parkinson disease

موضوع: parkinson disease الأحد ديسمبر 30, 2012 2:54 pm

What is Parkinson’s disease?

Parkinson’s disease (PD) is a progressive neurological condition that causes some or all of the following symptoms:

tremors
limb stiffness
poor or instable posture
difficulty with voluntary movement

It typically occurs after the age of 65 years, but about 15% of patients have a young onset form of the disease that can appear before age 50.

What are the symptoms of Parkinson’s disease?

The four main symptoms associated with Parkinson’s disease are:

Tremors that begin in one extremity (for example, your finger) and progressively spread up that extremity toward the center of your body. In the early stage of your disease, the tremors may affect only part of one extremity and may only occur on one side of your body. Though tremors are the most commonly recognized symptom of Parkinson’s disease, not all patients diagnosed with Parkinson’s disease develop tremors.
Rigidity, most often originating in your legs and neck. Parkinson’s disease can cause the muscles that move your joints to become contracted and stiff. This prolonged muscle contraction can result in pain and difficulty moving. Most people diagnosed with Parkinson’s disease experience rigidity.
Poor posture, balance, and coordination can increase your risk for falls and other accidents. You may develop a ‘stooped’ position, with your head tilted forward and down and sagging shoulders. Continual leaning forward or backward is also common.
Bradykinesiaandakinesia are also symptoms. Bradykinesia is a slow, shuffling walk. Akinesia refers to difficulty completing or initiating a voluntary muscle movement.

What causes Parkinson’s disease?

Parkinson’s disease is caused by the deterioration of neurons in an area deep in your brain called the substantianigra. When these nerve cells die, the level of dopamine, a neurotransmitter involved controlling voluntary muscle movement, in your brain decreases.

As more cells in the substantianigra in your brain die, your symptoms will generally get worse.

How can deep brain stimulation help to treat Parkinson’s disease?

Medications are available to treat your symptoms of Parkinson’s disease, but they will not cure your disease. Often, the medicines become less effective over time. Alternatively, your condition might not respond to medication at all. If this is the case, deep brain stimulation (DBS) could help to relieve, but not cure, your symptoms.

The deep brain stimulation device delivers a small electrical stimulus to an area of your brain. Once the device is turned on, your symptoms may diminish or cease altogether. In some cases, the symptoms in one part of your body may respond better than those in other parts.

Deep brain stimulation will not cure Parkinson’s disease. Your symptoms will get worse or return if your neurostimulator device is turned off.

Three pieces of surgically implanted hardware are used in DBS treatment:

The lead is the part of the device that is implanted in your brain. It is made up of four insulated wires that transition into four exposed electrodes at the tip of the stimulator.
The extension is a small wire that connects to the lead outside your brain and passes under your skin from your head and down your neck. It terminates in your upper chest at the site of the neurostimulator.
The neurostimulator is a pacemaker-like device that contains the power source for the lead and other electronics. Your surgeon will implant the neurostimulator in your upper chest, below your collarbone. The neurostimulator is attached to the extension, which carries electrical power to the lead, where targeted amounts of power are delivered to the affected area of your brain.

Your doctor will be able to adjust the neurostimulator wirelessly after surgery. You will also be able to turn the device on and off by holding a magnet near the device.

What are the risks of DBS surgery for Parkinson’s disease?

Deep brain stimulation surgery carries similar risks to other invasive neurological procedures, including the following:

infection
bleeding inside the brain
seizures
coma or death
pain at the surgery site
headache
cognitive problems

What are the potential side effects of DBS therapy?

Once your device is installed and turned on, you may experience the following side effects:

dizziness or lightheadedness (disequilibrium)
vision problems (double vision)v • numbness (hypoesthesia)
temporary worsening of symptoms
facial and limb muscle weakness or partial paralysis (paresis)
speech problems like whispering (dysarthria) and trouble forming words (dysphasia)
déjà vu (this can be corrected by surgical repositioning of the lead)
tingling sensation (paresthesia)
persistent cough with stimulation on
abnormal, involuntary movements (chorea, dystonia, dyskinesia)
movement problems or reduced coordination
jolting or shocking sensation

How can the surgery or side effects be reversed?

If the severity of your side effects outweighs the benefits of the treatment, the device can be turned off or adjusted. Your neurostimulator can be removed if necessary.

What can I expect my results to be like?

Results will vary for each patient. In one clinical study, 87% of patients showed improvement in motor control over the 12 months following their surgery.

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