Deep Brain Stimulation Therapy
DBS is a brain stimulation therapy that offers an adjustable and if necessary, reversible therapy for Parkinson’s disease. The therapy uses an implanted medical device similar to a pacemaker to deliver electrical stimulation to precisely targeted areas of the brain. Stimulation of these areas enables the brain circuits that control movement to function better.
There are surgical and medication side effects of DBS. Please refer to Risks and Benefits for more information.
Causes Of Parkinsons Disease
Parkinsons disease is an idiopathic illness, which means that its cause is unknown.
The signs and symptoms it present are caused by the loss of nerve cells in the part of the brain called substantia nigra.
This part of the brain is responsible for the production of dopamine, a neurotransmitter that links the brain and nervous system to coordinate body movements.
Loss of dopamine results in uncoordinated body movements, thereby producing the signs and symptoms of the disease.
Though the exact cause of Parkinsons disease is still unknown, there are possible explanations that may be responsible for the condition, such as:
- Genetics. Studies have shown that a minority of cases of PD have genetic involvement.
- Environmental factors. Exposure to pesticides, herbicides, and industrial pollution is now being looked at as a possible cause of PD. However, the results are still inconclusive.
- Presence of Lewy bodies. Lewy bodies are clumps of substances in the brain cells. These are often seen in people with Parkinsons disease. The studies about them are still inconclusive, but researchers believe that these substances hold useful information to what causes PD. Researchers are also focusing into alpha-synuclein found in the Lewy bodies.
The following are the associated risk factors in developing Parkinsons disease:
Which Types Of Exercise Are Best For Parkinsons
It is important to state upfront that there is no one best type of exercise for people with PD. It is most important to choose an exercise regimen that you enjoy, and will continue to do.
However, beyond doing exercise that you will stick with, there are some additional concepts to consider when designing an exercise program for someone with PD.
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What Are The Symptoms
The best-known symptoms of Parkinson’s disease involve loss of muscle control. However, experts now know that muscle control-related issues aren’t the only possible symptoms of Parkinson’s disease.
Motor symptoms which means movement-related symptoms of Parkinsons disease include the following:
Additional motor symptoms can include:
- Blinking less often than usual. This is also a symptom of reduced control of facial muscles.
- Cramped or small handwriting. Known as micrographia, this happens because of muscle control problems.
- Drooling. Another symptom that happens because of loss of facial muscle control.
- Mask-like facial expression. Known as hypomimia, this means facial expressions change very little or not at all.
- Trouble swallowing . This happens with reduced throat muscle control. It increases the risk of problems like pneumonia or choking.
- Unusually soft speaking voice . This happens because of reduced muscle control in the throat and chest.
Several symptoms are possible that aren’t connected to movement and muscle control. In years past, experts believed non-motor symptoms were risk factors for this disease when seen before motor symptoms. However, theres a growing amount of evidence that these symptoms can appear in the earliest stages of the disease. That means these symptoms might be warning signs that start years or even decades before motor symptoms.
Non-motor symptoms include:
Stages of Parkinsons disease
Treatment Options For Parkinsons
While there is no cure for Parkinsons at this time, there are a number of treatments that can ease symptoms. Parkinsons medications are the mainstay of treatment, but modalities are often used in combination. Physical, occupational and speech therapy can be critical to the treatment plan. Surgical options also have an important role for a subset of patients with Parkinsons disease. Finally, complementary therapies can be used to treat some Parkinsons disease symptoms. Your physician and other healthcare professionals can help you determine the best treatment plan for your symptoms.
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Factors Your Doctor May Consider Dbs Therapy
Deep brain stimulation therapy for Parkinson’s disease is not right for everyone. Only a doctor experienced with DBS can determine if you are a candidate. Generally, the therapy is not recommended for people who have been recently diagnosed with Parkinson’s disease, or for those who are doing well on medication.
You may be a candidate for DBS if:
- You experience troubling “off” periods
- You experience dyskinesias
- You are not responsive to doses of dopaminergic drugs in a typical day
Purpose Of Brain Surgery For Parkinsons Disease
Parkinsons disease surgery is used to treat motor effects of Parkinsons disease, such as tremor, but it does not help non-motor effects, such as reduced facial expression and dry skin.
Parkinsons disease can range from mild to severe, and it can be very disabling when the disease is severe. When high doses of medication are needed to control the symptoms, the medication can cause side effects such as dyskinesia , hallucinations, or both.
You might benefit from surgery if your symptoms do not improve adequately with medication or if you experience severe medication side effects.
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Managing Your Symptoms With Medication
Almost all patients with Parkinsons disease eventually need to take medication to help with their motor symptoms. Several classes of medications are available and can be viewed here. Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. It also may be used in combination with other classes of medications including Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents. Treatment is highly individualized and adjusted over time based on symptoms and side effects.
