How much do you know about surgical treatment of Parkinson's disease?

Author: Su Qingbin, deputy chief nurse, Zhongshan People's Hospital

Reviewer: Ruan Simei, Chief Nurse, Zhongshan People's Hospital

Parkinson's disease is a common neurodegenerative disease in middle-aged and elderly people. It is mainly manifested by movement disorders such as resting tremor, muscle rigidity, bradykinesia and abnormal gait. Some patients also have non-motor symptoms, such as mental disorders, sleep disorders, sensory disorders, etc. At present, the first choice for the treatment of Parkinson's disease is drug therapy, which can achieve good results in the early stages of the disease. However, as the disease progresses, patients develop drug resistance, and adverse reactions gradually increase, which greatly reduces the efficacy of drugs. Surgery has gradually become an important treatment for middle and late stage Parkinson's disease. However, many people don't know much about surgical treatment of Parkinson's disease. Can surgery really cure Parkinson's disease? Is it suitable for all Parkinson's patients? What should I pay attention to after surgery? Next, let's talk about the relevant knowledge of surgical treatment of Parkinson's disease.

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1. Causes of Parkinson's disease

To date, the cause of Parkinson's disease is still unclear, and there is no internationally recognized and definite cause of the disease. It is generally believed that the interaction of multiple factors leads to the degeneration of substantia nigra cells in the brain, which cannot secrete enough dopamine to regulate the brain's motor function and control muscle activity, thereby causing various motor dysfunctions. Epidemiological data on Parkinson's disease in my country show that the incidence of Parkinson's disease in people over 65 years old is 1.7%, and the incidence rate gradually increases with age, indicating that age is closely related to it. Many genetic susceptibility factors may be susceptibility factors for the onset of Parkinson's disease. About 10% of patients have a family history. In addition, certain toxic substances in the environment may damage brain neurons, which is also considered to be an important cause of Parkinson's disease.

2. Applicable population for surgical treatment of Parkinson's disease

In fact, surgical treatment is the last choice for Parkinson's patients, and it is not suitable for all Parkinson's patients. Surgical treatment is limited to patients in the middle and late stages who respond well to drugs, and specific conditions must be met, for example, the course of the disease must reach a certain length of time (at least 4 years or more). At the same time, patients voluntarily choose surgical treatment and are able to actively participate in and cooperate with surgery and postoperative follow-up. Surgical treatment is not recommended for patients in the following situations, such as those with Parkinson's disease superimposed syndrome, those with severe late-stage conditions, those with conventional contraindications to surgery, those with severe mental disorders, and those who need frequent MRI examinations. In addition, some patients should be particularly cautious, such as those with a history of neurosurgery or on-demand pacemakers in their bodies. In short, whether Parkinson's disease is indeed feasible for surgical treatment requires a comprehensive risk assessment by the doctor in combination with the patient's condition, age, physical condition, etc., and then a correct judgment can be made.

3. Surgical treatment of Parkinson's disease

Clinically, surgical treatment of Parkinson's disease includes two surgical methods: brain lesion with the medial part of the globus pallidus as the surgical target and deep brain stimulation. When patients with early Parkinson's disease were not treated with drugs, surgeons tried to damage certain parts of the brain tissue, but the effect was general. It was not until the 1990s that surgical treatment began to damage the globus pallidus. Although it can achieve immediate results, it is irreversible and complications such as cerebral hemorrhage and cerebral edema may occur after surgery, which aggravates the condition. Some patients may also experience recurrence of symptoms. This surgical method has now been replaced by deep brain stimulation. Deep brain stimulation has almost no damage to brain tissue, has a low incidence of postoperative complications, and has many advantages such as ideal symptom control. It is considered to be the "gold standard" for the treatment of advanced Parkinson's disease.

