Parkinson’s disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing “dopaminergic” neurons located in a specific area of the brain called substantia nigra. It is a chronic and progressive disease that manifests as a movement disorder in the patients’ daily life.
The Parkinson's disease starts with the loss of the brain cells that produce the dopamine which is one the body's neurotransmitters or what is are often referred to as the chemical messengers, the cell damage appears slowly and progress gradually over time, eventually the cells will die. It is estimated that between 60% to 80% of cells are damaged before clinical symptoms of the disease become evident. Therefore, the amount of dopamine decreases in brain and irregular brain activity occurs. This is how the symptoms of this disease begin to manifest.
Even if Parkinson's disease seems genetic in some cases, it often occurs randomly and its causes remains unknown until this day, however most researchers believe that there are both genetic and environmental factors that contribute to the injury and eventual the loss of these dopamine-producing cells
There are four main symptoms and clinical signs of Parkinson's disease:
The Symptoms and the progression of Parkinson's disease differ from one person to another due to the diversity of the disease. Its primary symptoms may be mild at first but will gradually become more intense and gets worse overtime.
In the early stages of this disease, people may feel slight tremors or experience some difficulties that affect their ability to perform the activities of daily living such as getting up from a chair, washing, dressing and even walking. Eventually, the patient will have difficulty using his limbs, his speech gets softer and more difficult to understand and his handwriting will deteriorate and become worse overtime. You will notice also that the sick person's facial expressions have disappeared.
The Symptoms usually start on one side of the body or the limbs and then progress to affect both sides. The symptom can be more severe and intense on one side of the body than on the other.
There is no specific clinical test to be used to diagnose Parkinson's disease. In addition, the diagnosis can only be made after the doctor obtain the patient’s medical history and perform a detailed neurological examination.
There are many diseases that show similar symptoms to Parkinson's Disease, they are called Parkinsonism. That’s why many diseases are misdiagnosed as Parkinson's Disease in most of the cases. For this reason, the clinical algorithm of the symptoms’ appearance and the neurological examination are very important in order to correctly diagnose this disease and to start its specific treatment in time.
In addition, observing a certain improvement after starting the treatment (drug treatment) is an important sign which allow the doctor to distinguish Parkinson's Disease from other similar ones.
Although there is no cure today for Parkinson's disease, some treatments are applied to reduce or control the clinical symptoms of this Disease. These treatments are:
Medication: The time of starting the treatment and its type varies from one person to the another. In general, the doctors start the drug treatment when the patients complain that the disease has affect their ability to perform the activities of daily living. The drug types and its doses are changed according to the course of the disease. The Patients will need lifelong drug treatment.
Deep Brain Stimulation (Brain Battery): we will explain this kind of treatment in detail in the next section.
There are some other treatments that are used to help the patient reduce his symptoms and control them; like physical, occupational and speech therapies in addition of some physical exercises.
Deep Brain Stimulation, also known as a brain battery, is a neurosurgical procedure that involves implanting electrodes into certain brain areas, these electrodes will be connected through wires placed under the skin to a medical device called a neurostimulator, sometimes referred to as a “brain pacemaker”, this latter will be implanted under the skin in the upper chest.
The brain is painlessly stimulated by these electrodes by generating electrical impulses to adjust the chemical imbalances within the brain; and block or change the abnormal brain activity; to treat a certain symptoms & clinical signs of the Parkinson’s disease such as slow movement (bradykinesia), tremors, and the limbs’ stiffness.
The amount of the electrical impulses will be controlled by the neurostimulator.
Choosing a suitable candidate for Deep Brain Stimulation is one of the most important steps. The neurology & psychiatric doctors as well as the neurosurgeon should evaluate the patient in order to determine if he is suitable for this operation. It is also mandatory that a neurological examination is performed on the patient before the medical committee made her decision.
The surgical candidacy criteria are the following:
Deep Brain Stimulation (Brain Battery) surgery carries less risks than other brain surgeries. In this surgical procedure, very satisfied results are obtained and high success rates are achieved, especially if the chosen patients were suitable for this surgery.
The first thing the doctors will do, is perform a detailed neurological examination on the patient. Then, a Computed Tomography and MR scans of the patient's brain are carried out. By using the obtained images, a 3D map of the brain is created. This will help the surgeons determine with high precision, the brain’s areas where the electrodes will be implanted.
Before starting the surgery, the doctors make a last check-up of the patient brain in addition of his CT and MRI scans images.
The surgery is performed in two stages. In the 1st part of the operation, the surgeon implants the electrodes into the predetermined brain’s areas while the patient is awake, he doesn’t feel any pain but it is very important that he is awake during the surgery, and he is in constant communication with the surgeon, to avoid that anything could goes during the implant.
In the second stage of this operation, the patient is put to sleep under general anesthesia, then the surgeon implant the neurostimulator in chest cavity and connect it to the electrodes through wires placed under the skin.
The whole surgery takes approximately 4-5 hours.After a week, the patient's medicines doses are adjusted and the brain battery is activated. One week later, a physical examination is performed by a doctor who regulate the intensity of the electrical impulses and make a second adjustment in the drugs doses.