Deep Brain Stimulation for Parkinson's Disease: Timing, Targets and Cost

Complete spinal cord injuries will not result in complete neurological recovery, and some patients recover only minimally. What we can address is the secondary symptoms: pain and spasticity, managed with baclofen or morphine pumps, and dorsal cord stimulators, which can improve sensation and reduce spasticity, with some incomplete-injury patients regaining a degree of leg power combined with physiotherapy. If hand function is preserved, we train patients to manage daily life with their upper limbs and a wheelchair. But for complete injuries specifically, meaningful motor recovery is not something we can promise.

I conducted a study on this myself — we took stem cells from the iliac bone and implanted them at the injury site in around 20 patients. One patient showed some improvement, but it couldn't be separated from natural recovery under medication, and statistically we found no significant benefit. We discontinued the trial. Stem cell therapy for complete spinal cord injury is still not recommended anywhere in the world; for partial injuries there may be some benefit, but meaningful recovery from stem cells in complete injuries has not been demonstrated.

Awake craniotomy, used for tumours near the motor cortex or speech areas, requires full patient cooperation throughout — some patients become agitated under partial sedation and we've had to convert to general anaesthesia. For international patients, a translator has to be present in the operating room the entire time, which adds another layer of difficulty. Personally I'm not very keen on it given how demanding it is for the patient; we now prefer using preoperative functional MRI to map eloquent areas and then operate under general anaesthesia while avoiding those mapped regions, which reduces the need for awake craniotomy in many cases.

Small vertebral hemangiomas are benign and don't require treatment unless they cause problems. If it's a large hemangioma involving the pedicle, causing vertebral body destruction, or resulting in a fracture or neural compression, then decompression and spinal fixation are required. Share the MRI report with the Jivo team and we can assess based on size and extent.

Communication is key. I'd suggest two things: topic-oriented sessions on one specific subject at a time — lumbar spine surgery, or brain tumours — where everyone shares experience and problems and we learn from each other, since doctors from Africa and India face similar socioeconomic challenges. And continuous feedback after a patient returns home: the local doctor monitors recovery and communicates with us on repeat imaging and medication adjustments. That collaboration, by WhatsApp or email at any time, directly improves outcomes.

Around 4 to 5 years after diagnosis, when the required medication dose is escalating, side effects are mounting, and the drug effect is starting to fade.

The subthalamic nucleus, localised through anatomical targeting on preoperative MRI, microelectrode recording of characteristic brain wave patterns, and intraoperative clinical testing where the patient performs specific movements to confirm the electrode is placed correctly.

The all-inclusive package at BLK-Max, covering surgery, anaesthesia, device, medicines, testing and hospital stay, runs approximately USD 30,000 to 35,000.

Non-rechargeable batteries need replacement every 5 to 7 years. Rechargeable systems last around 15 years, and newer devices allow settings to be adjusted remotely by mobile.

Yes. It is also used in dystonia, in intractable epilepsy via the anterior thalamus with 70 to 80% effectiveness, and in select, variable cases of psychiatric conditions such as OCD.