Parkinson’s disease
At least 500,000 people in the United States suffer from Parkinson’s with about 50,000 new cases reported annually, according to the U.S. National Institute of Neurological Disorders and Stroke. Worldwide, there are about 5 million cases. These numbers are expected to increase as the average age of the population rises.
Parkinson’s disease is characterized by tremors at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
The underlying cause of Parkinson’s is a loss of dopamine-producing cells in a region of the brain called the substantia nigra. Dopamine is a neurotransmitter that helps regulate movement. The reasons for the cell loss are unclear, but it is believed to be a combination of genetic and environmental factors.
There is no cure for Parkinson’s disease, but a variety of medications can provide relief from symptoms. The mainstay of treatment is levodopa, a chemical which is converted to dopamine in the brain. Although levodopa helps the majority of Parkinson’s disease sufferers, not everyone responds equally to the drug. In addition, long-term treatment with levodopa usually leads to wide fluctuations between the “on” and “off” medication states, with unpredictable responses and abnormal involuntary movements (dyskinesias). These side effects can be quite debilitating and may limit the effectiveness of Parkinson’s medications over time.
Deep brain stimulation (DBS) was approved by the U.S. FDA in 1997 to treat tremor, and in 2002 to treat the motor symptoms associated with Parkinson’s disease. DBS may be an option for some Parkinson’s patients to improve symptoms as the disease progresses and the effectiveness of drugs starts to wane. Although the exact mechanism of action is unclear, targeted brain stimulation using DBS can minimize the need for levodopa, reducing drug side effects. DBS also helps to reduce symptom fluctuations and reduce tremors, slow movement, and gait problems.
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It is estimated that 28% of Parkinson’s patients suffer from debilitating motor symptoms despite optimal medical therapy. For many of these patients, surgical intervention can help restore the fluidity of movement that we all come to take for granted . . .
Reviewed April 2, 2012
Jaimie M. Henderson, MD
Director-at-Large, International Neuromodulation Society, 2011 - 2014
Associate Professor of Neurosurgery, and, By Courtesy, of Neurology and Neurological Sciences; Robert and Ruth Halperin Faculty Scholar; Director, Stereotactic and Functional Neurosurgery; Co-Director, Neural Prosthetics Translational Laboratory; Stanford University School of Medicine, Stanford, California, USA
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