Don't be afraid if it's "Pa"

Author: Zhang Jianguo, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

Chairman of the Functional Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association

Reviewer: Dong Jian, Chief Physician, Zhongshan Hospital, Fudan University

Vice Chairman of the Science Popularization Branch of the Chinese Medical Association

The incidence of Parkinson's disease increases with age.

According to a survey, the prevalence of Parkinson's disease among people over 65 years old in my country is about 1.7%, which is not a low proportion.

Do you know about Parkinson's disease?

1. What is Parkinson’s disease?

Parkinson's disease is a common neurodegenerative disease in middle-aged and elderly people.

Of course, there are also a small number of patients who will develop the disease in their youth or even adolescence, which we call juvenile Parkinson's disease.

Pathologically, it is mainly manifested as the degeneration of dopaminergic neurons in the substantia nigra of the midbrain. In addition to the substantia nigra, it is now found that many other parts can also develop lesions.

Parkinson's disease is clinically manifested mainly by motor symptoms such as resting tremor, muscle rigidity, bradykinesia and postural balance disorders, as well as non-motor symptoms such as hyposmia, sleep disorders, cognitive impairment, autonomic dysfunction and depression.

Figure 1 Original copyright image, no permission to reprint

Because the cause of Parkinson's disease is unknown, there is no particularly clear and effective prevention plan for Parkinson's disease except for daily preventive measures such as healthy living and increased exercise. It can only be detected early and treated in time.

2. How to treat Parkinson’s disease?

At present, there is no drug or surgery that can completely cure Parkinson's disease, so whether it is medication or surgery, the purpose is to improve the patient's symptoms and improve the patient's quality of life.

For example, in the early stages of Parkinson's disease, symptoms can be completely controlled through medication, and the patient becomes exactly the same as a healthy person after taking the medication. We call this the honeymoon period of medication.

The most basic drugs are dopamine substitutes, such as dopamine hydrazine. There are also some other drugs, including pramipexole, selegiline, amantadine, etc., which need to be selected according to the patient's actual condition.

Figure 2 Original copyright image, no permission to reprint

Of course, as the disease progresses and the duration of medication increases, the efficacy of the drug will shorten. After the effect wears off, symptoms will appear, and the overall manifestation will be symptom fluctuations. At this time, we can consider surgical treatment.

Another indication for surgery is that the patient's symptoms affect both sides of the limbs, because Parkinson's disease usually starts on one side and gradually affects the other side. When it affects both sides of the limbs, it basically has a disease course of four or five years, and surgical treatment can also be considered.

Of course, this is not a fixed time point. The timing of surgical treatment should be a stage. For example, from four or five years to the next eight or nine years, it is suitable for surgery. But don't wait until you are bedridden and unable to take care of yourself before considering surgical treatment.

3. What are the surgical methods for Parkinson’s disease?

There are currently two surgical approaches for Parkinson's disease:

One is a destructive surgery, which is commonly known as cell knife surgery. It aims to control symptoms by destroying the diseased nuclei in the brain.

This type of surgery is simple to perform and less expensive, but it can only treat unilateral symptoms, and the damage is irreversible, so the surgical risk is greater.

Another surgical method is the brain pacemaker (DBS), which requires placing a stimulating electrode in our brain to control the movement-related nerve nuclei by emitting electrical pulses, thereby achieving the therapeutic purpose.

Relatively speaking, brain pacemakers are safer than ablation surgery and can be adjusted. Patients with bilateral symptoms can also be treated with this surgical method.

Figure 3 Original copyright image, no permission to reprint

Of course, surgical intervention can only control symptoms and cannot achieve complete cure, so drug treatment is still needed after surgery, but the amount of medication after surgery can be controlled or even reduced.

4. Can Parkinson's patients become like normal people after undergoing brain pacemaker surgery?

This is a misunderstanding of the effectiveness of surgery.

Brain pacemaker surgery can improve symptoms and enhance the quality of life, but it cannot achieve the same state as before the disease, so we must have reasonable expectations for the results of the surgery.

In addition, some patients may have some misunderstandings about the programming effect of brain pacemakers. Some people think that the higher the parameters are adjusted, the better, or that frequent adjustments will lead to better results. In fact, this is not the case.

Generally speaking, two or three times or three or four times of programming is sufficient within a year, and frequent adjustments are not necessary. Some patients always feel that the results are not satisfactory, and after adjusting the parameters one after another, they may have to return to the first parameter in the end, because other parameters have been tried and are not as effective as the first parameters.

Therefore, reasonable parameters are the best, not the higher the better.