Latest treatments for Parkinson’s disease

A degenerative brain condition, Parkinson’s Disease has no known cure. Yet there are numerous methods, both surgical and drug-based, that can effectively treat symptoms. The experts explain.

‘Parkinson’s Disease is a progressive neurological disorder due to degeneration of a part of the brain called the substantia nigra,’ explains Dr Jaco Cilliers, a neurologist at Mediclinic Bloemfontein. ‘This part of the brain produces a neurotransmitter, dopamine, which is, amongst other things, involved in the coordination, planning and execution of movement.  If there is too little dopamine, patients will start experiencing the typical symptoms of Parkinson’s disease.’

According to the The National Institute of Neurological Disorders and Stroke, the primary physical symptoms are:

• Tremor
• Rigidity – stiffness
• Bradykinesia – the slowing down and loss of spontaneous and automatic movement
• Postural instability – problems with balance.

Yet each case is unique. ‘There’s a combination of symptoms that’s different for every patient,’ says Dr Cilliers. ‘The tremor that typically occurs is most often in the hands, but also sometimes in the legs or jaw. The tremor is most prominent at rest – while the patient is relaxing and watching TV for example – as opposed to holding something.

A Parkinson’s patient often develops difficulty walking and one sometimes sees the typical shuffling gait pattern of walking where the feet are not picked up from the floor adequately, which might lead to falls. Other symptoms can include dizziness, memory problems, constipation, painful joints and limbs, problems with sleeping patterns and an excessively oily skin.

‘Patients generally also lose the ability to do fine motor activities, like using a knife and fork’, adds Dr Roger Melvill, a top neurosurgeon at Mediclinic Constantiaberg. ‘It can also affect mental or cognitive function and cause difficultly in managing the bowel and bladder.’

Risk factors

While Parkinson’s most commonly strikes the elderly, with most sufferers developing symptoms after they’ve reached 60, this is not always the case. In most instances the disease is an idiopathic disorder.

‘In other words, we don’t know why some people get it and others not,’ explains Dr Cilliers. ‘Many researchers believe that there is a combination of genetic susceptibility and exposure to an environmental trigger that causes the disease. There are however only a very limited number of cases directly genetic in origin.’

According to Genetics Home Reference, about 15% of people with Parkinson’s disease have a family history of this disorder. Genetics often come into play when younger people are affected. Men are also more commonly affected.

Treatment

While there is no known cure for Parkinson’s disease and it’s progressive, meaning that it tends to worsen over time, symptoms can be treated through medication, surgery or therapy.

‘The initial treatment is through tablets that build up the supply of dopamine that the brain is missing,’ explains Dr Melvill. There is a range of drugs on the market and patients work with doctors to find the ones that best suit them. Physiotherapy is also commonly administered.

Those with relatively advanced symptoms may consider the option of surgery in the form of Deep Brain Stimulation, which has proved effective in certain carefully-selected cases.

Dr Melvill, who performs the surgery, explains. ‘Firstly patients are cautioned that the surgery can only treat some of the movement abnormalities. It’s not good for freezing – when the feet won’t lift off the ground – or balance. Nor can it treat the mental effects of the disease, speech problems or bowel and bladder problems. It is however effective in improving motor function – tremors, slowness and lack of dexterity so that patients are better at walking and general movement.’

‘The day-long operation involves placing an electrode on each side of the head and then into various targets in the brain, each responsible for a different major symptom. Electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest beneath the collarbone. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the Parkinson’s symptoms.

Surgeons can identify targets through an MRI scan, planning their trajectory through the brain. Patients are generally awake during most of the operation so that doctors can test their responses (and that targets are reached) to make sure that there are no side effects and to ensure they’re responding well to stimulation. The pulse generator is switched on about ten days after the operation and patients are steadily monitored.’

Dr Melvill always cautions patients about the numerous risks that surgery involves which includes everything from behavioural complications and device problems to a potentially life threatening stroke. Yet when it’s effective, the surgery can provide a renewed and sustained quality of life for Parkinson’s sufferers.