Call For Appointment:  + 91 80 49202066 

 

 

 

Service offered
Movement disorders clinic provides a comprehensive care to the patients including

Medical assessment
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.

Patient counselling and therapy
All patients would be counselled on the disease process, outcome and management. They would be advised on appropriate medical or supportive therapies.

Caregiver counselling
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.

Botulinum toxin clinic
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.

Surgical Therapy

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.

 

Chemodenervation (Botulinum) Clinic

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. The following are the commonly asked questions about the usage of Botulinum toxin injections.

  1. What is Botulinum toxin?
    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.
  2. How does Botulinum toxin work?

    Botulinum toxin (Botox) 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.
  3. Is it a newly recognized medical treatment?
    No. 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.
  4. What are the common conditions where Botulinum toxin is used for?
    Botulinum toxin in neurological conditions is commonly used for treatment of dystonias, spasticity, Hemifacial spasms, Tremors, and Chronic migraine.
  5. What are the indications for Botulinum therapy?
    Botox is used in various medical conditions and include
    a. Focal dystonias - Involuntary, sustained, or spasmodic patterned muscle activity, Cervical dystonia (spasmodic torticollis), Blepharospasm (eyelid closure), Laryngeal dystonia (spasmodic dysphonia), Limb dystonia (writer's cramp), Oromandibular dystonia, Orolingual dystonia, Truncal dystonia
    b. Spasticity - following Stroke, Traumatic brain injury, Cerebral palsy, Multiple sclerosis, Spinal cord injury
    c. Nondystonic disorders of involuntary muscle activity, Hemifacial spasm, Tremor, Tics, myokymia and synkinesis, Myoclonus (tensor veli palatini muscle [middle ear], causing tinnitus), Hereditary muscle cramps, Nocturnal bruxism,
    d. Trismus, Strabismus (disorder of conjugate eye movement) and nystagmus
    e. Chronic pain and disorders of localized muscle spasms, Chronic low back pain, Myofascial pain syndrome
    f. Tension headache, Chronic migraine headache, Medication overuse headache
    g. Lateral epicondylitis, Knee pain, Shoulder pain,
    h. Neuropathic pain
    i. Smooth muscle hyperactive disorders, Neurogenic bladder – Detrusor hyperreflexia, Detrusor-sphincter dyssynergia, Benign prostatic hypertrophy, Achalasia cardia, Hirschsprung disease, Sphincter of Oddi dysfunctions
    j. Cosmetic use: Hyperkinetic facial lines (glabellar frown lines, crow's feet), Hypertrophic platysma muscle bands, Sweating, salivary, and allergy disorders
    k. Axillary and palmar hyperhidrosis
    l. Drooling in cerebral palsy and other neurological disorders
  6. Is there a difference in various brands available in market?
    Even though the end product used is Botulinum toxin, the drug has been differentiated based upon the type of Botulinum toxin used (commonly type A and type B). In addition various botulinum toxins possess individual potencies, and care is required to assure proper use and avoid medication errors. Recent changes to the established drug names by the FDA were intended to reinforce these differences and prevent medication errors. The products and their approved indications include the following:
    a. OnabotulinumtoxinA (Brand names : Botox, Botox Cosmetic)
    b. AbobotulinumtoxinA (Brand names : Dysport)
    c. IncobotulinumtoxinA (Brand name : Xeomin)
    d. Rimabotulinumtoxin B (Brand name: Myobloc)
    An important difference between the different brands of botulinum neurotoxin is the number of units needed for treatment and how much toxin is in a 'unit' of each product. The units used to measure dosage are not consistent among the commercially produced toxins, and the products are not interchangeable.
  7. Where and how is Botulinum toxin injected?
    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.
  8. Is it a very uncomfortable procedure?
    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.
  9. When and how long does the Botulinum toxin injections work?
    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.
  10. What are the adverse effects of Botulinum toxin?
    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.
  11. In case of any adverse effects, can it be reversed?
    As Botulinum toxin effects are temporary, most of the side effects usually resolve within days to weeks.
  12. What is the success rate of treatment?
    The success of a botulinum neurotoxin injection depends upon: a. The dose used b. The specific sites in the muscles where the product is injected c. The experience of the physician giving the injection d. Clear communication between physician and patient, so that both parties understand and agree on the specific symptoms that are being treated and what can be expected as a result of an injection. e. Because of the multiple factors that determine the success of a botulinum neurotoxin injection, a person might require being injected on two or three separate occasions before the optimal benefit is achieved. All of the factors listed above must be aligned for the best result, and this may take some time to perfect.
  13. How much would it cost for the Botulinum injections?
    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.
  14. How long can one use Botulinum injections?
    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.

Maecenas interdum tortor quis tellus facilisis varius. Donec sollicitudin lorem vitae enim iaculis quis feugiat elit pellentesque. Fusce congue rutrum lorem sed dignissim. Suspendisse id metus ac risus imperdiet ornare in vel lorem. Nulla condimentum consectetur adipiscing elit. Vestibulum venenatis orci non tortor accumsan.

Read more...

Deep Brain Stimulation

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.

What is DBS and How does it work?

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.

Where are the electrodes inserted?

Electrode targets in the brain are decided based upon your condition and type of symptoms needed to be treated. Currently most commonly used sites for DBS include, Subthalamic nucleus (STN), Globus pallidus internus (Gpi) and Ventral Intermediate nucleus (Vim).

When is DBS needed?

Parkinson’s Disease (PD)

If you are a patient with PD, DBS surgery may be considered when medication and/or other treatment strategies do not work to relieve your symptoms. You may be considered for surgery when you are experiencing disabling disease symptoms such as tremor, stiffness, slowness of movement, or abnormal movements induced by treatment that interfere with your ability to carry out your activities of daily living.

Tremor

If you are a patient with Tremor, DBS surgery may be considered when medication and/or other tremor control strategies have been tried and do not work. You may be considered for surgery when you are experiencing disabling tremor symptoms that interfere with your ability to carry out your activities of daily living.

Dystonia

If you are a patient with Dystonia, DBS surgery may be considered when medication and/or other treatment strategies such as Botox injections do not work to relieve your symptoms. You may be considered for surgery when you are experiencing severe symptoms such as pain and/or contractions that interfere with your ability to carry out your activities of daily living.

What are the advantages with DBS?

    1. The procedure is entirely reversible and does not destroy brain tissue.
    2. Significant reduction in the occurrence of tremors, stiffness and slow muscle function.
    3. Reduction in medication-induced dyskinesia, motor fluctuations, gait disturbance and balance problems.
    4. Medication “on-time” typically increases and medication use decreases by as much as 50%.
    5. Essential Tremor patients can experience up to a 90% reduction in tremor, often with subsequent reduction or discontinuation or reduction of medication.
    6. Patients with Dystonia see significant improvement in involuntary muscle contraction.

What are the risks associated with DBS?

    Overall DBS is a safe procedure with minimal associated risk. The surgery carries the same risks associated with any other neurosurgical procedure including bleeding, infection, neurological deficits and pain at the surgery sites.