Awake brain surgery turns ‘20 years of agony into a symphony’ for guitarist from USA

Doctors at Bhagwan Mahaveer Jain Hospital, where he underwent surgery on October 22, said the patient was fully awake and played the guitar during the seven-hour surgery to give them feedback to locate the exact place of the target to be corrected in his brain. 
| Photo Credit: special arragement

Music was life for this 65-year-old guitarist from Los Angeles. He learnt to play the guitar at six and took it up as his profession. But fate had other plans for him. He developed Guitarist’s Dystonia, a type of Task Specific Focal Hand Dystonia (TSFHD), and struggled to play simple basic chords. After living for around 20 years with this condition, the guitarist – Joseph D’Souza – is all eager to resume his musical career after an awake brain surgery in Bengaluru.

TSFHD is a neurological condition due to involuntary contractions of the muscles of the hand and the fingers, leading to abnormal posturing, thereby affecting the patients’ profession. Common examples are writer’s cramp, musician’s (Guitar) and golfer’s dystonia. The prevalence rate is approximately 30 per one lakh population.

Doctors at Bhagwan Mahaveer Jain Hospital, where he underwent surgery on October 22, said the patient was fully awake and played the guitar during the seven-hour surgery to give them feedback to locate the exact place of the target to be corrected in his brain. Discharged from the hospital on October 26, the patient now needs around three months of neuro-rehabilitation.

Career cut short

“I played for a renowned band at the age of 20. It took me places, and I became a musician and settled down in the USA. Everything was going well till 2004, when I started facing difficulty in playing. That was when the world fell apart for me. I developed this issue in my left hand – ring and pinky finger. The fingers would curl into my palm uncontrollably. I had no pain, no numbness, no tingling sensation, nothing at all,” said Mr. D’Souza. 

“The condition worsened, and I could not play even basic chords. After four years of struggle, a doctor at UCLA Los Angeles diagnosed my condition to be Guitarist’s Dystonia. I remember the doctors’ words that there is no known cure for my condition,” he recalled.

Fortunately for him, in 2017, he came across a video of a guitarist, Abhishek, undergoing surgery in Bengaluru for a similar condition. “I managed to get him, spoke to him about my condition and was convinced that it would work for me too. But I was very sceptical of undergoing brain surgery and hence delayed it for seven more years, thus living with this condition for 20 long years,” he said.

Mr. Abhishek from Bengaluru and another guitarist, Taskin Ali from Bangladesh, who were also suffering from Guitarist’s Dystonia, underwent awake brain surgeries at the same hospital in 2017 and 2018 and got relief. 

All these three guitarists, including Mr D’Souza, were operated upon by Sharan Srinivasan, Stereotactic and Functional Neurosurgeon and  Sanjiv C.C., Senior Neurologist and Movement Disorders Specialist at PRS Neurosciences, Bhagwan Mahaveer Jain Hospital.

How it is done

“MRI-guided, stereotactic neurosurgery is performed by functional neurosurgeons. Here, we performed a Vo (Ventralis Oralis) Thalamotomy using RF (Radio Frequency) current. This means ablating or burning a circuit inside the brain. This live surgery involves the patient being fully awake all through the entire process of seven hours,” said Srinivasan.

“The surgery involves 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. Then, these MRI images are loaded onto a specialised software wherein the probable ‘misbehaving brain circuit’ is identified and mapped,” the doctor explained.

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