Nursing Care Plan For Parkinsons Disease 1
Ineffective Airway Clearance related to Parkinsons disease as evidenced by shortness of breath, SpO2 level of 89%, cough, use of accessory muscles, increased mucus production, difficulty to expectorate phlegm
Desired Outcome: The patient will be able to maintain airway patency and improved airway clearance as evidenced by being able to expectorate phlegm effectively, respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within target range , and verbalize ease of breathing.
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Brain Connectomic Studies And Improved Precision Of Neuromodulation Targets
The process of altering brain function through direct manipulation of neural activity has long been used to treat patients with neuropsychiatric disorders and deep brain stimulation has provided clinical benefit to more than 150 000 patients with PD, dystonia and essential tremor . Apart from the conventional application in advanced PD, DBS has also been suggested to exert disease-modifying traits . In multiple preclinical studies on rat models, chronic STN electrical stimulation was shown to result in preservation of SNpc dopaminergic neurons and an increase of brain-derived neurotrophic factors followed by activation of the tropomyosin receptor kinase type B receptor signaling in the nigrostriatal system . Although preclinical experiments suggest potential neuroprotective effects of DBS, results from clinical studies have shown that dopaminergic neuron degeneration remains unaltered , and -syn burden is not reduced in PD patients treated with DBS .
Focused ultrasound as a newly developed neuromodulation technique
Repetitive transcranial magnetic stimulation
Few studies have investigated the effect of rTMS on levodopa-induced dyskinesias, showing only short-lasting or no beneficial effect.
The Surgical Option: Deep Brain Stimulation
Some patients with Parkinsons disease may benefit from deep brain stimulation , a surgical therapy that has been FDA approved for over a decade. DBS involves implanting an electrode into a targeted area of the brain, usually the subthalamic nucleus or the globus pallidus interna . The implants can be done on one side or both sides of the brain as needed. The electrodes are stimulated through a connection to a pacemaker-like device located under the skin in the chest. Patients that are considered good candidates for this procedure are those with a robust response to Levodopa, no significant cognitive or psychiatric problems, and no significant problems with balance. The procedure can help patients with medication-resistant tremors. It can also help patients who have significant motor fluctuations in which medication response varies during the day and dyskinesias or extra movements may occur as a side effect of medication.
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How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover
The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.
Nursing Care Plan For Parkinsons Disease 2
Impaired physical mobility related to disease process of Parkinsons disease as evidenced by bradykinesia, cognitive impairment, inability to bear weight, rigidity, tremors, generalized weakness, inability to do activities of daily living as normal, and verbalization of overwhelming tiredness
Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.
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Treating Parkinsons With Complementary Medicine
Complementary medicine incorporates many different practices that can be used alongside conventional medicine to try to ease PD symptoms. There is typically not as much rigorous data to support the use of complementary medicine techniques, as compared to conventional medicine, but many patients find them helpful. These include yoga and massage.
Management Of Medication Side Effects
Many of the treatments that are commonly used for treatment of Parkinson’s disease may produce distressing side effects. Hallucinations can be a side effect of Parkinsons medications and some people may need to take antipsychotic medications to reduce them.
Dyskinesias are involuntary movements that often result from long-term use of Parkinsons disease medications. Gocavri is approved for treatment of dyskinesia in Parkinson’s disease, and surgery is another potential treatment for this side effect.
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Alternative Treatments For Parkinson’s Disease
Alternative therapy may also be used to treat Parkinson’s disease. The most touted in recent years has been the effect of Vitamin E on reversing the progression of the disease although, this effect is still being debated by the scientific community.
Relaxation and guided imagery have also been suggested to help with stress, depression, and anxiety. Medical studies have shown that relaxation and guided imagery may help slow the progression of symptoms as well as quicken healing time after surgeries or injuries.
What Medications And Treatments Are Used
Medication treatments for Parkinsons disease fall into two categories: Direct treatments and symptom treatments. Direct treatments target Parkinsons itself. Symptom treatments only treat certain effects of the disease.
Medications that treat Parkinsons disease do so in multiple ways. Because of that, drugs that do one or more of the following are most likely:
Several medications treat specific symptoms of Parkinson’s disease. Symptoms treated often include the following:
- Erectile and sexual dysfunction.
- Hallucinations and other psychosis symptoms.
Deep brain stimulation
In years past, surgery was an option to intentionally damage and scar a part of your brain that was malfunctioning because of Parkinsons disease. Today, that same effect is possible using deep-brain stimulation, which uses an implanted device to deliver a mild electrical current to those same areas.
The major advantage is that deep-brain stimulation is reversible, while intentional scarring damage is not. This treatment approach is almost always an option in later stages of Parkinson’s disease when levodopa therapy becomes less effective, and in people who have tremor that doesnt seem to respond to the usual medications.
