Introduction
Parkinson’s disease is a progressive neurological condition that affects movement, balance, and coordination. It develops when the brain cells responsible for producing dopamine – a chemical essential for smooth, controlled movement – begin to deteriorate.
For many patients, medication provides effective symptom control for years. But as the condition progresses, medication may become less effective or produce troublesome side effects. At this stage, Parkinson’s disease treatment in India through advanced interventions such as deep brain stimulation (DBS) surgery offers a meaningful option for carefully selected patients.
This guide explains how Parkinson’s disease is managed, what DBS surgery involves, who is eligible, and how Sri Lankan patients can access specialist care.
What Is Parkinson’s Disease?
Parkinson’s disease is caused by the progressive loss of dopamine-producing neurons in a region of the brain called the substantia nigra. As dopamine levels fall, the brain’s ability to coordinate smooth, intentional movement is impaired.
The condition typically presents with a characteristic group of motor symptoms:
- Tremor – most commonly a resting tremor affecting the hand, arm, or leg
- Rigidity – stiffness in the limbs and trunk
- Bradykinesia – slowness of movement, making everyday tasks such as walking, buttoning clothing, or writing more difficult
- Postural instability – impaired balance and coordination, increasing the risk of falls
Non-motor symptoms are also common and include sleep disturbances, constipation, reduced sense of smell, depression, anxiety, cognitive changes, and autonomic dysfunction.
Parkinson’s disease is progressive – symptoms worsen over time, though the rate of progression varies significantly between individuals.
How Is Parkinson’s Disease Diagnosed?
There is no single definitive test for Parkinson’s disease. Diagnosis is primarily clinical, based on the neurologist’s assessment of symptoms, their pattern, and the response to dopaminergic medication.
Supporting investigations include:
- MRI of the brain – primarily used to exclude other conditions that can mimic Parkinson’s disease, such as normal pressure hydrocephalus or vascular parkinsonism
- DaTscan (dopamine transporter scan) – a nuclear medicine imaging study that assesses dopamine transporter activity in the brain, helping to differentiate Parkinson’s disease from essential tremor
- Neuropsychological testing – to assess cognitive function, particularly relevant when DBS surgery is being considered
- Levodopa challenge test – assessment of motor response to dopaminergic medication, which helps confirm the diagnosis and predict DBS candidacy
What Medications Are Used to Manage Parkinson’s Disease?
Medication remains the foundation of Parkinson’s disease treatment in India and globally. The main medication classes used include:
- Levodopa (combined with carbidopa) – the most effective medication for Parkinson’s symptoms, converting to dopamine in the brain. Highly effective in early and mid-stage disease
- Dopamine agonists – medications that mimic dopamine’s action, used alone or in combination with levodopa
- MAO-B inhibitors – slow the breakdown of dopamine in the brain, used in early disease or as add-on therapy
- COMT inhibitors – extend the effect of levodopa by reducing its breakdown
- Amantadine – used to manage dyskinesias (involuntary movements) that can develop as a side effect of long-term levodopa therapy
Over time, the effectiveness of medication may fluctuate, leading to periods of good symptom control (on periods) alternating with periods of poor control (off periods). This motor fluctuation is one of the key indicators that DBS surgery may be appropriate.
What Is Deep Brain Stimulation (DBS)?
Deep brain stimulation is a neurosurgical procedure in which thin electrodes are implanted into specific, precisely targeted areas of the brain. These electrodes are connected to a small pulse generator (similar to a cardiac pacemaker) implanted under the skin near the collarbone.
The pulse generator delivers continuous, adjustable electrical impulses to the targeted brain circuits, modulating abnormal neural activity and improving motor symptoms.
DBS does not cure Parkinson’s disease or halt its progression. It effectively manages symptoms – particularly tremor, rigidity, and motor fluctuations – and can significantly reduce the amount of medication required, thereby also reducing medication-related side effects such as dyskinesias.
Amrita Hospitals holds the distinction of being Asia’s first institution to perform robotic-assisted DBS implantation for Parkinson’s disease, using the ROSA robotic system for enhanced precision in electrode placement.
Who Is a Candidate for DBS Surgery?
DBS surgery is appropriate for a carefully selected group of patients. General candidacy criteria include:
- Confirmed diagnosis of Parkinson’s disease – not other parkinsonian syndromes such as multiple system atrophy or progressive supranuclear palsy, which do not respond to DBS
- Good response to levodopa – patients who respond well to levodopa medication are more likely to benefit from DBS, as DBS mimics the effect of optimal medication
- Presence of motor fluctuations or dyskinesias – DBS is particularly beneficial when medication is producing unpredictable on-off cycles or troublesome involuntary movements
- Adequate cognitive function – patients with significant dementia are generally not suitable candidates for DBS
- Overall health sufficient for surgery – a pre-operative assessment evaluates fitness for general anaesthesia and the surgical procedure
- Realistic expectations – patients and families should have a clear understanding of what DBS can and cannot achieve
DBS is generally considered when medication adjustments alone are no longer able to provide adequate symptom control. It is not reserved exclusively for advanced disease – some patients benefit from earlier intervention.
How Is DBS Surgery Performed?
DBS surgery at Amrita Hospitals is performed using the ROSA robotic system, which provides highly precise stereotactic guidance for electrode placement.