4. What is deep brain stimulation?

Deep brain stimulation is to implant microelectrodes in specific parts of the deep brain region (i.e., the target, often the subthalamic nucleus) through stereotactic technology, and cooperate with subcutaneous implantation of a pulse generator to give continuous pulse stimulation to the nerve nucleus, inhibit abnormal motor nerve pathways (not destroy brain tissue), and thus achieve the purpose of improving symptoms. The whole operation includes four major steps: positioning under local anesthesia before surgery, implantation of microelectrodes under general anesthesia, intraoperative testing and implantation of connecting wires and pulse generators. The operation usually takes 4 to 5 hours. The key to the operation is the precise positioning of the implanted electrodes. There are usually two methods to choose from. One is to use the Leksell head frame to calculate the coordinates through the computer system, and the surgeon uses the coordinates to implant the microelectrode to the target position during the operation; the other is mainly to implant the microelectrode by a robot arm. The two methods require the installation of the Leksell head frame (Figure 2) and the bony Mark point (Figure 3) on the scalp before surgery. At this time, the patient's head may feel sore and swollen. Do not touch it at will to cause displacement and falling off, so as to avoid calculation and cause deviation in the position of the implanted microelectrode.

Figure 2 Leksell head frame Figure 3 Bony markers

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5. Can surgery cure Parkinson’s disease?

Parkinson's disease is a neurodegenerative disease whose pathological basis is the neurodegeneration of brain tissue, especially the degeneration of the substantia nigra-striatum system and the reduction in the number of dopaminergic neurotransmitters. This neurodegeneration is irreversible, and surgery cannot restore the lost neuronal function. Surgical treatment inhibits the function of specific brain nuclei by stimulating or damaging them, thereby alleviating symptoms, but it cannot reverse the pathological process of the disease. At present, various methods for treating Parkinson's disease, including surgical treatment, drug therapy, psychological intervention, nutritional support and rehabilitation therapy, aim to relieve symptoms and delay the progression of the disease, but none of them can completely cure Parkinson's disease.

6. Precautions for patients after surgery

1. One month after the operation, the patient needs to return to the hospital to start the machine via program control. After starting the machine, be careful to avoid contact with magnetic fields or magnetic sensors, such as large substations, magnetic resonance imaging, security gates, etc., to prevent the pulser from being accidentally turned on and off by interference from the magnetic field.

2. Although deep brain stimulation has a good effect, it cannot completely replace drugs. Patients still need to take medicine on time. Before starting the machine, continue to take oral medicine as prescribed by the doctor to control symptoms. After starting the machine, gradually reduce the dosage according to the doctor's instructions. Do not reduce or stop the dosage without authorization. If nausea, vomiting, etc. occur after taking the medicine, seek medical attention in time. At the same time, regular follow-up examinations should be carried out.

3. After discharge, avoid twisting the neck significantly to prevent excessive pulling or displacement of the electrode. In case of complications of device implantation, such as dyskinesia, diplopia, etc., you need to report to the doctor. The cause may be due to changes in device parameters, which can be solved by adjusting the target position and changing the device parameters.

4. After the operation, you still need to gradually perform limb function exercises under the guidance of a rehabilitation therapist, such as flexion and extension, rotation, etc., to maintain limb movement function as much as possible; and insist on activities within your ability, such as eating, dressing, washing, etc., to maintain or improve muscle strength and flexibility and maintain the overall function of the body.

5. Pay attention to diet and nutrition. The elderly are prone to this disease. Their gastrointestinal function declines, and they are prone to gastrointestinal fatigue, constipation, etc., and daily muscle and body tremors will increase energy consumption. Therefore, attention should be paid to the nutritional regulation of patients. In terms of diet, it is necessary to ensure the intake of calories and water, eat more vegetables and fruits, and supplement with sufficient vitamins.

6. In daily life, maintain the safety of the indoor environment and pay attention to anti-slip and anti-collision.

7. When it comes to clothing, be sure to wear clothes that are easy to manage and try to avoid pullovers, clothes with buttons, shoes that require laces, etc.

8. Maintaining a positive and optimistic attitude, enhancing confidence in treatment, and finding joy in life will help control the disease and improve the quality of life.

Conclusion

In short, deep brain stimulation is a safe and effective method for treating mid- to late-stage Parkinson's disease. It can significantly improve patients' symptoms, enhance their mobility and quality of life. However, surgery is not suitable for all patients, nor can it be a permanent cure. Patients still need to take medication and persist in rehabilitation exercises after surgery to achieve the best treatment effect.