Surgery gives relief to migraine patients
MUMBAI: Smita Kulkarni has popped 15 Ibuprofen painkiller tablets on some days, banged her head against the wall on other days and visited various doctors every year. For 16 years, the Pune resident waged a losing battle with migraine. On Thursday, 31-year-old Kulkarni took another step to drive away the pain along her left temple: a five-hour-long brain procedure at Mumbai's Jaslok Hospital. This is the second time this procedure has been performed in India.
"Each of my migraine attack would last at least five days. I would be too disoriented to do anything on such days," said the mother of a seven-year-old boy. Worse, she would have at least two such attacks every month.
'she had chronic migraine that hadn"t eased even with medications for years. She was an ideal candidate for the occipital nerve stimulator procedure," said neurosurgeon Paresh Doshi, who fixed an implantable device near Kulkarni's occipital nerve. She is only the second patient on whom Dr Doshi has performed this surgery.
Migraine is the most common of all the 150 different conditions that can produce a headache, and it can sometimes also be one of the most painful. "It is often a chronic disorder that won"t go away just with a two-or-three-month treatment. But unfortunately, there is no awareness in India about the need to handle it like other chronic conditions such as diabetes or asthma," said neurologist Dr K Ravishankar of Jaslok and Lilavati Hospitals" headache clinic who directed Smita for surgery.
Dr Ravishankar estimates that 20% of the women between the ages of 15 to 40 and 8% of men suffer from the disorder. "It is one of the most researched headache disorders in the US, with the latest consensus being that it is a genetically inherited vulnerable disorder of the brain," he added.
Migraine runs in the Kulkarni family too. She had to give up her studies during the second year of graduation as she would keep missing classes.
Most migraine patients get relief with modern medicine. "It's a small fraction of them like Kulkarni who need a surgical procedure," said neurosurgeon Doshi.
The occipital nerve stimulation procedure is not complex like other brain surgeries; the surgeon doesn"t need to cut or go deep into the brain but only place two thin wires in the back of the skull. "Twelve nerves arise from the brain; migraine attacks are felt in distribution of the fifth nerve called the trigeminal nerve," said Dr Doshi. This nerve 'communicates" with the occipital nerve which lies in the spinal cord. "Any stimulation to the occipital nerve thus can be communicated to the fifth nerve through the pathways in the brainstem, changing the neuro-transmissions," he added.
The implants provide electrical impulses, through a power source implanted just below the collar bone, that stimulate the occipital nerve. In other words, the migraine patient's pain circuit is broken. "Doctors believe the procedure works in three ways. The implants increase the patient's pain threshold, they jam the pain signals and or change the neuro-transmitter patterns," said Dr Doshi.
Dr Milind Sankhe, a neurosurgeon from Hinduja Hospital in Mahim, said that surgery for migraine is rare in India. Another doctor who didn"t want to be named said long-term studies are needed to assess the efficacy of this surgery. In fact, a study called ONSTIM is underway in Europe.
No comments:
Post a Comment