Researchers are exploring other possible treatments that could help with Parkinsons disease. While these arent widely available, they do offer hope to people with this condition. Some of the experimental treatment approaches include:
Whats The Primary Treatment For Parkinsons Disease
The main treatment goal for PD is to maintain a consistent concentration of dopamine in the brain. Some medications achieve this by simply supplementing dopamine. Other medications slow down the natural breakdown of dopamine, so the chemical lasts longer.
It may be helpful to think of these medications in three broad categories:
Dopamine replacements. These are like dopamine supplements for the brain. The main example of this is carbidopa/levodopa . This comes in pill, inhaler, and infusion forms.
Dopamine mimics . These activate the receptors in the brain that make dopamine. These medications come in the form of pills, patches, and injections. Examples include medications like pramipexole, ropinirole, rotigotine, and apomorphine.
The downside of increasing dopamine levels in the brain is that dopamine circulates throughout the body, too. Extra dopamine can cause side effects like nausea, lightheadedness, hallucinations, and uncontrolled movements.
Also, as PD progresses, theres a need for higher doses of these medications. This can increase unwanted side effects. And sometimes it can be hard to tease out which symptoms are from PD and which are medication side effects.
Meditation And Relaxation Techniques
Meditation and relaxation techniques can take many forms. Listening to relaxing music is the most basic form. Mindful meditation can be used to relax and focus on breathing or negative emotions and thoughts. It can also be used to help a person become more aware of their surroundings or body movements. Several studies have shown a connection between Parkinsons disease symptoms and mindful meditation.
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How Parkinson’s Disease Is Treated
The treatment options for Parkinson’s disease include several different medications, surgical procedures, and physical therapies. What’s appropriate for you depends on the symptoms you’re experiencing and how severe your disease is. You will most likely benefit from treatments for your tremors and other motor symptoms, but other options for some of the non-motor effects of Parkinson’s disease may also be beneficial for you.
Glucagonlike Peptide 1 Receptor Agonists And Other Antidiabetic Agents
Biological processes involved in PD share common features with obesity and type 2 diabetes mellitus , including the dysregulation of insulin signaling in the brain. The term brain insulin resistance has been suggested to describe decreased sensitivity of CNS pathways to insulin, followed by disturbances in synaptic, metabolic and immune response functions . Strategies to normalize insulin sensitivity in neurons have thus been in the spotlight of clinical trials aiming to establish whether they may provide neuroprotective actions.
The neuroprotective effect of GLP-1 RAs is assumed to be mediated by improved brain insulin sensitivity however, human studies evaluating their biological effect in the CNS are limited. Functional MRI imaging studies have primarily focused on investigating brain networks involved in the anorectic effect of GLP-1 RAs , but sparse mechanistic data are available for understanding neuroprotective effects of these drugs. In a more recent trial of exenatide in PD, disease modifying effects measured by nigrostriatal dopamine transporter imaging were reported . Subsequently, brain insulin and Akt signaling pathways were also evaluated in neuronal-derived exosomes and it was shown that exenatide treatment, but not placebo, activated these pathways . This significant, secondary analysis of the trial increases understanding of the molecular mechanism underlying the treatment effect and provides a possible biomarker to measure target engagement.
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Parkinsons Disease Treatment & Therapies
Parkinsons disease treatment and therapies aim to relieve symptoms and maintain functioning to improve quality of life. There is currently no cure for Parkinsons disease. Many years may pass before early symptoms progress to the point of interfering with normal activities.
Medication therapy is the most widely used and most effective Parkinsons disease treatment. Neurologists, or other specialists, may try several medications or a combination of PD drugs to develop a unique treatment plan for you. The goal of Parkinsons disease treatment is to manage symptoms while keeping side effects minimal. Deep Brain Stimulation surgery, also known as DBS, may be an option for select patients who have responded well to medication therapy.
Exercise and physical activity are also highly recommended for Parkinsons patients. Exercise and staying active overall are now believed to slow the progression of the disease and also increase the ability to remain independent. Tai Chi, Yoga, and dance are a few exercise programs that seem to benefit PD patients, especially with regard to balance and gait training. Visit the PAC current Exercise Programs page to see what exercise programs are currently being offered throughout the Carolinas.
Deep Brain Stimulation SurgerySurgery may be an option to relieve symptoms for some people with Parkinsons. International experts in PD gathered in 2011 to collaborate and publish an expert consensus on Deep Brain Stimulation .
Surgery: What To Expect Dbs Therapy
People who receive a DBS system usually describe the surgical procedure as demanding and exhausting. There may be some discomfort during the initial stages of the surgery. However, the placement of the lead is not painful . Your doctor will be able to answer any questions you may have about the procedure.
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What Causes The Condition
Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.
Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.
Familial Parkinsons disease
Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.
Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.
Idiopathic Parkinsons disease
Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.
With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.
The possible causes are: