Case Studies

 

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Mr.I.B
Calcutta

This 38 years old resident of Calcutta, engineer by profession had advanced Parkinson Disease for last 12 years. His symptoms started from right side in the form of tremor in the limb and difficulty in walking which gradually progressed to involve the other side also. In off stage he had tremor, rigidity and bradykinesia and freezing. He was unable to dress and undress himself and without help he was unable to turn to side. His symptoms were more marked on right side. In on stage he had severe dyskinesia mainly on to the right side. Sometime the dyskinesia would last for one to one and a half-hour. He was subjected to Deep Brain Stimulation Surgery on 3rd January 2001. Both sides subthalamic implantation was done and later on they were connected to Kinetra (Pacemaker). He has shown significant improvement Surgery after surgery. There is no tremor on both sides of his body, rigidity is reduced considerably There is no dyskinesia, there is no freezing and he does not require help for his day to day activity. Most of the time he remains on. He is provided with a programmer by which he can reduce/ increase the voltage as and when required. His medications have been reduced to half and according to him his improvement in day to day activities would be in the range of around 70% . In 10 years time his disease has progressed . He had replacement of Pacemaker twice but still he is independent and continuing his job.

 

 

 

Mr.A.S
Ludhiana

This 51 years old, resident of Ludhiana was a army personal 10 years back but he had to take retirement from the army because of the Parkinson Disease which he had for last 10 years. In the initial stage he could cope up with the disease but gradually the disease has progressed and for last 5 years he was confined to bed. In off stage he was unable to perform any act because of tremor and associated rigidity and freezing while in on stage he has severe dyskinesia (Abnormal movement because of medications) lasting till the effects of medicine last. He was subjected to both sided Subthalamic implants in September 2000. At the moment he is much better. According to him he is fit for job. There is significant reduction in his medications and now he has no more dyskinesia . Over last 12 years he is crippled with the disease but he continue his daily routine .He had replacement of pacemaker twice

 

 

 

 

Mr.R.S
Jammu

This 36 years old male patient had parkinson disease diagnosed in 1989 when he noticed tremor and rigidity on left side of his body. Gradually he developed Slowness. Initially he responded very well to sinemet, the dose of which gradually increased. He developed drug induced dyskinesia since 1995. Presently he has severe on and off fluctuations and severe dyskinesia lasting till the effects of medication. He has severe freezing and retropulsion. He is unable to tolerate sinemet more than three tablets of 275 Mg.

 

He was subjected to deep brain stimulation(Subthalamus) on 20th March 2002. After surgery his medications has been reduced to half. There is no freezing and dyskinesia. According to him he is 60 - 70% improved after surgery. This patient have done two replacement one is "Non Rechargeable" and second is "Rechargeable" IPG. This patient able to perform day to day activity independently and is contuing his job

 

 

M.M
Bhopal

This 47 years old person had onset of disease 7 years back in form of tremor in the left hand which gradually progressed to difficulty in walking and for last 2 years he develop frequent freezing and tremor on the right side also. He was subjected to bilateral Subthalamic stimulation with Kinetra implantation on 2.9.2003. After surgery and subsequent follow-up he improved by 80% in tremor control. There is no freezing and he totally independent in all his activities. This patient have done one replacement "Rechargeable" IPG. he is able to perform day to day activity independently

 

 

 

Mr S.S
UK

Mr. S.S met with a road side accident in summer of 2001.He noticed tremor in the left upper limb after 6 weeks of injury. Gradually his symptoms progressed. He became more lethargic and became fatigue easily. Patient developed stiffness, difficulty in walking and balance problem. The symptoms progressed very rapidly and for last 6 months he was on wheelchair and even on wheelchair he required assistance. He was put on all anti-Parkinson’s medication and on oral baclofen at highest dose without any significant improvement. His MRI was normal. He was diagnosed to have Parkinson’s plus syndrome. He was told that no therapy could benefit him. He was brought to India at VIMHANS, New Delhi in the month of Oct2004.After detailed evaluation it was decided that if his stiffness can be reduced he would be more manageable. Trial bolus of Intrathecal baclofen 50ug was given and he responded very well and rigidity (stiffness) reduced significantly. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 28/10/04. Implantation of Synchromed-II intrathecal programmable baclofen pump was done. He responded very well to therapy. At the time of his departure from INDIA patient was walking with minimal support. His family was happy. Intrathecal Baclofen therapy improved his quality of life and activities of daily living.

 

 

Mr. R.R
Gwalior

Mr R.R 58yrs/M had an road accident in Oct 2003,followed by weakness of right upper limb. After one week of injury he reported excruciating pain in right upper limb. His NCV revealed right Pan brachial plexus injury. He was operated at VIMHANS, New Delhi. Microsurgical neurolysis was done on 13/08/04 which did not improve his pain He was lateron subjected to two successive stelliate ganglion block, which also could not improve his pain. The pain was so bad that patient wanted his right upper limb to be amputed as early as possible. On 1/09/04 he was given a trial bolus of intrathecal morphine. Patient gets immediately pain relief for a day. He was advised to undergo implantation of intrathecal morphine delivery pump. Dr Alok Gupta, Consultant Neurosurgeon, VIMHANS, and New Delhi operated him on 2/09/04. Patient responded very well and has complete pain relief till date. Patient is on only 1.9mg/day dose. Of morphine infusion.