Parkinson’s Disease

It is an insidious disease that progresses slowly. It is caused by deficiency of a substance, namely dopamine, in the brain. It is manifested by symptoms, including but not limited to stiffness of muscles (rigidity) and slowness of movements as well as tremor in hands as the major symptom.

What is the average age at diagnosis and what is the prevalence?

It is diagnosed in one of every 100 people over the age of 70. It is a chronic, progressive disease.

What are symptoms of Parkinson’s disease?

Parkinson's signs and symptoms may include; tremor , slowed movement (bradykinesia), rigid muscles, impaired posture and balance, loss of automatic movements, speech changes and writing changes

What is the treatment of Parkinson’s disease?

First, medication treatment is started. The response to medication treatment gradually decreases over time in some patients. This interval is characterized by inter-patient variations.

When a deep brain stimulator is placed, the nervous structures that are located deep in the brain and function to coordinate movements are transmitted electrical signals in order to have patients, who face serious difficulties due to the deficiency, act independently in activities of daily living and to facilitate life.

What are other diseases accompanied by movement disorders?

Essential Tremor

Involuntary movements develop in hands, arms, head and legs. Essential tremor is the most common movement disorder that can occur at any age.

Dystonia

This movement disorder is characterized by repetitive, twisting and involuntary contractions of muscles, resulting in abnormal postures. This disease poses negative influence on the quality of life and it is more common in children and adolescents.

What are the surgical treatment methods?

Surgical procedures can be considered, when medications cannot control symptoms of movements disorders or side effects of medications occur. Parkinson’s disease, dystonia and essential tremor are movement disorders that are most commonly treated by surgical procedures.

Who are candidates of surgical treatment methods?

The patient is evaluated by the movement disorders team that consists of Neurologists, Neurosurgeons and Psychiatrists. Medications and treatments that are already used and the medical history are reviewed. Surgical treatment is considered for patients who will likely benefit in the light of detailed examinations.

Broadly, there are three types of surgical methods:

1- Deep Brain Stimulation (colloquially referred to as Brain Battery or Pacemaker)

2- Lesion surgery (Radiofrequency thermocoagulation)

3- Gamma Knife Radiosurgery

Each surgical method has unique advantages and disadvantages. The doctor decides the best method for each patient.

Deep Brain Stimulation (colloquially referred to as Brain Battery or Pacemaker)

In Deep Brain Stimulation, a very thin electric cable is placed in the centers that are responsible for the onset of the movement disorder and complaints of the patient are relieved by continuously sending electric current.

Deep brain stimulation targets thalamus (for tremor), pallidum (for Parkinson’s disease and dystonia) and subthalamic nucleus (for Parkinson’s disease). The most significant advantage of deep brain stimulation is the lack of tissue damage. The electric current sent by the battery is adjusted according to needs of the patient and thus, complaints can be controlled. The battery that is placed beneath the clavicle should be replaced at 4- to 5-year intervals on average. Recently, it is the globally preferred method for the surgical management of movement disorders.

Lesion surgery (Radiofrequency thermocoagulation)

Lesion surgery is another method used for the treatment of movement disorders. A small hole is drilled in the skull in order to advance a needle to the diseased area of the brain; the heat generated in the tip of the needle is used to destruct the area. This method has been used for long years for thalamotomy (for tremor), pallidotomy (for Parkinson’s disease and dystonia) and subthalamatomy (for Parkinson’s disease). A quick response is obtained after the procedure.

Gamma Knife Radiosurgery

Gamma Knife Radiosurgery can be used to treat movement disorders. Gamma Knife can be used for thalamotomy and subthalamatomy. Gamma Knife is advantageous as curative rays are directed to the target zone without the need of any surgical procedure. By this way, complications of surgery are eliminated. However, it takes several months to witness the effects of the treatment. Gamma Knife is a safe option for patients who have intracranial or systemic disease that contraindicates the surgery.

                                                                                                                                          Selcuk Peker M.D.

                                                                                                                               Professor of Neurosurgery

                                                                                                                                    Koc University Hospital