Introduction
For most people living with Parkinson’s disease, the tremors, rigidity, and loss of motor control that define the condition are managed – sometimes effectively, sometimes not – through medication. For a significant proportion of patients, however, medication eventually stops providing adequate relief. It is at this point that surgical intervention becomes a consideration.
In 2017, Amrita Hospitals in Kochi made history by performing Asia’s first robotic DBS surgery for Parkinson’s disease in India, using the ROSA robotic system to implant a deep brain stimulation device with a level of precision that had not previously been achieved through manual surgical techniques alone.
This article explains what that procedure involved, why it represented a genuine clinical advance, and what it means for Sri Lankan patients who are living with Parkinson’s disease and exploring their treatment options.
A Landmark Moment in Asian Neurosurgery
The patient was a 45-year-old auto-rickshaw driver from Kerala’s Guruvayur district. Zubair had been living with Parkinson’s disease since his mid-thirties. The tremors had become severe enough that he could no longer complete a single trip without shaking uncontrollably – often having to pull over, ask passengers to disembark, take his medication by the roadside, and wait for the effects to settle before attempting another fare.
He was the only earning member of his family. The progression of his condition was not only a medical problem – it was threatening his family’s livelihood entirely.
When Zubair’s wife brought him to Amrita Hospitals’ Movement Disorder Clinic, the team identified him as a candidate for Deep Brain Stimulation. What followed was not only a life-changing procedure for Zubair – it became a milestone in Asian neurosurgery. The DBS implantation performed at Amrita Hospitals was the first in Asia to use the ROSA robotic system, a technology that enables surgical precision not achievable by the human hand alone.
Following the procedure, Zubair’s Parkinson’s symptoms disappeared. He returned to driving. He described being able to watch a film with his family for the first time in years, without the disturbance of uncontrolled tremors. Recognising the financial situation of the patient, Amrita Hospitals conducted the surgery free of charge.
What Is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a neurosurgical procedure involving the implantation of a small device – sometimes referred to as a brain pacemaker – that delivers continuous electrical impulses to specific, precisely targeted areas deep within the brain.
DBS was first introduced in the United States in 1987. Since then, it has become one of the most well-evidenced surgical treatments in neurology, with an established safety and efficacy record across thousands of patients globally.
The electrical impulses delivered by the DBS device modulate the abnormal neural activity that causes the motor symptoms of Parkinson’s disease – particularly tremor, rigidity, and the unpredictable on-off fluctuations that develop in patients on long-term medication. The device does not cure Parkinson’s disease or halt its neurological progression. What it does is provide meaningful, sustained symptom control – in appropriately selected patients – that medication alone can no longer achieve.
DBS has also demonstrated benefit in a range of other neurological and psychiatric conditions, including epilepsy, essential tremor, obsessive-compulsive disorder, and chronic pain. For Parkinson’s disease, it remains the most widely used and best-evidenced surgical intervention.
What Made This Procedure a First in Asia?
DBS itself was not new when Amrita Hospitals performed this procedure. What was new – and what made this a genuine first across Asia – was the use of the ROSA robotic system to guide the implantation.
In conventional DBS surgery, electrode placement relies on a combination of pre-operative imaging, a stereotactic frame fixed to the patient’s head, and the surgeon’s manual judgment during the procedure. While experienced neurosurgeons achieve very good outcomes with this approach, the degree of precision is inherently limited by the physical constraints of human hand movement.
The ROSA system – Robotic Stereotactic Assistance – operates as what the surgical team described as a GPS system for the skull. It processes pre-operative MRI and CT imaging data to plan the precise trajectory and target coordinates for electrode placement, then guides the surgical instruments along that planned path with a level of accuracy that manual techniques alone cannot consistently replicate.
This matters clinically because the targets for DBS electrode placement – most commonly the subthalamic nucleus, a structure roughly the size of a small almond located deep within the brain – are extremely small. A deviation of even a few millimetres can affect both the efficacy of stimulation and the risk of complications.
By using the ROSA system, Amrita Hospitals brought a new standard of precision to DBS implantation – and did so in Asia for the first time.
What Is the ROSA Robotic System and Why Does It Matter?
The ROSA system is a robotic platform specifically designed for minimally invasive neurosurgery. It combines advanced imaging integration, robotic arm guidance, and real-time intraoperative feedback to assist neurosurgeons in performing procedures on the brain and spine with exceptional accuracy.