Stage 1: Electrode Implantation
- The patient’s head is fixed in a stereotactic frame or fitted with a frameless tracking system
- MRI and CT imaging data are used to plan the precise trajectory and target coordinates for electrode placement
- Under general anaesthesia or, in selected cases, with the patient awake during part of the procedure (to allow real-time neurological monitoring), the electrodes are inserted through small burr holes in the skull and advanced to the target – most commonly the subthalamic nucleus (STN) or the globus pallidus internus (GPi)
- Electrode position is confirmed with intraoperative imaging
Stage 2: Pulse Generator Implantation
- In a separate procedure (often on the same day or within a few days), the pulse generator is implanted under the skin below the collarbone
- The generator is connected to the brain electrodes via extension wires running under the skin
Programming
- After implantation, the DBS system is programmed by a specialist to optimise stimulation parameters for the individual patient
- Programming is adjusted over several sessions following surgery and may require fine-tuning over time
What Are the Outcomes of DBS for Parkinson’s Disease?
DBS is one of the most well-evidenced surgical interventions in neurology. Expected outcomes for appropriately selected patients include:
- Significant reduction in tremor – often the most dramatic improvement
- Reduction in rigidity and bradykinesia during off periods
- Reduction in the duration and severity of off periods
- Reduction in dyskinesias, allowing medication doses to be reduced
- Improved quality of life scores in the majority of patients who meet candidacy criteria
DBS does not stop the underlying progression of Parkinson’s disease. As the condition progresses over years, stimulation parameters may need adjustment and medication may need to be increased again. However, many patients maintain meaningful benefit from DBS for 10 or more years following implantation.
What Other Treatments Are Available for Parkinson’s Disease?
Beyond medication and DBS, other treatment modalities include:
- Physiotherapy – essential for maintaining mobility, balance, and fall prevention throughout the course of the disease
- Speech and language therapy – to address speech changes and swallowing difficulties that can develop as the condition progresses
- Occupational therapy – to support independence in daily activities
- Levodopa-carbidopa intestinal gel (LCIG) – a continuous infusion of levodopa delivered directly into the small intestine via a pump, for patients with advanced motor fluctuations who are not DBS candidates
- Focused ultrasound thalamotomy – a non-invasive procedure using focused ultrasound energy to create a lesion in the thalamus, primarily used for tremor in patients who are not suitable for DBS
Why Do Sri Lankan Patients Choose India for Parkinson’s Treatment?
- Amrita Hospitals is Asia’s first centre to perform robotic-assisted DBS implantation using the ROSA system – a landmark achievement reflecting genuine subspecialty leadership
- Dedicated movement disorders programme with neurologists and neurosurgeons experienced in the full management of Parkinson’s disease
- Comprehensive pre-surgical evaluation including DaTscan, neuropsychological testing, and levodopa challenge assessment
- Post-operative DBS programming and follow-up – with remote programming options available for patients who return to Sri Lanka
You can learn more about the broader range of neurological treatments available in our article on Brain Tumour Treatment in India: Surgical and Radiation Options for Sri Lankan Patients, which outlines the depth of neurosurgical expertise at Amrita Hospitals.
To understand all available neurosciences services, explore the neurosciences and movement disorders specialities at Amrita Hospitals.
How Do Sri Lankan Patients Access Parkinson’s Treatment in India?
- Gather your current medical records – neurologist letters, medication history, MRI or DaTscan reports
- Share these with Amrita Info Centre Sri Lanka for forwarding to the movement disorders team
- Receive an initial assessment on DBS candidacy and recommended evaluation steps
- Travel to Amrita Hospitals for the pre-surgical evaluation
- Proceed to surgery based on the evaluation outcome
For patients managing the visa process, our guide on the Complete Guide to Medical Visa for India from Sri Lanka provides a detailed overview of documentation and application steps.
To start the process, reach out to our team through the contact page and we will respond with clear guidance on next steps.
Frequently Asked Questions
Is DBS surgery reversible? Yes. One of the important features of DBS is that it is reversible and adjustable. The stimulator can be turned off, and the electrodes can be removed if necessary, unlike ablative procedures that permanently destroy brain tissue. Stimulation parameters can also be adjusted non-invasively over time.
How long does DBS surgery take? The electrode implantation procedure typically takes 3 to 5 hours. The pulse generator implantation is a shorter procedure, usually taking 1 to 2 hours. Both stages may be performed on the same day or on separate days depending on the patient’s condition.
How long will I need to stay in India for DBS surgery and follow-up? Most patients require a total stay of approximately 2 to 3 weeks in India, covering pre-operative assessment, surgery, initial recovery, and the first programming sessions. Further remote programming follow-up can be arranged for patients after they return to Sri Lanka.
Does DBS work for all types of Parkinson’s disease? DBS is most effective for classic Parkinson’s disease with good levodopa response. It is generally not effective for atypical parkinsonian syndromes such as multiple system atrophy or progressive supranuclear palsy. Accurate diagnosis is essential before DBS is considered.
Will I still need medication after DBS? Most patients continue to take Parkinson’s medication after DBS, but the doses required are often significantly reduced. The combination of DBS and reduced medication typically provides better symptom control than either approach alone.
Can the DBS device be affected by other medical procedures? Certain medical procedures, including some types of MRI and diathermy (surgical electrocautery), require special precautions in patients with DBS devices. Patients are given detailed guidance on this before and after implantation, and the treating team at Amrita Hospitals coordinates with any other healthcare providers involved in the patient’s care.
Conclusion
Parkinson’s disease treatment in India offers Sri Lankan patients access to a full spectrum of neurological care – from expert medication management through to robotic-assisted DBS surgery at a centre with a proven record in this subspeciality. For patients whose symptoms are no longer adequately controlled by medication alone, a formal DBS evaluation is a well-supported and evidence-based next step.
Amrita Info Centre Sri Lanka is ready to support you through every stage of that process, from sharing your reports to returning home after treatment.