Parkinson’s disease is a common degenerative disease of the nervous system in middle and old age. Epidemiological surveys show that the prevalence rate of people over 65 years old in China is 1.7%. With the growth of the middle-aged and elderly population in China, the number of people suffering from Parkinson’s disease may continue to rise in the future and should be given high priority.
Why do you have Parkinson’s disease? What are the main symptoms of Parkinson’s disease?
It is believed that Parkinson’s disease is caused by progressive degeneration of dopaminergic neurons in the substantia nigra and the formation of Lewy bodies, resulting in a decrease in dopamine transmission and an imbalance between dopamine and acetylcholine transmission in the striatum of the brain. The symptoms include motor and non-motor symptoms, with motor symptoms such as tremor, myotonia, bradykinesia, and postural balance disorders, and non-motor symptoms including sleep disorders (insomnia, abnormal sleep behavior during rapid eye movements, excessive daytime sleepiness, and restless legs syndrome), sensory disorders (hyposmia, pain, or numbness), autonomic dysfunction (constipation, urinary disorders, and positional hypotension), and cognitive and psychiatric disorders (depression, anxiety, hallucinations, delusions, impulsive compulsive behavior and cognitive decompensation and dementia).
Treatment modalities for Parkinson’s disease
Currently, the treatment methods and tools for Parkinson’s disease include medication, surgery, botulinum toxin treatment, exercise therapy, psychological interventions, and caregiving. Drug therapy is the main tool for early treatment of Parkinson’s disease, surgery is an effective supplement when drug therapy is not good, botulinum toxin injection is an effective method for treating local spasticity and dystonia, and exercise and rehabilitation therapy, psychological intervention and caregiving are applicable throughout the treatment of Parkinson’s disease. Therefore, when clinical conditions allow, the formation of a multidisciplinary team of physicians with neurology, functional neurosurgery, neuropsychology, rehabilitation and even community general practitioners can treat and manage Parkinson’s disease patients more effectively and better bring greater benefit to patients in terms of symptom improvement and quality of life enhancement.
Drug treatment for Parkinson’s disease
Once Parkinson’s disease is diagnosed in its early stages, medication should be started to not only better improve symptoms, but also to slow disease progression. Treatment should follow both evidence-based medical evidence and emphasize individualized features. Drug regimens will vary from patient to patient with different symptoms (whether they are predominantly tremor or tonic oligometabolic), and they need to take into account the severity of the disease, age of onset, employment status, presence of cognitive impairment, presence of co-morbidities, possible adverse effects of drugs, patient’s wishes, affordability, and other factors. Early-stage monotherapy is generally used, but small-dose combinations of two drugs with different mechanisms of action can also be used to strive for optimal efficacy and longer maintenance with lower incidence of adverse effects and motor complications. For middle and late stage Parkinson’s disease, the clinical manifestations tend to be complex, both related to the progression of the disease itself and the influence of factors such as adverse drug reactions or motor complications. Treatment should continue to strive to improve motor symptoms, but also to properly manage some motor complications and non-motor symptoms.
Non-motor symptoms can occur throughout all stages of Parkinson’s disease, and certain non-motor symptoms, such as hyposmia, abnormal sleep behavior during periods of rapid eye movements, constipation and depression can appear earlier than motor symptoms and can also fluctuate with motor fluctuations, severely affecting the patient’s quality of life. Therefore, managing motor symptoms in patients with Parkinson’s disease needs to be accompanied by managing the patient’s non-motor symptoms as well.
When surgery is needed
In the early stages of Parkinson’s disease, medication is effective, and we call this the “honeymoon period” of medication, which lasts about 4 to 5 years. As the disease progresses, medication becomes less effective, or is complicated by severe symptom fluctuations or dyskinesia, surgical treatment is required. Deep brain stimulation (DBS), commonly known as a “pacemaker”, is a procedure that involves implanting stimulating electrodes in specific nuclei or brain regions to modulate the function of the nuclei or brain regions through pulsed electrical stimulation to improve symptoms. It can significantly improve the motor symptoms of Parkinson’s disease patients, improve the quality of life of patients, and give patients a second “honeymoon period”. The preoperative evaluation is essential to determine the suitability for surgery, the risks of surgery, the best surgical target, and the postoperative outcome, and is usually performed by both neurologists and surgeons, with the involvement of anesthesiologists and imaging specialists when necessary.
The precise implantation of the stimulation electrodes is the most critical aspect of successful DBS surgery, which is performed by experienced neurosurgeons. Post-operative program control is another key aspect of achieving good outcomes, as the optimal stimulation contact and the best stimulation parameters (appropriate stimulation voltage, pulse width and frequency) need to be selected to maximize the patient’s symptoms while avoiding stimulation side effects.
The physician can remotely adjust the patient’s stimulator parameters online, i.e., remote program control, to facilitate patients who are far from the hospital, have poor transportation conditions, or have limited mobility, and help patients solve their problems in a timely manner, which played a great role during the New Coronary Pneumonia epidemic. postoperative DBS usually requires adjustment of the medication regimen, which can reduce the amount and type of medication taken, reduce drug side effects, and slow down the progression of the disease. Comprehensive postoperative treatment should not be neglected and also requires the cooperation of related departments such as rehabilitation, nutrition and Chinese medicine.
Care and attention is important
For patients with Parkinson’s disease, in addition to specialized medication and surgical treatment, scientific care is important to maintain the patient’s quality of life. Scientific care can often play a supplementary therapeutic role in effectively controlling the disease and improving symptoms; at the same time, it can more effectively prevent accidents such as accidental aspiration or falls. Comprehensive care should be provided for motor and non-motor symptoms, including medication care, diet care, psychological care and rehabilitation training. The patient should be informed of the usage and precautions of medications to avoid adverse drug reactions; the patient’s nutritional status and constipation should be improved by formulating a targeted diet plan; the patient’s psychological status should be assessed in a timely manner, and positive guidance should be given to regulate the patient’s negative emotions and improve the patient’s quality of life; the patient’s rehabilitation training should be supervised in cooperation with family members to maintain good motor function and improve the patient’s ability to take care of himself. There is no absolute treatment for Parkinson’s disease.
The treatment of Parkinson’s disease does not have an absolute fixed pattern, and the needs of treatment vary from patient to patient and from patient to patient at different stages of the disease. Scientists at home and abroad are also actively exploring better treatments. In addition to the development of new drugs, research breakthroughs in gene therapy and neural stem cell transplantation are expected to provide better treatment options for Parkinson’s disease patients in the future.