Parkinson's Disease

WHAT IS PARKINSON’S DISEASE?

Parkinson's disease is a condition which results from a loss of dopamine in the substantia nigra of the brain stem.

Parkinson’s disease affects 1% of people aged over 50 years. Sometimes it affects younger people. In most cases the cause is unknown.

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What are the symptoms of Parkinson’s disease?

The three main symptoms of Parkinson’s disease are usually tremor, stiffness and slow movement. Patients often develop medication-related side-effects such as dyskinesias (‘wriggles’), and may fluctuate wildly from being almost ‘frozen’ to experiencing uncontrollable and unintended movement. Walking problems are very common.

How is it treated?

Parkinson's disease is treated in the first instance with medications, such as levadopa (Sinemet®). Unfortunately, the effectiveness of such medications may decrease over a number of years, and they may also cause other abnormal involuntary movements.

What are the reasons for surgery?

When medications are no longer working well, or their side effects are too severe, surgery may help. The procedure most commonly used to treat Parkinson's disease is deep brain stimulation (DBS).

Clinical studies and experience suggest that surgery should be considered earlier rather than later. This is due to the high likelihood of developing severe medication side-effects with long-term treatment. Better outcomes are typically experienced with earlier surgery, and there is a higher chance of avoiding, delaying or minimising the economic and social side-effects associated with advanced Parkinson’s disease.

What are the alternatives to surgery?

At present, the only alternatives to surgery are medications. You should check with a movement disorder neurologist to make sure that you have tried all of the appropriate medications before seriously considering surgery.

What do you need to tell the doctor before surgery?

It is important that you tell your surgeon if you:

  • Have blood clotting or bleeding problems
  • Are taking aspirin, warfarin, or anything else (even some herbal supplements) that might thin your blood
  • Have high blood pressure
  • Have any allergies
  • Have any other health problems

What is deep brain stimulation?

Deep brain stimulation works by inserting fine wires (electrodes) into one of three sites in the brain that are important in Parkinson's disease. These are the subthalamic nucleus (STN), the thalamus, and the pallidum. The STN is the most common structure targeted.

DBS works by reducing the activity of these tiny areas that are overactive in Parkinson's disease. DBS helps to slow these parts of the brain down because the electrical pulse inhibits the activity in the brain surrounding the wire.

What are the benefits of deep brain stimulation?

The aim of DBS is to relieve some of the problems caused by Parkinson's disease, such as tremor, stiffness, slowness, and uncontrolled movements (dyskinesias). It tends to reduce motor fluctuations and increases the amount of time spent "on". It also allows most patients to reduce their medications, often by a substantial amount.

Who may benefit from surgery?

Surgery can significantly improve the quality of life for patients with Parkinson’s disease. However these operations are not suitable for all patients and thorough assessments must be carried out to ensure that the likely benefits of surgery outweigh the risks.

A suitable patient for consideration for surgery may be as follows:

  • Parkinsons disease without unusual features that has responded to dopamine medication at some stage
  • Failed optimum medical therapy
  • Disabling drug-induced dyskinesias

How successful is surgery?

Surgery for Parkinson's disease frequently results in a reduction in the symptoms and signs of this condition, and an improvement in quality of life. Some patients are able to return to their previous occupation following successful treatment. Surgery does not return you to "normal" however, and it is important that you understand this before going ahead. Overall, of the patients selected for surgery, around 80-90% will significantly benefit.

How long will the benefits last?

This will vary from patient to patient. Typically, patients obtain a benefit for 5-8 years or longer. The benefit gradually decreases with time (due to progression of the underlying disease). A small proportion of patients may benefit from repeat surgery if the benefits drop off.

What should you notify your doctor of after surgery?

  • Increasing headache
  • Fever
  • Swelling or infection of the wounds
  • Leakage of fluid from the wound
  • Fitting (seizures)
  • Abnormal sensations or movements in your face, arms or legs
  • Weakness or numbness
  • Drowsiness
  • Any other concerns