Sakshi Sarda, a resident of Gulbarga (now Kalaburagi, Karnataka) who has been in a ‘minimally conscious state’ (a type of coma) for the last 30 months, got an eight-contactpoint electrode (implant) fitted at the base of her skull, at Jaslok Hospital on Pedder Road on October 1. “I am going to be positive and presume God wants Sakshi’s 100% recovery,” her husband, Sampat Sarda (42), told TOI over the phone about the neurostimulator surgery.
Her neurosurgeon, Dr Paresh Doshi, said Sakshi’s hands were less stiff days after the surgery. “She should make progress within the next six months, perhaps get movement in her hands and face,” he said, adding that it is the first time spinal cord stimulation surgery was used for such a patient in India.
Functional neurosurgery using electrodes have been around for decades. In Japan and the US, doctors have placed electrodes in the brain (called deep brain stimulation) or the spine (spinal cord stimulation) of patients in vegetative state to get “mixed results”.
In 2012, doctors from Nihon University School of Medicine in Tokyo showed improvement in seven out of the 10 patients in vegetative state using spinal cord stimulation. A 22-year-old motorcycle accident victim could not only talk, he could even solve the Rubik’s cube within 12 months of the operation. Another 37-year-old man learnt to play the guitar. None could, however, regain functionality of their legs.
It was after reading such medical articles that Sampat, who is in the agri business, got the idea of stimulation surgery. “My wife suffered a long-duration epileptic attack in April 2018 and went into cardiac arrest,” he said. Local doctors revived her in 45 minutes, but she suffered brain damage due to a lack of oxygen to the brain in that period.
She has since been in “minimally conscious state” — when a patient has periods in which he/she can respond to commands such as move a finger. “In the last 30 months, we have tried to keep Sakshi in a stimulated environment. We take her around in a wheelchair, move her in the bed every few minutes so that she doesn’t develop bedsores,” said Sampat, adding that she also underwent extensive physiotherapy.
Sakshi’s blank stares slowly improved; she would cry when her husband, 17-year-old daughter or 15-yearold son left her side. “Now, the question was about further improvement,” said Sampat.
That is when their physiotherapist Devidas Patil found out about Dr Doshi, who has performed DBS for conditions ranging from Parkinson’s to depression. “We talked to the doctor for three weeks before it was agreed we would reach Mumbai for an evaluation and surgery if possible,” he said.
Keeping the Covid-19 pandemic in mind, the family travelled to Mumbai in an ambulance on September 27. Sakshi’s neurophysiological functions were then evaluated. “We had to check the blood flow in the brain as well as nerve connections to understand she would benefit from a spinal cord stimulation,” said Dr Doshi.
On October 1, pain specialist Dr Preeti Doshi used X-ray guidance to place the eightcontact point electrode at the base of the skull. A pacemaker was also implanted to increase or decrease stimulation. The family left for Gulbarga on October 10, spending Rs 12 lakh on the surgery. “We have restarted physiotherapy and can already see changes. She now seems express her emotions on her face. We are hopeful,” said Sampat.
A senior neurologist in Mumbai said such surgeries should be seen as the lastditch attempt of a desperate family. Dr Deepak Arjundas, senior neurologist from Apollo Hospitals in Chennai, told TOI he had observed a patient operated by Japanese neurosurgeon Tetsuo Kanno (who used to treat the late Tamil Nadu chief minister M G Ramachandran) in Japan in 1989. The patient, a doctor, was left in a vegetative state after a severe asthmatic attack.
In the 12 weeks that Dr Arjundas was there, the patient learnt to sit up and move his hands. “Spinal stimulation improves blood supply to the thalamus and improves brain function,” he said. It is meant for patients below 60 who can afford rehabilitation services, he said.