by Henry Hayter
X ray of deep brain stimulation
Parkinson’s is a neurodegenerative disease that is caused by
the degeneration of [1]dopaminergic
neurons in the Substantia nigra region
of the brain ( the region which is responsible for the facilitation of movement
and large amounts of dopamine production) which results in a number of symptoms
which tend to develop over a long period of time (usually several years) , the
symptoms of Parkinson’s include : Limb rigidity, Bradykinesia or slow limb
movement and tremors, loss of balance and gait/posture, the severity of these
symptoms is measured on the modified 2Hoehn and Yahr Scale . The scale is from 1 to 5
with 1 containing the least debilitating symptoms such as bradykinesia in
unilateral movement only and 5 containing the most debilitating symptoms which
have left the patient wheelchair or bed bound by the disease . Parkinson’s
disease is currently without a permanent cure although treatments such as
L-Dopa therapy and physiotherapy do delay the development of more severe
symptoms. DBS is another temporary cure for parkinson’s disease as can work
effectively for upwards of 10 years although the process of DBS is invasive and
as such is often reserved for more severe cases of Parkinson’s disease,
furthermore given that the average parkinson’s patient is in their late 50s or
mid 60s it is more risky to undergo a surgery due to the increased likelihood
of comorbidities affecting the patient’s overall health.
Deep Brain Stimulation or DBS is a surgical procedure in which electrodes are inserted into a targeted region of the brain ,often the subthalamic nucleus (STN) and the globus pallidus interna (GPi). The electrodes are inserted via an MRI in the first of two procedures. During the second procedure an Impulse generator battery is placed below the clavicle and connected to the electrodes via a lead. The generator provides impulses to the electrodes interfering the impulses sent from the degenerating region of the brain preventing the symptoms of Parkinson’s disease from manifesting. As a result the DBS treatment is the most effective treatment for Parkinson's where other treatments have failed to effectively halt the disease's progression.
The
relative newness of DBS as a treatment of PD being only 24 years old has meant
that the long term effects of the treatment on the patient is yet to be fully
understood. A survey was carried out in 2017 finding that 51% of patients of
DBS were alive 10 years later , the survey also found that of the patients who
responded 90% were satisfied with the alleviation of symptoms that the
treatment had provided and that 75% of those who received the DBS thought that
their symptoms had improved noticeably since receiving the treatment.
Given the lack of alternative
long term treatments that many patients who undergo DBS have available to them
- it should be noted that while DBS is often used alongside chemical and
physiotherapy techniques including the L-Dopa therapy mentioned before, DBS has
been shown to provide the greatest amount of symptom relief over the longest
period of time and therefore is a popular treatment for those who suffer from
Parkinson’s and whose chemical therapy and physiotherapy is failing to
alleviate all of the symptoms of the disease fully .
Sources,
https://www.physio-pedia.com/images/5/52/PPHYscaleParkinsons.pdf
[1] Neurons which are responsible for dopamine
production
2 The scale used to determine the impact of
Parkinson’s on the patient and how likely they are to need to seek further
treatment, full scale can be seen at:
https://www.physio-pedia.com/images/5/52/PPHYscaleParkinsons.pdf
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