What is Parkinson’s disease and how is it treated?
Parkinson’s disease is a “degenerative disease” affecting the brain. “Degenerative diseases” are a group of disorders which result from progressive and premature death of nerve cells in the brain.
“Alzheimer ’s disease” which causes progressive memory and cognitive (intellectual) decline in the elderly, is the commonest and the most popularly known degenerative disease.
Parkinson’s disease is yet another degenerative disease and is next only to Alzheimer’s disease in commonness. In Parkinson’s disease, the nerve cells predominantly affected are those concerned with posture of the body and movement; patients with PD, therefore, have predominantly movement related symptoms (tremor, slowness of activities, stiffness of limbs, loss of balance and difficulty to walk etc.). However the disease process in PD is not solely confined to the areas of brain controlling movement. Other areas like those concerned with sleep, mood, autonomic functions (like control of blood pressure and urinary bladder functions), behavior and intellect could also get affected to a variable degree.
Abnormal functioning of these areas of the brain can result in ‘non-motor’ manifestations like--- • A variety of sleep disturbances, depression, anxiety, psychiatric symptoms, and incontinence of urine and memory dysfunction, in addition to the well- known movement-related (motor) symptoms in Parkinson’s disease.
It is unfortunate that the reason and mechanism of nerve cell death in Parkinson’s disease (or any other degenerative disease) have not so far been clearly discovered by medical scientists in spite of intense extensive research going on all over the world. As it is not clear as to why or how the nerve cells die, there are no treatments available to modify this process (premature demise of the nerve cells) and thereby, to cure or at the least, arrest the progression of the disease. Therefore, the treatment of all degenerative diseases (including PD) are currently confined to and aimed at controlling the symptoms and improving the patient’s functioning and quality of life. The diagnosis of PD is largely clinical, and is arrived at by a careful analysis of the patient’s history, clinical examination, and the response to treatment. As of now, there is no laboratory investigation or imaging study (“scan”) which confirms the diagnosis of PD with 100% accuracy, excluding all other conditions. Certain other rarer degenerative disorders (eg: Progressive Supranuclear palsy (PSP), Multiple System Atrophy (MSA) etc- together lumped as “atypical Parkinsonisms” or “Parkinson Plus” syndromes) have symptoms very similar to Parkinson’s disease initially. In some cases, a careful observation of the patient, and his / her response to treatment over a period of time (sometimes a few years) may be necessary to reach a conclusion regarding whether it is PD or “Atypical Parkinsonism”. However, as there is no specific curative or “progression-preventing” treatment available to any of these degenerative diseases, the initial, inevitable delay in making a confidant diagnosis does not do any harm to the patient. The atypical Parkinsonisms as a whole respond poorly to medical treatment and do not improve with Deep Brain Stimulation. The recommended treatment of patients with PD in early stages is medical (i.e., with oral medications), aimed at relieving the movement-related (“motor”) and other “non- motor” symptoms resulting from the disease. As discussed above, there is no currently available treatment to restore the cells which have died off or to prevent further damage to the brain by arresting further nerve cell death. All the currently available “symptomatic” treatment modalities aim at correcting the chemical deficiencies in the brain resulting from loss of brain cells (which are the natural source of these chemicals). The most important chemical substance which becomes deficient in the brain is called ‘dopamine’ and the most important medicine used in the treatment of PD, called ‘Levodopa’ acts by replenishing this chemical in the brain. Thus the currently available treatment modalities only relive the patient’s symptoms and improve the quality of life. None of them can prevent the disease from worsening over the course of time As the disease progresses, the patient is likely to require more and more medications to control the symptoms. A condition called ‘motor fluctuation’ develops - three or four doses of medications fail to give relief to symptoms through-out the day. Each dose of Levodopa will result in a period of “On” characterized by relief of symptoms. This is followed by an “Off” period where all the symptoms recur. The patient will have to take the next dose to turn “On” again. The duration of improvement with each dose of medication gradually comes down with passage of years and the patient will require more and more number of doses to remain active throughout the day. Parallel to this, a gradual worsening of the difficulties during “off” time also occurs. Another problem faced with in this stage is ‘drug induced dyskinesia’. This is characterized by abnormal, excessive ‘dancing’ movements of the body during the period when the patient is experiencing the beneficial effects of the drug (“On” period). The severity of the dyskinesias and the resulting disability also worsen slowly with passage of years. Finally, a stage is reached where the treatment with medicines becomes difficult and impossible to tailor further, as any reduction in dose (aimed at controlling dyskinesias) leads to worsening of symptoms of PD and any increase in dose to relieve the PD symptoms result in worsening of the abnormal excessive “dyskinetic” movements.
What is Deep brain stimulation (DBS)?
Deep brain stimulation is a surgical procedure done in “intermediate” stages of Parkinson's Disease when medical therapy alone fails to control the patient’s....
What are the beneficial effects of doing DBS?
Deep Brain Stimulation is a modern surgical treatment modality used for the treatment of patients with Parkinson’s disease (PD).
What is the effect of DBS on the non motor symptoms of Parkinson's Disease?
Deep Brain Stimulation may give partial improvement to some of the non motor symptoms of PD...
What is the effect of DBS on progression of Parkinson's Disease?
DBS is not a cure for PD or a remedy to arrest the progression of the disease and maintain the same state...
How is the Deep Brain Stimulator system implanted?
The system is implanted by the Stereotactic Neurosurgeon with clinical and electrophysiological guidance...
What are the complications of Deep brain stimulation surgery?
The surgical procedure is associated with complications like bleeding inside...
What are the types of Neurostimulators? Is there any need to replace the Neurostimulator?
wo types of Neurostimulators are available- rechargeable and non-rechargeable.
Disclaimer: The information provided here should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. The information is provided solely for educational purpose and should not be considered a substitute for medical advice.
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