Navigating Choices: Factors Influencing Deep Brain Stimulation (DBS) Surgery Decisions in Developing Countries – India

What factors contribute to the significant difference in the rate of Deep Brain Stimulation (DBS) surgery for Parkinson’s Disease (PD) between developed and developing countries?  What influences the decision of patients with PD in the developing world to opt for or against Deep Brain Stimulation (DBS) surgery? What are the primary barriers hindering a larger proportion of eligible PD patients in the developing world from undergoing Deep Brain Stimulation (DBS) surgery?  These questions have been addressed in a recently published medical paper from India in the medical journal – Movement Disorders in Clinical Practice.   Let’s see what we as a general population can understand from this article.

Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease – The Developing World’s (India) Perspective:

  • Study focused on patients with Parkinson’s disease (PD) and motor complications in developing countries (India) spanned over 5 year period (2016-2020) involving 1017 Parkinson’s Disease patients.
  • Among 1017 Parkinson’s Disease people, 223 patients met the medical criteria for consideration of Deep Brain Stimulation (DBS) surgery.
  • Among 223 medically indicated for DBS surgery, Only 35% (78 patients) patients opted for DBS surgery.
  • Among these 78 Patients who opted for surgery, 37 patients were found to be unfit for DBS surgery during the Pre-operative workup and only 41 patients finally underwent DBS Surgery.
  • So in brief, in 1017 patients with Parkinson’s Disease, roughly 22% met the clinical criteria for DBS surgery.  From the whole cohort, 7% opted for DBS surgery and among them, only about 4% were deemed fit and underwent the procedure.

Let’s see what factor played a role in decision making for Deep Brain stimulation Surgery in these patients in India.

Characteristics of Patients Opting for DBS Surgery:


  • Older age: Patients choosing DBS were generally older.
  • Higher socioeconomic status: Those opting for surgery had a higher socioeconomic status.

Disease Duration and Motor Complications:

  • Longer duration of PD: Patients choosing DBS had PD for a longer period.
  • Longer duration of motor fluctuations: Opted-for surgery patients experienced motor fluctuations for an extended time.

Motor Symptoms:

  • More severe motor disability in the OFF state: Severity of motor disability was higher in surgery-opting patients when not on medication.
  • More severe freezing of gait in the OFF state: Patients choosing DBS experienced more severe freezing of gait without medication.

Psychiatric and Cognitive Symptoms:

  • History of hallucinations and psychotic symptoms: Opted-for surgery patients had a higher incidence of these symptoms.
  • Higher burden of cognitive symptoms: Prevalence of cognitive dysfunction was higher in surgery-opting patients.

Correlation Between Socioeconomic Status and Surgical Decisions:

  • Correlation found between higher socioeconomic status and the willingness to undergo DBS surgery.
  • Almost 40% of patients opting for medical management cited financial constraints.

Barriers to DBS Surgery:

Reasons for Not Undergoing Surgery:

  • Financial constraints: 39.3% cited financial limitations.
  • Concerns about risks and complications: 13.1% were hesitant due to surgical concerns.
  • Lack of conviction about benefits: 9% were not convinced about expected benefits.
  • Inadequate family support: 6.9% lacked sufficient family support.

Consideration for Future DBS Surgery:

  • 31.7% of patients opting for medical management kept DBS as an option for future consideration.

Comparison with Western Populations:

  • Difference in DBS surgery rates between Western and developing countries.
  • In India, limited access, insurance coverage, and socioeconomic factors contribute to the low rate (35%).
  • Western countries, with comprehensive health coverage, may have higher rates, but concerns about efficacy and safety still influence decisions.


  • Understanding the complex interplay of socioeconomic, medical, and personal factors crucial for making informed decisions about Deep Brain Stimulation (DBS) surgery in developing countries.
  • Financial constraints, limited insurance, and familial support emerged as significant barriers.
  • Future research and policy considerations should address these barriers to ensure equitable access to DBS surgery in developing regions.

