A team of experts including renowned neurologists, neurosurgeons, researchers and a host of support personnel offers the latest proven treatments for people with movement disorders, including Parkinson’s disease, essential tremor and dystonia. Our surgical team is world-renowned for performing deep brain stimulation (DBS) surgeries and has experience with more than 1,200 DBS implants. The group also has expertise in the surgical management of spasticity. Various medication clinical trials as well as gene therapy surgical trial programs are under way.
What is Parkinson’s disease?
Parkinson’s disease is a chronic, progressive neurological disease that affects a small area of nerve cells deep within the brain. These cells normally produce dopamine, a chemical that transmits signals between areas in the brain. Parkinson’s disease causes these cells to die, leading to a lack of dopamine in the brain. It is this loss of dopamine that causes nerve cells to fire out of control, leading to tremor, stiffness and loss of movement control.
Approximately 1.5 million Americans have Parkinson’s disease, including one out of every 100 people over the age of 60. More than 50,000 Americans are diagnosed with Parkinson’s disease each year.
What are the symptoms of Parkinson’s disease?
Common symptoms of Parkinson’s disease include tremor or a shaking that begins in a hand, leg or the jaw. In some cases this tremor will be confined to only one body part or side of the body. However, it may spread as the disease progresses and it can worsen with stress. Tremor rarely disables a person and often disappears during sleep and when the arm or leg is being moved.
Bradykinesia is another common symptom that includes generalized slowness of movement. Common activities such as getting dressed or bathing may take a person with Parkinson’s much longer to complete. Most people with Parkinson’s disease develop some degree of rigidity, or stiffness of limbs. This rigidity is caused by uncontrolled tensing of muscles and results in the person being unable to move about freely. People with Parkinson’s also may experience muscle aches or pains.
Balance and coordination problems are additional symptoms of Parkinson’s disease. People typically develop a forward or backward lean that makes them more likely to fall when bumped. Additionally, people with Parkinson’s often develop a posture in which the head is bowed and shoulders are slumped. Other symptoms include depression, feelings of fear and anxiety, decreased facial expressions, difficulty in swallowing and chewing, speech changes, cramped handwriting, urinary problems or constipation, skin problems, such as dandruff, and sleeping problems.
It is important to note that the symptoms of Parkinson’s disease vary among people, sometimes making it hard to diagnose. In fact, as many as 40 percent of people are not diagnosed and 25 percent are misdiagnosed.
What are the treatment options for Parkinson’s disease?
Although there is no cure for Parkinson’s disease, a variety of medications are available for the treatment of symptoms. Current medical treatment is focused on improvement of movement symptoms.
Levodopa is the most commonly used drug for treatment of Parkinson’s. Nerve cells can use levodopa to make dopamine to replenish the low amount in the brain. Levodopa helps about 75 percent of all Parkinson’s disease patients, although it is most effective in treating bradykinesia and rigidity. Carbidopa, a drug commonly used along with Levodopa, reduces the amount of Levodopa needed and helps to prevent or diminish some of its side effects.
Additional medications include selegiline and the dopaminergic agonists ropinirole and pramipexole. These medications act like dopamine and are sometimes used first in early disease. Entacapone is used in combination with levodopa and slows the body’s ability to rid itself of levodopa allowing the effect to last longer.
Generally, surgery is considered for patients who are not satisfied with their increasing loss of control of movement, whose symptoms are causing a decline in the quality of life and who have had an adequate and reasonable trial of medications.
Deep brain stimulation (DBS) surgery involves the implantation into a specific target area in the brain of a very thin lead contain four electrode contacts. The lead extends through a small opening in the skull and is connected to an extension wire. The extension wire is connected to an impulse generator or “pacemaker,” which is implanted under the skin in the chest. Programming of the pacemaker is easy and painless.
During a DBS procedure, the surgeon is aided by computerized brain-mapping technology to find the precise location in the brain where nerve signals generate the tremors and other symptoms. Highly sophisticated imaging and recording equipment are used to map both the physical structure and the functioning of the brain.
The patient is awake during surgery to allow the surgical team to assess the patient’s brain functions. While the electrode is being advanced through the brain, the patient does not feel any pain because of the unique nature of the human brain and its inability to generate pain signals. When the surgeon makes the small opening in the skull a local anesthetic is administered. The anesthetic used is similar to those used during a dental procedure to numb an area of the mouth.
Most patients are hospitalized for about three days. The pacemaker control is implanted below the collarbone either at the time of electrode implantation or later. The patient is placed under general anesthesia for this part of the procedure. The pacemaker is stimulated for the first time within a few weeks after implantation, four to six weeks after surgery.
DBS offers patients relief from the tremors, rigidity, slowness of movement, stiffness and may help balance problems associated with their condition. The stimulation can be adjusted as a patient’s condition changes over time.
In properly selected patients, DBS is remarkably safe and effective. Beneficial effects have been demonstrated to last for several years. Patients who initially responded well to medications, but have since developed side effects, could see 50 to 70 percent improvement in such symptoms as tremor and slowness of movement after DBS. Patients report an average of 50 percent improvement in their walking and balance after DBS. Similarly, patients with involuntary movements (dyskinesia) due to their medications, experience more than 80 percent reduction in their involuntary movements. Most patients are able to significantly reduce their medications following DBS.