Bengaluru March 5, 2021: In a boon to patients of Parkinson’s Disease, advanced third-generation D-mine apomorphine pumps and pens (injections) manufactured by German pharma major Ever Pharma have been launched in Bengaluru by Celera Neuro Sciences. The state-of-the-art apomorphine-delivery devices, widely used in Europe, were unveiled by Dr. K Sudhakar, Hon’ble Minister of Medical Education & Health, Govt. of Karnataka, at the ongoing symposium on Parkinson’s Disease in Bengaluru, organized by King’s College London (KCL) and Parkinson’s Research Alliance of India (PRAI).

Said Dr. Babu Narayanan, Medical Director, Celera Neuro Sciences which has brought the products to India after getting DCGI approval: “Parkinson’s patients in India till now had only two options: oral pills for early stages of the disease, or Deep Brain Stimulation (DBS) surgery for advanced stages. There was no other treatment available. These latest-generation European apomorphine-delivery devices fill this gap and offer an important medical option in the management of Parkinson’s Disease and improving quality of life. They ensure much better outcomes for patients who haven’t achieved optimum benefits with available drugs or are suffering from side-effects of oral medications.”

Said Bengaluru’s renowned Parkinson’s Disease specialist Dr. Prashanth LK: “India is emerging as a hot spot for Parkinson’s disease. Unlike most ageing-related disorders, Parkinson’s has many effective treatment options available. Apomorphine infusion therapies and rescue injections (pens) are the current state-of-the-art therapies for people with moderately advanced Parkinson’s disease. The PRAI-KCL collaboration has helped bring these advanced German devices to India for apomorphine therapy. These can be used as rescue therapies in people having unpredictable responses to oral medications, or as an infusion therapy for those requiring steady phase medication responses.”

Added Dr. Babu Narayanan: “Most patients in India cannot afford DBS. This procedure is also not a choice for all ages or stages of Parkinson’s Disease. Apomorphine is recommended for patients who have started to have motor fluctuations, which means the effect of oral medications is not lasting long enough. It is also an effective alternative for patients who are not the right candidates for DBS, or those who want to avoid surgery. In fact, international guidelines now recommend use of apomorphine therapy before considering DBS for patients. We are now in the process of opening clinics in hospitals all over India in collaboration with prominent neurologists who will administer apomorphine therapy to patients with these latest-generation Western pumps and pens.”

Also Read: DBS Surgery – a latest technology for Parkinson

The current apomorphine pumps available in India are not patient-friendly and lack reliability. For example, patients need to refill them after breaking up to 20 ampules of apomorphine, which is difficult to do with trembling hands. In contrast, the third-generation D-mine apomorphine pumps, widely used in Europe, can be self-handled by patients in five easy steps, with much less patient training needed. The pump-filling process is controlled electronically, with much higher safety and convenience, compared to pumps which are operated manually, with cumbersome procedures. D-mine pumps are pre-filled and offer continuous infusion of apomorphine, leading to absorption within five minutes. The oral pill burden of patients also comes down substantially.

Parkinson’s patients need to take medications at timely intervals, which often leads to fluctuating levels of medication in their bodies and irregular benefits. Continuous Dopaminergic Therapy is a method by which the body receives dopamine on a continuous basis, because of which fluctuations associated with medications are negated significantly. With the launch of D-mine apomorphine continuous-infusion pumps and injection pens, Indian patients can now benefit from Continuous Dopaminergic Therapy, which till now was available only in Western countries.

The current prevalence of Parkinson’s Disease in India is around 300-400 out of 100,000, which is expected to double by 2030. It will be a major non-communicable degenerative disorder along with dementia to burden the healthcare system of India. Though majority of the patients are above 50 years of age, its incidence in younger population is also on the rise.

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Epilepsy is the fourth most common chronic disorder of the brain characterized by recurrent ‘seizures’ or ‘fits. The seizures are caused due to sudden, excessive and abnormal electrical discharges in the brain cells. It can affect people of all ages; however, each individual has its unique concerns and problems.

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neuro-biologic, cognitive, psychological, and social consequences of this condition.

Epilepsy affects one’s overall health, safety

Having seizures and epilepsy can definitely affect one’s overall health, safety, relationships, work, etc., but the public perception of people with epilepsy and stigmas attached with the neurological disorder are often more traumatic than actual seizures.

This differentiation is crucial for better outcomes in treatment as non-epileptic events usually do not respond well to antiepileptic medications, and misdiagnosis leads to delay in initiating appropriate therapy. Confirming or ruling out epilepsy not only prevents unnecessary treatment and exposure to interventions but also reduces patient and family anxiety and possibly unnecessary stigma.

According to World Health Organization (WHO), about 50 million people have epilepsy across the world, out of which approximately 10 million people are in India. Although epilepsy is treatable, yet three-fourth of affected people in developing countries fail to receive the required treatment on time- it could be due to lack of resources or ignorance and lack of awareness.

India is home to about 10 million people with epilepsy.

Worldwide, it is estimated that 10·5 million children under 15 years have active epilepsy, representing about 25% of the global epilepsy population. Of the 3·5 million people who develop epilepsy annually, 40% are younger than 15 years, and more than 80% live in developing countries. India is home to about 10 million people with epilepsy.

A recent meta-analysis of published and unpublished studies puts the overall prevalence rate of epilepsy in India at 5.59 per 1,000 population. The prevalence has been found to be 1.9% in the rural population as compared with 0.6% in urban population. There are very few incidence studies from India, and the most recent one suggests an age standardized incidence rate of 27.3/100,000 per year

Management and treatment 

Unlike some bizarre and strange notions/stories prevalent about epilepsy in our country, we need to highlight it as a serious medical condition which requires immediate medical intervention and is mostly treatable with medications, particularly anticonvulsant drugs. The critical thing about epilepsy is that one should not delay and initiate the treatment as soon as it is diagnosed. This can prevent any further deterioration of the condition.

Usually the type of treatment prescribed will depend on several factors, including the frequency and severity of the seizures and the person’s age, overall health, and medical history, etc. But, if the seizures are not controlled through medicines, a surgery may be recommend. Infact, for thousands of epilepsy patients, brain surgery can be the best option to end seizures. It may significantly improve patient’s quality of life.

Numerous types of surgery are available to treat epilepsy including:

1. Resective Surgery – It is the most common type of surgery for treating epilepsy. Using resective surgery, a surgeon can surgically remove the part of your brain where seizures happen. They remove an area, a brain lesion or a brain lobe, which is roughly the size of a golf ball. The most common type of resective surgery is a temporal lobectomy. It is also the most successful form of surgery for epilepsy which reduces the number of seizures while limiting your risk of permanent brain damage.

2. Deep Brain Stimulation Surgery – Deep brain stimulation (DBS) therapy is a surgical treatment which aims to reduce seizures not controlled with medication and where surgery to treat the cause of seizures is not possible. It is ideal for people whose epilepsy is difficult to treat, and who cannot have epilepsy surgery to separate or remove the part of the brain that causes seizures. DBS therapy involves implanting electrodes into specific areas of the brain, and then stimulating these areas with small regular electrical impulses.

Dr. Sumit Singh
Director, Neurosciences
Agrim institute of neurosciences
Artemis Hospital, Gurugram

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