Deep Brain Stimulation and Surgical Treatments
Are there effective surgeries for Parkinson's disease?
Similar to available drug treatments, no currently available surgical treatment has been proven to either slow down the disease or "rejuvenate" the sick and dying nerve cells affected by Parkinsonís disease. Today's Parkinsonís disease surgeries offer only symptomatic benefits. Because of the level of risk inherent in any brain surgery, it is usually an option reserved for patients with severe or quickly debilitating Parkinson's disease or those with severe medication-induced side effects, such as debilitating dyskinesias.
The decision about whether or not to undergo surgery should be made in consultation with the physicians and caregivers involved in a patient's treatment regimen. Identifying an experienced surgical team is essential.
What is Deep Brain Stimulation (DBS)?
Today, the most commonly discussed surgical treatment is deep brain stimulation (DBS), a procedure that seeks to reduce "on/off" fluctuations as well as dyskinesias.
In DBS, a thin electrode is implanted into the brain, targeting motor circuits that are not functioning properly. Small electrical pulses from a device similar to a cardiac pacemaker are then used to stimulate a small brain region and block the signals that cause some Parkinson's symptoms. DBS may be targeted to the globus pallidus or subthalamic nucleus to improve motor function. The stimulator is adjusted as necessary to optimize the effects of the surgery.
The mechanism by which DBS works is not completely understood, but it seems to counteract the abnormal neuronal functioning that occurs in Parkinsonís disease. DBS is increasingly attractive for many advanced Parkinson's patients, particularly as more surgeons become proficient in the technique.
DBS is not suitable for all patients. Generally, patients with typical Parkinsonís disease who have had a good response to levodopa, but who are experiencing medication-related motor side effects, such as dyskinesias, may be good candidates. DBS is usually not recommended for patients with dementia.
Generally, DBS does not improve those symptoms that do not respond to levodopa. DBS may help patients achieve motor function off of medication that is similar to their best pre-operative motor function while on medication, although this is not always the case. DBS also reduces motor fluctuations and off-time. While DBS can produce major improvements in many aspects of Parkinsonís disease, this is not always the case. It is important to approach DBS with realistic expectations and an acceptance of the risks and benefits associated with surgery.
What are other surgical approaches?
Because deep brain stimulation has increasingly become the surgical method of choice, other, older surgeries ó such as pallidotomies and thalamotomies ó are used less often. Both of these approaches lesion the brain, in effect putting small holes in targeted areas to achieve outcomes, and these lesions are not reversible.
What about complementary and alternative medicine (CAM)?
Massage, meditation and other treatments or techniques designed to relieve tension and stress may bring temporary, symptomatic relief. Acupressure and acupuncture, certain diets and vitamin supplements are other common complementary treatments. As long as your neurologist knows what CAM treatment you are using, and it causes no harm, it falls under the category of personal choice.
What sorts of non-drug treatments do Parkinsonís patients use?
Non-drug treatments not only can help relieve some of the motor symptoms of Parkinson's disease, but can aid in the management of postural instability and non-motor symptoms as well. Determining which non-drug treatments may best address and treat your Parkinson's disease should be done in consultation with the physicians and other caregivers involved in your overall treatment plan.
- Exercise. Given what we know about the universal health benefits of exercise, it is not surprising that exercise and physical therapy are the most frequently suggested non-pharmacological treatments for Parkinson's disease. Exercise programs can help people with Parkinson's disease stay active and relatively limber, and improve balance and motor coordination. Some doctors also prescribe physical therapy or muscle-strengthening exercises. Exercise may have effects on some of the non-motor symptoms of Parkinson's as well. For example, exercise can reduce sleep dysfunction and can improve overall emotional well-being.
- Speech Therapy. Parkinson's disease can bring on problems with speech, including reduced or fading volume, vocal clarity issues, and reduced or increased pace of speaking. Speech therapy is increasingly viewed as an intervention that can greatly enhance speech and overall quality of life. Lee Silverman Voice Treatment (LSVT) is the program most frequently recommended.
- Occupational Therapy. Occupational therapists seek to help Parkinsonís patients in a variety of tasks that impact daily living and quality of life, from physical movement to handwriting to adaptation of utensils and other household items.
- Psychological Therapy/Counseling. Depression and anxiety can be intrinsic symptoms of Parkinson's disease ó much like rigidity or tremor. Left untreated, these symptoms can significantly diminish a person's quality of life and overall health. In concert with pharmacological treatments, psychological therapy and counseling can be helpful.
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