global Hospitals
Wednesday, September 28, 2011 02:18 PM IST (08:48 AM GMT)
Editors: General: Consumer interest; Business: Healthcare, biotechnology & pharmaceutical; Healthcare
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BGS Global Hospitals Performs a Complex Deep Brain Stimulation Treatment on a 19 Year Old Iraqi Patient with Dystonia Caused by Bullet Injury to the Brain


Bangalore, Karnataka, India, Wednesday, September 28, 2011 -- (Business Wire India) -- -- Challenging surgery performed 17 years after suffering injury to the brain
-- It is a minimally invasive surgery that is reversible, adjustable and programmable to individual requirements
-- Expert team of Neurologists and Neurosurgeons performed this procedure successfully
-- Dystonia arising out of bullet injury to the brain very rare in the world

BGS Global Hospitals, Bangalore successfully performed a minimally invasive, reversible and adjustable surgery - Deep Brain Stimulation for dystonia (a movement disorder) in a 19 year old patient from Iraq, 17 years after he received a gunshot injury in his head.

The case

Bavel Fatih Mohammed, now 19 years hailing from As- Sulaymaniyah, Northern Iraq, suffered a gunshot injury in the head when he was two year old child.

The bullet pierced through the top left side of the head, and passed through the brain - the frontal cortex, thalamus - aqueduct - and came out from the right side of the back of the neck. He was then hospitalised for over two years in a local hospital and during this period he was comatose for around 7 months. Since then he has been left with significant disability affecting his activities of daily living especially the walking.

His condition when he arrived at BGS Global Hospitals

Bavel arrived at BGS Global Hospitals, Bangalore, 17 years after being injured by the bullet in his head.

He was noticed to have abnormal posturing of the body especially of the right upper and lower limb, his hand was bent backward, leg flexed and moved backward. He was walking mostly on the toes with the right foot and legs were crossing over each other affecting his body balance further.

In addition he was in pain due to spasms while walking and could take only a few steps with lot of difficulty. The movement of his right hand also further interfered with the use of left hand including eating. He could not use the right hand at all for any meaningful activity. He also had difficulty in opening both eyes.

Deep Brain Stimulation performed on patient

Bavel was diagnosed to be suffering from a movement disorder termed Seconday dystonia (Right hemidystonia). Dr. L. K. Prashanth, Consultant Neurologist and Movement Disorders Specialist, BGS Global Hospitals elaborated, "Deep Brain Stimulation technique performed for Bavel lasted over 8 hours and involved the following steps:

1. A stereotactic frame was fixed to the patient's head under local anaesthesia.

2. A specific part of the brain called Globus Pallidum was identified using CT and MRI. Using the frame fixed on the patient the neurosurgeon can determine X, Y, Z coordinates and hence pinpoint the exact location in the brain for electrode implanting by using a special software.

3. A small burr hole about one inch in diameter was made on the left side of the head and through this the DBS electrode was implanted in the left Globus pallidum interna after confirming the same through electrophysiological recordings. A test stimulation was performed in the operation theatre to ascertain that this is the best site.

4. A special DBS battery (impulse generator) was implanted in a pocket created below the collar bone. The battery was connected to the electrode on the brain by a connecting wire which was tunnelled underneath the skin. This procedure of connecting the battery is done under General anaesthesia as against the electrode implantation which is done under local anaesthesia.

Post operative Programming

The battery is used to stimulate the region of interest in the brain with different electrical voltages to get best clinical benefit. It is controlled through a hand held programmer. This programmer communicates with the battery to manage voltage and battery pulse width and frequency.

Dr. L. K. Prashanth added, "The electrode has 4 points to discharge current. With programming we identify the best contact to have good clinical benefits. The patient will be followed up regularly over the next 6 weeks and with periodic programming the final parameters will be fixed. In Bavel's case we have done about 70 % of the programming already."

Deep Brain Stimulation in this case - A difficult procedure

Dr. N. K. Venkataramana, Chief Neurosurgeon BGS Global Hospitals said, "The case is very challenging and difficult. We are treating the patient 17 years after brain injury and the cause of dystonia arising out of gunshot injury to the brain such as in this case is very rare in the world. Deep Brain Stimulation treatment is a challenging and time consuming procedure because we need to ascertain the exact position of the electrode through micro electrode recording of the brain. This treatment was however opted over an open surgery to avoid the risk of increased damage to the brain. It makes no lesion in the brain, it is a minimally invasive surgery that is reversible, adjustable and programmable to individual requirements."

Condition of Bavel now after the treatment

Dr. N. K. Venkataramana elaborated on Bavel's condition, "The improvement in Bavel's condition is now about 40 % in just twenty days after treatment. With complete programming and accrued benefits over time we expected him to achieve over 90% recovery.

-- His gait has improved
-- Standing ability improved. He can stand straight and firmly plant his right foot on the ground
-- He has better balance
-- He can walk comfortably. (He went for a two hour walk for the first time in his life a few days back)
-- He can climb up and down stairs
-- The right hand has become straighter, the odd backward movement being nearly corrected.
-- He can open his eyes better.

Bavel has a double vision when he opens his eyes fully. A corrective surgery required for this will be performed at a later date."

(He was in the hospital for 20 days and was discharged on 19th Sep 2011. The surgery was performed on 5th Sept 2011).

More about Dystonia

Dystonia is diverse movement disorder characterized by abnormal, involuntary muscle contractions, causing twisting and repetitive movements or abnormal postures. Dystonia is thought to occur due to disorganization in certain areas of brain (e.g., Basal ganglia) that is responsible for normal body movements. Abnormal signals are sent from the brain to the muscles, which cause simultaneous contractions of several muscles. When this happens it leads to abnormal and sometimes painful posturing of body parts. The primary dystonia's (genetically determined) frequency varies from 0.7 to 50 per 100,000 people. It is also common in communities where marriages occur in blood relations.

BGS Global Hospitals - Centre for Stereotaxy and Movement Disorders

Advanced Neuroscience Institute, BGS Global Hospitals has a Centre for Stereotaxy and Movement Disorders which offers a complete range of minimally invasive procedures. Stereotaxy is a specialised surgical technique to reach the deep seated areas of the brain with precision.

This offers both diagnostic and therapeutic options for brain tumours, cysts, blood clots, Parkinsons Disease, termers, pain and intractable epilepsy. BGS Global Hospitals is located at 67, Uttarahalli Road, Kengeri, Bangalore.

To view the photograph, please click on the link given below:

bgs global hospitals - Dr. L K Prashant and Dr. N. K. Venkataramana (centre) seen with Bavel
For picture(s)/data to illustrate this release click below:

http://www.BusinessWireIndia.com/attachments/Pic_1(496).JPG
Pic_1(496).JPG


CONTACT DETAILS
Sandhya Prasad, Deputy General Manager-Corporate Communications, BGS Global Hospitals, +91 9886656787, sandhya.global@gmail.com

KEYWORDS
CONSUMER, HEALTHCARE, HEALTHCARE

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