Movement disorders clinic provides a comprehensive care to the patients including Medical assessment, Patient counselling and therapy, Caregiver counselling, Botulinum toxin clinic, Surgical Therapy
Movement disorders clinic provides a comprehensive care to the patients including
A comprehensive medical, especially towards the neurological assessment is provided to every patient. The goal is to assess comprehensively various medical issues and formulation of therapeutic goals.
All patients would be counselled on the disease process, outcome and management. They would be advised on appropriate medical or supportive therapies.
As most of the movement disorders have a long duration course, caregiver’s understanding and support forms an important crux in the management. Specific counselling of caregiver about the disease process and expectations would be addressed.
Various movement disorder patients who require botulinum toxin therapy would be counselled and provided with the botulinum toxin injections to have a better outcome of the symptoms. Botulinum toxin is a neurotoxin that is extracted from a bacterium under laboratory conditions. It can be used in small doses for treating stiff and abnormally active muscles in various neurological diseases. Botulinum toxin relaxes muscles by blocking the nerve signals to the muscle fibres around the injection site. The toxin usually starts working a few days after the injections, and the effect can last between three and 12 months.
It is given by injection into the specific muscle(s) being treated. The muscles to be injected will be identified by palpation and using Electromyographic machine. There are various neurological disorders where botulinum toxin injections are used. They may include Dystonia, Facial spasms, Eye spasms, Spasticity to name few. Commercially, Botulinum toxin is available under various names which include Botox, Dysport, Xeomin etc. Botulinum toxin injections are given as a day care procedure. You are fit to return back to your usual schedule soon following the injections.
Patients with various movement disorders, resistant to medical drug therapies would be assessed for possible surgical therapy benefits and managed thereafter. Various surgical therapies offered include lesionectomies and Deep brain stimulation (DBS). Deep brain stimulation (DBS) is more specifically offered to patients who have either moderately advanced Parkinson’s disease, severe dystonia or disabling tremors. Patients who are considered for Deep brain stimulation would be assessed completely for surgical fitness and benefits. All the patients would be comprehensively managed in the post-operative period for optimal programming and long term care.
Deep brain stimulation involves implantation of neurostimulatior, similar to cardiac pacemaker, called as internal pulse generator (IPG), to deliver electrical stimulation to precisely targeted structures of the brain. This stimulation works like a sort of ‘brain pacemaker’ which interferes with the signals that cause disabling movements, and hence reducing abnormal body movements. This electrical stimulation is delivered through a lead or electrode, which is connected to a battery implanted underneath the chest. Through this modulation the amount of benefits can be modified to optimize patient’s needs, hence technically becoming an surgery in which benefits can be changed over time. This surgery is also considered as ‘reversible’ surgery as it can be turned OFF.
Deep Brain Stimulation, also known as DBS, is the most advanced and effective surgical treatment available to help people suffering from Parkinson’s disease, Essential Tremor and Dystonia. While there is no known cure for these neurological conditions, DBS can significantly reduce symptoms and improve a person’s quality of life.
DBS uses a surgically implanted device, similar to a cardiac pacemaker, called an internal pulse generator (IPG) or neurostimulator to deliver electrical stimulation to precisely targeted structures in the brain that are involved in motor control. Stimulation of these structures works like a sort of “brain pacemaker” interfering with the signals that cause some of the disabling movements. This interference results in greater control over your body movements. The electrical stimulation is delivered through a lead or electrode. The entire system is implanted completely inside the body and depending on your condition you may have multiple electrodes and one or two IPGs (Battery). The IPG is implanted just below the collarbone. The neurostimulator can be adjusted as needed for optimum symptom control.
“Movement Disorders” is a subspecialty of Neurology. Movement disorders are neurological conditions that affect the speed, fluency, quality and ease of an individual movement. Most of the symptoms are finally relayed in the way of abnormal excessive contraction of the muscles. One of the well recognized current day’s state of art treatment is chemodenervation. Chemodenervation is a process, in which signals from the nerves to the muscles are modified using various medications. There are various medications which include chemicals and neurotoxins used in a controlled manner to achieve a desired action. This effect is used to control unwanted and excessive muscular contractions due to various etiologies and disease process. Chemodenervation using Botulinum toxin, is currently a well-recognized and accepted treatment in management of various medical disorders. Even though there are various therapeutic indications for Botulinum toxin injections, in neurology it commonly used for dystonia, spasticity (stiffness of muscle following stroke), and chronic migraine. Movement disorders clinic provides Botulinum toxin injections to these common neurological problems, especially in relation to movement disorders.
Botulinum Neurotoxin, is a biological product which has revolutionized the treatment of various neurological symptoms since its recognition in late 1980’s. Botulinum neurotoxin is derived from the bacterium Clostridium botulinum. There are various serotypes of this toxin, but commonly used are the Type – A and Type – B. Botulinum toxin (Brand names : Botox, Dysport, Xeomin, etc) is a nerve "blocker" that binds to the nerves that lead to the muscle and prevents the release of acetylcholine, a neurotransmitter that activates muscle contractions. If the message is blocked, muscle spasms are significantly reduced or eliminated.
Botox treatment is a well-recognized therapeutic option available since early 1980’s. In last 30 years, it has itself established as a well-accepted treatment for various disorders based upon scientific publications and observations.
The various disorders wherein Botulinum is currently used are:
The medication is directly injected into the area of the body where benefit is intended for. E.g., in to cervical muscles in cervical dystonia and ocular muscles for blepharospasm. For selected areas of the body, and particularly when injecting muscles that are difficult or impossible to palpate, guidance using an electromyograph (EMG) may be necessary. For instance, when injecting the deep muscles of the jaw, neck, or vocal cords, an EMG-guided injection may improve precision since these muscles cannot be readily palpated. An EMG measures and records muscle activity and may help the physician locate overactive muscles. The procedure is done with a very fine needle and most of the people do not complain of any discomfort. At most the pain can be as that or less of a small mosquito bite.
It normally takes several days for the effects of the botulinum neurotoxin to become apparent. The benefit peaks in approximately four weeks and lasts three to four months. In some cases the benefits can last between 6 to 12 months.
Temporary side effects for both types A and B may include muscle weakness, mild pain at the injection site, and dry mouth. Patients should feel free to ask their physician about additional side effects that may be specific to the body area that is to be injected--for example, temporary difficulty swallowing may occur in patients injected for laryngeal or cervical dystonias, but is highly unlikely for someone getting injected for writer's cramp. If a patient experiences side effects, adjusting the dosage or site of injection for future treatments may help avoid these effects. As Botulinum toxin effects are temporary, most of the side effects usually resolve within days to weeks.
The cost varies based upon the amount of medication being planned to use. It may cost as little as 2000 to 3000 rupees in case of where minimal amounts are required (e.g Hemifacial spasm) and increases with the amount of medication being used. Based on over a decade of clinical experience, patients who respond well to botulinum neurotoxin may continue treatment over the course of many years without side effects from long-term use.
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We are trying to provide various groups, patients support systems, clinics, therapy centers available for Parkinson's disease and other movement disorders patients. Please feel free to contribute towards the same.
|Parkinson's disease Society of Karnataka (PDSK)||Bangalore|
|Basal Ganglia Society, Bangalore||Bangalore|
|Basal Ganglia Society, Mysore||Mysore|
|Parkinson's Disease Society of India||Mumbai||
|Parkinson's Disease Foundation||www.pdf.org|
|American Parkinson Disease Association||www.apdaparkinson.org|
|National Parkinson Foundation||www.parkinson.org|