Parkinson Diseases Clinic

What is Parkinson’s Disease?

Parkinson’s disease is a progressive neurodegenerative disorder that primarily affects movement control. It is characterized by the gradual deterioration of dopamine-producing neurons in the brain, leading to a range of motor and non-motor symptoms. The disease typically manifests after the age of 60, though early-onset cases can occur.

Causes and Risk Factors of Parkinson's disease

The exact cause of Parkinson’s disease remains unknown, but several factors are believed to contribute:
Genetics: While most cases are sporadic, certain genetic mutations have been linked to Parkinson’s, suggesting a hereditary component in some individuals.
Environmental Factors: Exposure to pesticides, heavy metals, and other environmental toxins may increase the risk of developing the disease.
Head Injuries: Traumatic brain injuries have been associated with a higher risk of Parkinson’s, possibly due to damage to dopamine-producing neurons.

Symptoms of Parkinson's disease

Parkinson’s disease presents a combination of motor and non-motor symptoms:

Motor Symptoms:

Tremor: Involuntary shaking, often beginning in a limb, most noticeable at rest.
Bradykinesia: Slowness of movement, making daily activities challenging.
Muscle Rigidity: Stiffness in the limbs and trunk, limiting the range of motion.
Postural Instability: Impaired balance, increasing the risk of falls.

Non-Motor Symptoms:

Cognitive Impairment: Difficulties with attention, planning, and problem-solving.
Mood Disorders: Depression and anxiety are common among patients.
Sleep Disturbances: Including insomnia and rapid eye movement (REM) sleep behavior disorder.
Autonomic Dysfunction: Issues such as constipation, urinary problems, and blood pressure fluctuations.

Diagnosis of Parkinson's disease

Diagnosing Parkinson’s disease is primarily clinical, based on medical history and neurological examination. There are no definitive tests, but imaging studies like MRI or PET scans may be used to rule out other conditions. A positive response to dopaminergic medication can support the diagnosis.

Treatment of Parkinson's disease

While there is no cure for Parkinson’s disease, various treatments aim to manage symptoms:

Medications:

Levodopa: The most effective treatment, converted to dopamine in the brain to alleviate motor symptoms.
Dopamine Agonists: Mimic dopamine effects in the brain.
MAO-B Inhibitors: Prevent the breakdown of brain dopamine.

Surgical Interventions:

Deep Brain Stimulation (DBS): Implantation of electrodes in specific brain regions to modulate abnormal activity, beneficial for advanced cases unresponsive to medication.

Therapies:

Physical Therapy: Enhances mobility and flexibility.
Occupational Therapy: Assists in adapting daily activities.
Speech Therapy: Addresses speech and swallowing difficulties.
Living with Parkinson’s Disease
Managing Parkinson’s disease involves a comprehensive

Approach:

Regular Medical Care: Continuous monitoring and adjustment of treatment plans.
Support Systems: Engaging with support groups and counseling can provide emotional assistance.
Lifestyle Modifications: Regular exercise, a balanced diet, and adequate sleep contribute to overall well-being.

Types of Surgery for Parkinson's Disease:

Deep Brain Stimulation (DBS):

The most common surgical approach for Parkinson’s. In DBS, a device similar to a pacemaker is implanted in the brain. This device sends electrical impulses to specific brain regions, helping regulate abnormal brain activity that causes motor symptoms. It can help with tremors, rigidity, and bradykinesia.

Pallidotomy:

Involves destroying a small part of the brain called the globus pallidus, which is involved in movement control. This can help reduce tremors and rigidity, though it’s less commonly performed due to the effectiveness of DBS.

Thalamotomy:

Involves removing or damaging part of the thalamus, a region of the brain that helps control movement. This surgery can be particularly helpful in treating severe tremors.
Fetal Tissue Transplantation (experimental): This involves implanting fetal dopamine-producing cells into the brain to replace the lost dopamine-producing neurons in Parkinson’s. It’s an experimental approach and not widely used today.

Why is Parkinson's surgery needed?

Here are the main reasons why Parkinson’s surgery might be needed:

Medication-Resistant Symptoms:
As Parkinson’s progresses, medications like levodopa (which helps increase dopamine levels) may become less effective or lead to side effects such as dyskinesia (involuntary movements). When medications no longer provide sufficient relief or cause troublesome side effects, surgery may be considered.
Improvement of Motor Symptoms:
Parkinson’s disease primarily affects motor skills, leading to symptoms like tremors, bradykinesia (slowness of movement), muscle rigidity, and postural instability. Surgery aims to improve these symptoms, which can significantly enhance the patient’s quality of life and independence.
Advanced Parkinson’s Disease:
In advanced stages of Parkinson’s, when symptoms are severe and the disease is progressing rapidly, surgery can help manage symptoms more effectively than medication alone.
For Better Control of “On-Off” Episodes:
“On-off” fluctuations refer to the periods when Parkinson’s medication wears off, causing sudden changes in movement, from being mobile (“on”) to immobile (“off”). Surgery can help reduce the severity and frequency of these episodes.