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Parkinson’s Disease

Parkinson’s Disease

Parkinson’s disease is a neural degenerative disorder. It results from a progressive loss of dopamine secreting cells. Due to the loss of dopamine, the body movement of people with Parkinson’s disease is affected. This affects the nigrostriatal tract. Parkinson’s is an incurable disease. The progression of the disease can be slowed down using the most advanced medications and treatment techniques.

 

 

Parkinson’s Symptoms

Parkinson’s disease has a collection of symptoms including:

  • Tremors
  • Rigidity
  • Reduced or decreased movement
  • Impaired gait or ability to walk
  • Change in speech
  • Loss of automatic movements
  • Change in writing

Causes of Parkinson’s Disease

The disease can be caused due to genetic as well as environmental factors.

  • Genetic mutation either causes cell demolition or indecent cell function. Parkinson’s disease has an impact on the nerve cells, which are responsible for the production of dopamine in the body. Dopamine is responsible for controlling the motor functions of the body. Insufficient dopamine production affects the movements of the body.
  • Environmental factors such as extended hazardous chemical exposure and serious brain injury can lead to Parkinson’s disease.

Risk factors

Various factors increase the chance of Parkinson’s disease including the following:

  • Gender: Men are more susceptible than women.
  • Age: Patients above the age of 60 years have an increased risk of suffering from the disease.
  • Family history: A person is more likely to develop the disease if he or she has a family medical history of Parkinson’s disease.
  • Race: White people are more affected than any other racial group.

Parkinson’s Diagnosis

Diagnosing Parkinson’s disease is not possible using a single method. A detailed physical and neurological examination is required to diagnose the disease. 

The physical examination is carried out to rule out other disorders. The family history also assists the physician to assess if genetics is leading to the prevalence of Parkinson’s disease. 

A neurological exam, conducted by a skilled doctor, would include assessment of the below mentioned symptoms:

  • Tremor or shaking
  • Loss of sense of smell
  • Poor motor control
  • The rigidity of arms, trunk, or legs
  • Postural instability, the problem in balancing

Parkinson’s Treatment

Once the diagnosis of Parkinson’s disease is made the initial treatment is medical. This is done under the supervision of a movement disorder neurologist along with supportive therapy.

Deep Brain Stimulation For Parkinson’s Disease

Deep brain stimulation surgery is a method of treatment for Parkinson’s disease. It provides safe and effective control of the symptoms of Parkinson’s disease. It can also help reduce the medication requirements by up to 50 to 70%. The candidates for such therapy are carefully chosen. Most commonly this includes:

  • Patients who have moderate to severe Parkinson’s disease. Their symptoms are progressively worsening or are medically unmanageable
  • Patients who have wide motor fluctuations whilst on medical therapy
  • Patients with an intolerance or who are developing adverse effects from medical therapy

There are several sites in the brain which are targets for deep brain stimulation in Parkinson’s disease. The main site is the subthalamic nucleus. Other sites may be chosen depending on whether some symptoms are more pronounced and troublesome than the others. These include the thalamus, the posterior subthalamic area, or the pedunculopontine nucleus.

DBS therapy provides effective control of symptoms and improved quality of life over the medium to long term. Yet, it is important to understand that it does not slow the progression of neurodegenerative disease.

The CRW Framed Technique

Traditionally, this procedure has been done using a framed technique. This involves placing a frame onto the patient’s skull using screws. The operation is performed with the patient awake, with the frame on their skull and fixed on to the operating table. This can very challenging for the surgeon and is a formidable undertaking for a patient. Unsurprisingly, not many patients opt to have this type of surgery.

Now many centres in the world have moved on to doing this operation while the patient is asleep. Over time there have been advances in imaging technology and electrode improvements. This enhances the surgeon’s ability to visualise the target for stimulation therapy.

The Frameless Technique

Another significant development is the evolution of the “Frameless Deep Brain Stimulation” technique. This technique uses a custom-made patient-specific frame. This replaces the cumbersome traditional frame which in addition to being on the patient’s skull and needed to be attached to the operating table for the duration of the surgery.

This technique along with the ability to do the operation asleep makes patients more accepting of deep brain stimulation surgery. Published current medical literature has shown results are as successful as the traditional technique.

Mr. Nair is the only surgeon in Victoria who currently offers this type of frameless stereotactic surgery. To ensure a successful outcome, we use intra-operative CT and MRI scans. These confirm the accurate positioning of electrodes during the operation.

Advantages of Asleep Frameless Deep Brain Stimulation:

  • Avoids patients having to stay awake for the whole duration of the operation
  • Better patient experience and acceptance
  • Does not require patients to skip medications for the surgery
  • Avoids multiple intra-operative recording electrode insertions and possible risk of bleeds
  • Reduced loss of cerebrospinal fluid
  • Enables for a reduced operation and anaesthetic time
  • Ability to confirm accuracy by performing CT or MRI scans within the operating room itself

Parkinson’s Prevention

Parkinson’s disease cannot be prevented. However its advancement or progression can be delayed or stopped to some extent. Some of the measures for the prevention of disease progression include:

  • Perform daily exercises and avoid stress
  • Dodge off exposure to hazardous chemicals
  • Start drinking green tea and coffee

Parkinson’s disease mostly impacts the quality of life, but the life-span of the patient might remain the same. The reduced quality of life can have multiple psychological impacts on the patients.

Research and advances in treatment for Parkinson’s disease

Mr. Nair is the neurosurgeon who leads a pioneering team at the Royal Melbourne Hospital. This team has been performing groundbreaking research in the treatment of Parkinson’s disease.

Under his leadership, the surgical team performed the world’s first-ever implantation of stem cells as part of a clinical trial. Together the team is trying to develop an alternative and more effective treatment for Parkinson’s disease.

As of now, stem cell therapy is not a mainstream treatment option for Parkinson’s disease. The current status is that it is in a phase one trial. Previous research studies have been conducted in primates. The results have been extremely promising to offer hope to patients and doctors.

Frequently asked questions

Is Parkinson’s disease curable?

No, it is not. Although research is ongoing to find a potential cure for the disease. Currently there are only medications to halt or delay the progression of the disease.

What leads to Parkinson’s diseases?

Both genetic, as well as environmental factors, can lead to Parkinson’s disease.

Can the disease be prevented?

No, it can’t be prevented. Surgery or drug interventions can decrease the symptoms or delay the progression.

How can I make my condition better living with Parkinson’s disease?

Things that may help you cope better with the disease include:

  • Taking medication on time
  • Living a healthy lifestyle
  • Regular exercise
  • Managing stress and depression

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