BENGALURU: In yet another case of restoring neural functions in musicians with dystonia, a team of doctors at a private hospital successfully conducted an awake brain surgery on a patient with 'guitarist dystonia.'
The patient, 65-year-old guitarist Joseph D'Souza, was awake during the seven-hour surgery and played the guitar while he was being operated upon. "We ask such patients - who are musicians - to perform music while being operated on to help us locate the troubled circuit inside the brain, which does not show up in MRIs," said Dr Sharan Srinivasan, stereotactic & functional neurosurgeon, PRS Neurosciences, Bhagwan Mahaveer Jain Hospital (BMJH).
He, along with Dr Sanjiv CC, senior neurologist and movement disorders specialist, BMJH, successfully performed their third awake brain surgery, this time on D'Souza from Los Angeles and "found 100 per cent instant solution on the operation table for guitarist dystonia," said Srinivasan, popularly known as 'the guitar surgeon.'
D'Souza is the third musician patient, who underwent the awake brain surgery at the hands of Srinivasan, Sanjiv and their team after Abhishek and Taskin Ali, from Bangladesh. "All three were guitarists and had a common problem of focal hand dystonia. D'Souza had guitarist's dystonia - a type of Task Specific Focal Hand Dystonia (TSFHD) for which there is no known cure," said Srinivasan.
Explaining the procedure, the neurosurgeon said, "In the MRI-guided, stereotactic neurosurgery we performed a Vo Thalamotomy using RF (Radio Frequency) current. This means ablating or 'burning' a circuit inside the brain. This live surgery involved the patient being fully awake through the entire process. It involved fixing a titanium, stereotactic frame to the head, with two screws in the front and two screws at the back of the head, screwed into his skull and then capturing a special 'stereotactic MRI' of the brain," he explained.
"The MRI images were loaded onto a specialised software wherein the probable 'misbehaving brain circuit' deep inside the brain was identified and mapped. The moment the target spot was stimulated, Joseph experienced mild numbness/ paresthesia in the left 4th and 5th fingers. These were his problem fingers! This meant that we were spot-on with our targeting. Then we made the '7 burns', one after the other, along three different trajectories and he began experiencing progressive improvements in his guitarist dystonia and by the fifth burn, he said he was 'near normal'," said Srinivasan.
"TSFHD is a neurological condition due to involuntary contractions of the muscles of the hand and the fingers leading to abnormal posturing, thereby patients cannot perform their professional work. Common examples are writer's cramp, musician's (guitar) and golfer's dystonia. The prevalence rate is approximately 30 per one lakh population. It can be treated initially with various medications. The severe forms ultimately need to be treated with neurosurgery like Vo thalamotomy," said Sanjiv.
D'Souza started facing difficulty in playing the guitar in 2004. "The ring and pinky fingers in my left hand would curl into my palm uncontrollably. I had no pain, no numbness, no tingling sensation, nothing at all. The condition worsened and I struggled to play simple basic chords. I was first diagnosed with Guitarist's Dystonia by a doctor at UCLA Los Angeles. In 2017, my friends shared a video of a guitarist (Abhishek) undergoing surgery in Bengaluru for a condition that was very similar to mine and that gave me hope. I hunted for Abhishek's contact details, and after speaking to him, was convinced that the surgery could work for me as well. I was, however, skeptical and delayed it for seven more years," said D'Souza.
"Eliminating dystonia is the first step, but the patient now has to re-skill himself. And this can take many months or even longer," said D'Souza's neurosurgeons