Empowering Well-being: Daily Routine for Parkinson Disease

Incorporating a well-rounded daily routine for Parkinson Disease is crucial for well-being. Tailoring activities to address specific needs can enhance overall health and quality of life. Let’s explore daily recommendations under six key areas.

Aerobic Activities:

In the pursuit of holistic well-being, aerobic activities emerge as a cornerstone for seniors and individuals navigating Parkinson’s disease. These activities not only foster physical health but also contribute significantly to mental and emotional resilience.  Aerobic exercises, known for their rhythmic and continuous nature, are pivotal for enhancing cardiovascular health. For seniors and Parkinson’s patients, engaging in these activities promotes increased blood circulation, oxygenation, and overall endurance. This, in turn, contributes to improved energy levels and cognitive function.

Tailoring exercises to individual needs is crucial. Low-impact activities such as walking, swimming, and stationary cycling are excellent choices. These exercises are gentle on joints, reducing the risk of injuries. Aim for at least 30 minutes of moderate-intensity aerobic activity most days of the week.

Research suggests that aerobic exercises can have positive effects on motor functions and cognitive performance in individuals with Parkinson’s disease. These activities may help manage symptoms, enhance balance, and promote a sense of well-being.

Tailor activities to individual fitness levels and modify them as needed. Incorporating warm-up and cool-down sessions is crucial to prevent injuries.  The key lies in creating a personalized and sustainable aerobic exercise plan that aligns with individual capabilities and preferences. By embracing the power of movement, individuals can unlock a pathway to enhanced vitality, both physically and mentally.

#AerobicHealth #SeniorFitness


In the realm of holistic well-being, meditation stands as a profound practice with the potential to enhance the lives of seniors and individuals grappling with Parkinson’s disease. Beyond its calming effects, meditation contributes significantly to mental clarity, emotional resilience, and overall quality of life.

Various meditation techniques cater to different preferences. Pranayama, Mindfulness meditation, guided visualization, and loving-kindness meditation are popular choices.  Studies suggest that regular meditation can positively impact cognitive function, potentially slowing the cognitive decline associated with aging. For Parkinson’s patients, meditation may provide cognitive support, aiding in concentration and mental clarity.

Establishing a Meditation Routine:

Begin with short sessions and gradually extend the duration as comfort grows. Integrating meditation into daily life can be as simple as finding a quiet space, focusing on breath, and embracing the present moment. Consistency is key to reaping the full benefits.  Participating in group meditation sessions fosters a sense of community and shared purpose. For seniors and those managing Parkinson’s, this communal aspect of meditation provides an avenue for shared experiences and emotional support.

In the pursuit of well-being, meditation emerges as a transformative practice for seniors and individuals navigating Parkinson’s disease. By embracing moments of stillness, individuals can discover a profound source of mental and emotional strength. Whether practiced individually or in a group setting, meditation unveils a pathway to serenity, empowering individuals to navigate life’s challenges with grace.

#MindfulnessForSeniors #ParkinsonsWellness

Strength and Balance Training:

In the journey towards holistic well-being, the significance of strength and balance training cannot be overstated for seniors and those managing Parkinson’s disease. These targeted exercises not only enhance physical resilience but also contribute to improved mobility, reduced fall risks, and an overall sense of empowerment.

Crafting a personalized strength and balance training routine is essential. Include exercises that focus on major muscle groups, such as squats, lunges, and leg lifts. For Parkinson’s patients, incorporating exercises that enhance core strength can contribute to improved stability.  Consider low-impact options for those with mobility concerns. Water aerobics, tai chi, and yoga are excellent choices that provide a gentle yet effective approach to building strength and improving balance.  Participating in group strength and balance classes not only adds a social component but also provides a supportive environment.

Strength and balance training stand as pillars of physical well-being, offering seniors and individuals with Parkinson’s disease the tools to navigate daily life with confidence. By incorporating these exercises into a regular routine, individuals can not only enhance their physical capabilities but also cultivate a sense of empowerment and resilience.