For DBS implantation, ROSA offers several specific advantages:
- Pre-operative planning precision – the surgical trajectory is planned digitally using the patient’s own imaging, accounting for individual anatomy and the exact location of the target structure
- Robotic arm guidance – the robotic arm holds and directs instruments along the planned trajectory, removing the influence of hand tremor or fatigue on the accuracy of electrode placement
- Minimally invasive approach – the ROSA system enables the procedure to be performed through very small burr holes in the skull, reducing trauma to surrounding brain tissue
- Reproducible accuracy – the robotic system applies the same level of precision to every case, regardless of the complexity of the individual anatomy
Amrita Hospitals is not only Asia’s first institution to have used ROSA for DBS implantation – it is also Asia Pacific’s pioneer in ROSA robotic-assisted neurosurgery more broadly, reflecting a sustained institutional commitment to advancing neurosurgical precision through robotic technology.
Who Is DBS Surgery Suitable For?
Robotic DBS surgery for Parkinson’s disease in India is appropriate for a carefully selected group of patients. General eligibility criteria include:
- A confirmed diagnosis of idiopathic Parkinson’s disease – not atypical parkinsonian syndromes such as multiple system atrophy or progressive supranuclear palsy, which do not respond to DBS
- A good response to levodopa medication – patients who respond well to levodopa are more likely to benefit from DBS, as the device essentially replicates optimal medication effect on a continuous basis
- The presence of motor fluctuations or dyskinesias – DBS is particularly beneficial when medication is producing unpredictable on-off cycles or troublesome involuntary movements that cannot be adequately managed by further medication adjustment
- Adequate cognitive function – significant dementia is generally a contraindication to DBS
- Overall fitness for surgery and anaesthesia
- Realistic expectations – patients and families should have a clear and accurate understanding of what DBS can and cannot achieve
DBS is not reserved exclusively for end-stage disease. Some patients benefit from earlier intervention, before the cumulative effects of long-term medication and disease progression have caused additional complications.
What Does the DBS Procedure Involve?
The DBS procedure at Amrita Hospitals using the ROSA system follows a structured two-stage process:
Stage 1 – Awake Electrode Placement
In the first stage, the patient remains awake during the critical phase of electrode insertion. This is not as alarming as it sounds – the brain itself has no pain receptors, and the patient is kept comfortable throughout. Being awake during this stage serves an important clinical purpose: a neurologist can observe the patient’s motor responses in real time as the electrodes are positioned, allowing the surgical team to confirm that stimulation at the planned target produces the expected therapeutic effect and that no unintended neurological effects occur.
The ROSA robotic arm guides the electrode along the pre-planned trajectory through a small burr hole in the skull. Once the electrode is confirmed to be correctly positioned, it is secured in place.
Stage 2 – Pulse Generator Implantation
In the second stage, performed under general anaesthesia, the pulse generator – the device that produces the electrical impulses – is implanted beneath the skin near the collarbone. It is connected to the brain electrodes via thin wires tunnelled under the skin through the neck and scalp.
Post-operative Programming
After implantation, the DBS system is programmed by a specialist to optimise stimulation parameters for the individual patient. This programming is non-invasive and can be adjusted over time as the patient’s needs change.
What Were the Outcomes for the Patient?
The outcome for Zubair was clinically remarkable. Following the robotic-assisted DBS procedure, his Parkinson’s symptoms resolved to the point where he was able to return to his normal daily life and work as an auto-rickshaw driver.
In his own words: after so many years, he was able to watch a film with his family without any disturbance. He could attend social gatherings. He could go back to work.
These are not minor quality of life improvements. For a patient whose symptoms had been severe enough to prevent him from working and supporting his family, the restoration of near-normal motor function represented a profound change in his daily reality.
His case illustrates precisely the population for whom DBS is most beneficial – patients in whom Parkinson’s disease has progressed to the point where medication can no longer provide consistent control, and for whom surgical intervention offers a pathway back to functional independence.
What Does This Mean for Sri Lankan Patients With Parkinson’s Disease?
For Sri Lankan patients living with Parkinson’s disease, this milestone carries direct practical relevance for several reasons.
Access to Proven Technology
The ROSA robotic system is available at Amrita Hospitals. Sri Lankan patients who are candidates for DBS can access the same robotic-assisted precision that produced Asia’s first successful outcome of this kind. This is not a technology that is being piloted – it has an established track record at this institution.
Institutional Experience
Clinical outcomes in complex neurosurgery are strongly influenced by institutional volume and experience. Amrita Hospitals has been performing DBS procedures – including robotic-assisted implantations – since its landmark 2017 case. The depth of experience accumulated since then means that Sri Lankan patients are being treated by a team with genuine subspeciality expertise.
