Parkinson's disease is a progressive disorder of the nervous system that affects voluntary movement.
Symptoms vary person to person and typically affect one side of the body first , even as they worsen. Traditionally total cure was never possible and patients were put on medications to manage their worsening symptoms.
Parkinson disease can progressively affect quality of life , with symtomps such as:
Tremor - Tremor in a limb, often in the hand or fingers at rest, a back-and-forth rubbing of your thumb and forefinger, known as "pill-rolling"Slowed voluntary movement (bradykinesia) - Reduced ability to move and walk, and dragging feet with smaller steps as well as difficulty in rising from sitting/getting out of a bed/chairOrthostatic hypotension - Lightheadedness or dizzy when standingRigid muscles - Muscle stiffness and abnormal tone in the body limiting your motion and causing painImpaired posture and balance - Stooped posture, unsteady balanceLoss of automatic movements - Decreased facial movement like blinking, smiling or swinging your arms when you walkDysarthria - Difficulty in speaking and speech-related problems like speaking softly, quickly, with a slur or hesitation, monotonous without inflectionsDysphagia - Difficulty in swallowingWriting changes - Difficulty to write, and writing may appear small.
A: As on date, there is no permanent solution found for Parkinson's disease. Medications are the most beneficial form of treatment. Some medications for PD are given below:
Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of neurological symptoms-most commonly the symptoms of Parkinson's disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, a common neurological movement disorder. DBS does not damage healthy brain tissue by destroying nerve cells. Instead the procedure blocks electrical signals from targeted areas in the brain.
DBS is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. It is primarily utilized for patients who have Parkinson's disease, dystonia, or essential tremor (ET), and who canâ€™t adequately control their disease with medication.
For those with Parkinsons's, DBS can reduce tremors and significantly improve slowness and stiffness; and make tremors disappear for those with ET. DBS can help relax muscles and improve abnormal postures caused by muscle contractions for those with dystonia. In all cases, DBS can help enhance quality of life.
It's important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects.
Am I a good candidate?
There are somewhat different criteria for determining if DBS is a good option for you based on your diagnosis and condition. For Parkinsons disease, DBS is typically helpful if you experience motor fluctuations or tremors that interfere with activities that are not already adequately managed by medication, are not improved by changes in medication, or you experience side effects that prevent you from taking higher doses. For ET, DBS may be considered if you have tremors that interfere with your quality of life and cannot be controlled adequately with medications. Other key factors considered are age in combination with general health, a solid support system of family and friends, absence of dementia or an active psychiatric illness such as severe depression, and realistic expectations for treatment outcomes.
Before any patient is considered for DBS surgery, they are evaluated by the U-M Surgical Therapies Improving Movement (STIM) multidisciplinary team, which has extensive training in DBS. The STIM team includes a neurosurgeon, neurologist, clinical neuropsychologist, speech pathologist, social worker, and other team members who ensure that you and your family understand the procedure and discuss your expectations and concerns.
MRI Brain is done one day before surgery to see the deep nuclei (subthalamus) of brain.
Patient is kept off medication for 12 hrs.
This surgery is done under local anesthesia and sedation.
On the day of surgery Stereotactic frame (Leksell, ZD Frame) is fixed
under local anesthesia, and then patient is taken to Radiology
Department for CT Scanning.
The subthalmic target is calculated by fusing CT Scan and MRI images on work station.
In the operation theatre two small holes in th skull are made, Micro electrode recording is done using 5 channel MER. After analyzing the recording of MER, the track which has longest and strongest signal of sub thalamus chosen for the stimulation. If stimulation confirms the reduction of tremor,stiffness and slowness in operation theatre DBS lead is placed in that track using C-arm.
DBS lead is placed in that track using C-arm.
DBS lead is connected to IPG (Kinetra, Libra XP "Non Reahcrgeable" and Braio "Rechargeable") under general anesthesia. This procedure is done on the same day or can be done after one day under general anesthesia.
After the Deep Brain Stimulation electrodes implantation, the next important step of this surgery is programming. Initial programming is done in two weeks time and later-on further programming is done as out patient basis in subsequent visits.Patient can himself programme using hand held patient's programmer under guidance of a neurologist or programming assistant.
The cost of Parkinson’s disease treatment in Iran start from $6000 and deep brain stimulation surgery cost start from $8000. The cost may vary depending on the type of treatment opted by the patient, number of travelers, number of days required for treatment and more.
It is a progressive neurological disorder of the brain. It was first defined by Dr. James Parkinson. He wrote a paper “Essay on the Shaking Palsy” in 1817 in which he first described this disease. The average age of start for Parkinson’s disease is 60 years; however, it can be found in people much younger.
A: When the area of the brain identified to be substantia nigra encounters with impairment of nerve cells, Parkinson's disease is caused at that point in time. These nerve cells while functioning normally produce a vital brain chemical known as dopamine. Dopamine acts as a chemical messenger that communicates between the substantia nigra and another area of one's brain known to be basal ganglia. Smooth and balanced movement of muscles is possible by this communication. A deficiency of dopamine makes abnormal nerve functioning that causes inability to control body movements.
A: Parkinson's disease is not fully curable so far as modern medical science is concerned.But, by detecting individual symptoms and regulating a proper course of treatment, many patients with the disease can live a comfortable life.
Till date, no way is found to prevent Parkinson's disease. But, options like, drug therapy, surgery can lower the symptoms, and make life with the disease easier.