Parkinson's disease is a neurodegenerative condition of the nervous system that not only affects 1.5 millions Americans, it also touches the lives of the family, friends and loved ones of those with the disease.
Often associated with advanced age, Parkinson's affects a person’s center of gravity. With Parkinson’s, a person can experience soreness, stiffness (rigidity), tremors, and problems with balance or postural instability.
Parkinson’s disease develops gradually. Symptoms typically appear in one extremity but soon spread throughout the body. Gait, memory, speech, slowness of movement (bradykinesia), and swallowing disturbances may occur in more advanced cases, leaving a person immobile and often dependent on family.
Our experts at the Center for Neuromodulation understand the complicated nature of Parkinson’s. In collaboration with the Parkinson and Movement Disorders Center, our neurosurgeons work with neuropsychologists, speech therapists, and physical therapists to recommend the best, integrated treatment options for patients with Parkinson’s.
What causes Parkinson’s disease?
The exact cause of Parkinson’s disease is unknown. However, the symptoms of the disease are caused by tissue degeneration within the substantia nigra and other brainstem structures that employ dopamine or related chemicals to signal other regions within the brain. Dopamine is responsible for coordinated movement and when a patient’s dopamine levels fall, slowness and rigidity set in.
Other risk factors include:
- Age – With advanced age, comes increased tissue degeneration. At 80 years old, a person has a 2 percent chance of acquiring Parkinson’s.
- Environmental influence – Exposure to pesticides can increase the risk of developing the condition.
- Genetic susceptibility – There is a higher incidence of Parkinson’s if you have a first degree relative with the disease and more rare forms of the condition can be inherited.
Traditional Treatment for Parkinson’s disease
Since the late 1960s, dopamine replacement has been the mainstay of Parkinson's disease therapy. The most effective medication is a combination of levodopa (a precursor to dopamine) and carbidopa. The carbidopa prevents your body from breaking down the levodopa in your bloodstream, allowing more levodopa to reach the brain. The levodopa is converted to dopamine, thereby restoring brain concentration.
Additional medications used in the management of Parkinson's disease include dopamine agonists (medications that mimic the effects of dopamine within the brain) and medications that slow the breakdown of dopamine, prolonging its effects. Numerous other medications are employed to manage ancillary symptoms.
Deep Brain Stimulation for Parkinson’s
If medications fail to adequately control symptoms of Parkinson’s, deep brain stimulation (DBS) should be considered. Similar to a pacemaker of the heart, DBS is implanted into the brain and is programmed to target focused regions of the brain responsible for the symptoms of Parkinson’s.
Since the device is always present, patients are often able to reduce their medication intake by almost half, thereby eliminating any associated motor fluctuations.
Our neurosurgeons are highly experienced in DBS. Our team collaborates with neurologists to provide accurate programming of the DBS device, which is key to a successful treatment.
Qualifications for Deep Brain Stimulation
DBS is an advanced neurosurgical procedure designed for patients who have advanced Parkinson’s. Although our neurosurgeons will determine candidacy for DBS during a consultation, in general, patients must:
- Reach the stage of dyskinesia associated with medication use
- Experience excessive movements or tremors that cannot be controlled with medication
- Fail to respond to medication
For a comprehensive evaluation, call the Center for Neuromodulator at the Department of Neurosurgery at 212-241-0050.