Awareness and Access
As Dr. Ashok Pillai, the neurosurgeon who performed Asia’s first robotic DBS procedure, has noted, one of the significant barriers to DBS adoption in the region is a lack of awareness among patients. Many people living with advanced Parkinson’s disease – in Sri Lanka and across South Asia – do not know that surgical options exist, or assume that medication is the only available treatment.
This is not the case. For patients who meet the eligibility criteria, robotic DBS surgery for Parkinson’s disease in India is a clinically well-supported intervention with meaningful, documented outcomes.
Coordinated Access from Sri Lanka
Sri Lankan patients do not need to navigate this process independently. Amrita Info Centre Sri Lanka provides structured coordination – from initial report review and specialist assessment through to medical visa support and travel logistics – so that the path from diagnosis to treatment is as clear and manageable as possible.
For patients who would like to understand the broader context of Parkinson’s treatment options before considering DBS, our full article on Parkinson’s disease treatment in India for Sri Lankan patients provides a comprehensive overview of both medical and surgical management approaches.
To explore the full range of neurosurgical and neurological services available, visit specialist hospitals in India for neurological treatment.
How Do Sri Lankan Patients Access DBS Surgery at Amrita Hospitals?
The process for Sri Lankan patients considering DBS surgery begins with a clinical assessment:
- Gather your existing neurological records – specialist letters, medication history, MRI or DaTscan reports, and any previous movement disorder clinic assessments
- Share these with Amrita Info Centre Sri Lanka for forwarding to the movement disorders and neurosurgery team at Amrita Hospitals
- Receive an initial assessment on DBS candidacy and the recommended pre-surgical evaluation steps
- Travel to Amrita Hospitals for the full pre-surgical evaluation – including video assessment, neuropsychological testing, and levodopa challenge
- Proceed to surgery based on the evaluation outcome, with medical visa support managed by Amrita Info Centre Sri Lanka
For patients beginning the visa process, our article on the Complete Guide to Medical Visa for India from Sri Lanka covers every documentation and application step in detail.
For patients who would like to understand how the DBS procedure fits within the broader landscape of robotic surgery available at Amrita Hospitals, our article on robotic surgery in India for Sri Lankan patients provides useful context on the institution’s robotic surgical capabilities across specialities.
Frequently Asked Questions
Is robotic DBS surgery different from conventional DBS surgery in its outcome for the patient? The clinical outcome – improved Parkinson’s symptom control – is the same. What robotic assistance improves is the precision of electrode placement, which has direct implications for the consistency and accuracy of the therapeutic result and the risk of placement-related complications. More precise placement means more reliable stimulation of the intended target.
Is the patient awake during the entire DBS procedure? No. The patient is awake during the electrode placement stage so that the surgical team can monitor neurological responses in real time. The second stage – implantation of the pulse generator beneath the skin – is performed under general anaesthesia.
How soon after DBS surgery do patients notice improvement? The DBS device is activated and programmed after surgery. Most patients begin to notice improvement once programming is underway, though optimal settings may take several weeks to establish through a process of gradual adjustment. Tremor in particular often responds quickly and dramatically once stimulation begins.
Does DBS work for all Parkinson’s patients? No. DBS is most effective for patients with idiopathic Parkinson’s disease who have a clear response to levodopa medication. It is generally not effective for atypical parkinsonian syndromes. Accurate diagnosis and careful pre-surgical evaluation are essential before DBS is considered.
Can Amrita Hospitals provide a remote assessment before a Sri Lankan patient travels? Yes. In many cases, an initial review of existing neurological reports, medication history, and imaging can be arranged remotely through Amrita Info Centre Sri Lanka. This allows the movement disorders team to provide a preliminary assessment of DBS candidacy and advise on the most efficient evaluation pathway before travel is planned.
What happens if the DBS device needs adjustment after the patient returns to Sri Lanka? DBS programming can be adjusted remotely in many cases through telemedicine, and in some cases through remote programming technology. Amrita Hospitals provides guidance on follow-up programming arrangements for patients who have returned home after surgery.
Conclusion
Asia’s first robotic-assisted DBS implantation for Parkinson’s disease was not simply a technical milestone – it was a demonstration that robotic precision and the right institutional expertise can meaningfully change the lives of patients for whom conventional treatment has reached its limits.
For Sri Lankan patients living with advanced Parkinson’s disease, Amrita Hospitals represents a genuine and accessible option – one with an established track record in robotic DBS surgery for Parkinson’s disease in India and a coordinated patient support pathway that begins in Colombo.
The first step is sharing your reports and understanding whether DBS is appropriate for your specific situation. That process can begin today, through Amrita Info Centre Sri Lanka.