#StrengthTraining #BalanceForSeniors #ParkinsonsWellness #SuryaNamsakara

Stretching Exercises:

In the pursuit of comprehensive well-being, the often-overlooked practice of stretching exercises plays a pivotal role for seniors and individuals managing Parkinson’s disease. Beyond enhancing flexibility, these exercises contribute to improved joint health, increased range of motion, and a heightened sense of physical comfort.

Emphasize gentle, gradual stretches, especially for seniors or those with limited mobility. Focus on major muscle groups such as the neck, shoulders, back, and legs. Incorporate both static and dynamic stretching techniques for a well-rounded approach.  Individualized stretching routines are key. Consider specific needs, such as addressing areas of discomfort or focusing on enhancing flexibility in particular joints. Seek guidance from healthcare professionals for personalized recommendations.

Stretching exercises offer a gateway to improved flexibility, joint health, and overall physical comfort for seniors and those with Parkinson’s disease.  Incorporating this daily routine for Parkinson Disease makes a dramatic change into the overall outcome of the disorder.

#FlexibilityRoutine #StretchingForSeniors #ParkinsonsWellness

Engaging Activities: 

In the pursuit of holistic well-being, engaging activities, such as gardening and participating in small chores, emerge as invaluable tools for seniors and individuals navigating Parkinson’s disease. Beyond providing a sense of purpose, these activities contribute to physical activity, mental stimulation, and an overall enhancement of daily life.

Gardening is a multifaceted activity that not only encourages physical movement but also provides exposure to nature, promoting mental well-being. Planting, weeding, and tending to a garden offer low-impact exercises that contribute to overall mobility.

Participating in everyday chores, even on a smaller scale, can be a form of functional exercise. Folding laundry, light cleaning, or organizing spaces contribute to physical activity and help maintain motor skills.

The goal is to create activities that are enjoyable, achievable, and aligned with personal interests.  or seniors and individuals with Parkinson’s, these activities infuse daily life with purpose, physical activity, and mental stimulation. By embracing active joy, individuals can cultivate a fulfilling and vibrant daily routine.

#EngagingActivities #ActiveLiving #ParkinsonsWellness # Daily Routine for Parkinson Disease

Social Activities:

In the realm of holistic well-being, the value of social activities and group events cannot be overstated for seniors and individuals managing Parkinson’s disease. Beyond mere socialization, these activities foster a sense of belonging, emotional support, and contribute to an enriched quality of life.  Engaging in group events provides a structured avenue to combat loneliness, fostering connections and meaningful relationships.  Sharing experiences, laughter, and camaraderie during group events create a positive atmosphere that helps alleviate stress and boost mood.  Engaging in conversations, playing games, or participating in group activities can help maintain mental sharpness, benefiting both seniors and individuals with Parkinson’s.

Group events offer a platform to celebrate milestones, whether personal or collective. Recognizing achievements, birthdays, or special occasions within a supportive community enhances a sense of joy and accomplishment.  Incorporating intergenerational activities can be especially enriching. Seniors and Parkinson’s patients benefit from the energy and perspectives of younger generations, creating a dynamic and inclusive social environment.

Social activities and group events are not mere pastimes—they are essential threads in the fabric of well-being. For seniors and individuals with Parkinson’s, these activities weave a tapestry of connection, support, and joy. By actively participating in social events, individuals can foster a community that uplifts and enhances the overall quality of life.

#SocialWellness #CommunityConnection #ParkinsonsSupport # Daily Routine for Parkinson Disease

To reap the full spectrum of benefits, strive to dedicate at least 30 minutes to each event, engaging in activities at least three days a week. This commitment ensures a consistent and impactful embrace of social well-being, promoting a fulfilling and vibrant lifestyle. By weaving the tapestry of connection and shared moments, we cultivate resilience, joy, and a community that uplifts us on this journey of well-being – Incorporate a healthy daily routine for Parkinson disease.

#SocialWellness #CommunityConnection #ParkinsonsSupport