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Improving Surgical Care Options

Parkinson’s Disease

Parkinson’s disease is a disorder of the central nervous system caused by loss of brain cells throughout various regions of the brain. It is attributed to the loss of dopamine production, a key messenger in the brain that facilitates movement and coordination. There are no objective tests to diagnose Parkinson’s disease, and misdiagnosis rates remain high.

The Parkinson’s Disease Foundation estimates that as many as one million patients live with Parkinson’s disease with an additional 60,000 patients diagnosed per year. Over 10,000,000 patients worldwide are living with Parkinson’s disease. There have not been any drugs introduced that have been effective at treating Parkinson’s disease. The average onset is over 60 years old, but some people have been diagnosed as young as 40 years old.

Physicians look to find two or more signs to make a diagnosis, including balance problems, rigidity and tremors that occur during rest. In 2011, the U.S. FDA approved the first imaging device called a DaTscan that can capture images of the dopamine system in the brain. By itself, these scans cannot diagnose Parkinson’s but can help confirm a diagnosis. Parkinson’s disease is typically not fatal; however, complications caused by the symptoms of Parkinson’s can be fatal.

Today’s primary treatment for Parkinson’s disease involves medications that have not proven to resolve symptoms but rather ease symptoms. Years ago, surgical procedures such as thalamotomy and pallidotomy targeted certain parts of the brain and involved destroying the tissue. More recently, these procedures have been replaced with deep brain stimulation (DBS). A doctor evaluates the patient by reviewing the patient’s symptoms and medications taken and administering detailed memory, thinking and imaging tests to determine if they are appropriate for DBS.

According to the Michael J. Fox Parkinson’s Disease Research Foundation website, patients that seem to do best with DBS are those that have had the disease for at least four years and have benefited from taking medications prescribed to control the disease. In addition, DBS seems to help with reducing the issues with motor functions such as tremors, stiffness and slowness but not for balance issues.

Placement of an electrode into the brain. The head is stabilised in a frame for stereotactic surgery. Photograph by Thomasbg