Parkinson's Disease

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Many patients seeking treatment for Parkinson’s disease in Dallas and Fort Worth explore deep brain stimulation as a viable treatment option. Deep brain stimulation and other treatment options require the expertise of renowned neurosurgeon Dr. Nader Pouratian.

What Is Parkinson’s Disease?

Parkinson disease is a degenerative disorder of the brain that affects movement. The disease gradually progresses over time and can become debilitating. Most people associate Parkinson disease with a tremor, but there are multiple other movement problems that patient can experience, including:

  • Tremors – Involuntary movements that can occur in the face, arms, fingers, legs, and toes. Tremors usually occur at rest, but in severe cases, tremors can also occur with movement.
  • Rigidity – Muscle stiffness that hinders movement
  • Bradykinesia – Slowing of movement
  • Hypomimia – Decreased facial expressions as well as decreased blinking
  • Abnormal Gait – Difficulty walking, including freezing of gait
  • Abnormal Posture – Bent standing posture

While it is called a movement disorder, Parkinson disease affects more than just movement. Other symptoms of Parkinson disease include:

  • Depression – can occur in up to 80% of patients with Parkinson disease
  • Constipation – Infrequent and difficult bowel movements
  • Anosmia – Decreased smell
  • Sleep disorder – Vivid dreams, acting out in sleep, and difficulty sleeping
  • Impaired decision making and multitasking
  • Dementia – Often later in disease. When it occurs early, it may indicate a different diagnosis should be considered
  • Chronic pain
Dr. Pouratian is my neurosurgeon and performed DBS (deep brain stimulation) surgery on me in 2012. From the moment I met him I felt comfortable and knew I was in good hands. His confidence and expertise on Parkinson’s disease and DBS was very reassuring. I never questioned his abilities for a minute. Dr. Pouratian has excellent bed-side manner and someone I truly consider a friend.Self-verified patient of Dr. Pouratian

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Causes

Parkinson disease is caused by the gradual death of neurons (nerve cells) in the brain. These neurons produce dopamine, a neurotransmitter that is responsible for transmitting signals between neurons in the brain. When dopamine levels decrease due to the neuron death it can cause abnormal brain activity to occur and can lead to the development of Parkinson disease.

While the exact cause of Parkinson’s disease is not fully understood, there are identifiable factors that have been shown to play a role in the development of Parkinson’s disease. These factors include your genes and environmental triggers such as exposure to toxins known to cause Parkinson’s disease. Age is also an important factor since Parkinson’s rarely occur in younger individuals and is much more prevalent in patients around 60 years old. Men are also at a higher risk of developing Parkinson’s disease.

Diagnosis

During your consultation for Parkinson’s disease, your medical history will be thoroughly reviewed. An evaluation of your responsiveness to medications, quality of life, and severity of motor symptoms will be conducted.

If it is determined that you have Parkinson’s, a specialized treatment program will be developed based on your condition. You will be informed of the possible complications and potential benefits of the chosen treatment modality.

Treatment

Treatment for Parkinson disease is driven by symptoms. In general, treatment is not initiated until symptoms are bothersome. Treatment always begins with medications that aim to increase the amount of dopamine in the brain. The gold standard therapy is Sinemet, or carbidopa-levadopa, with directly provides dopamine to the brain. There are other medications as well, including dopamine agonists (which act like dopamine in the brain) and medications that help dopamine last longer in the brain (MAO and COMT inhibitors). Managing medications for Parkinson disease can be very complex and requires balancing many medications, and often requires taking medications 5-6 x per day.

When medications cause side effects and when the movement symptoms of Parkinson disease are the most bothersome symptoms, one can consider Deep Brain Stimulation. It has been established as an effective therapy for managing motor symptoms of various neurologic and psychiatric conditions, including Parkinson’s disease.

Deep brain stimulation is like a pacemaker for the brain. Deep brain stimulation works with medicines to make medications work more effectively and reduce the side effects of medication. The most important predictor of the potential benefit of deep brain stimulation is how effective medications are when medications are working perfectly. Deep brain stimulation is not considered a “last ditch” effort for someone with severe disease and it is also not used when medications are still working effectively. Rather, it is a treatment that specifically works for people who benefit from medications but have side effects with medicaitons, like wearing off, fluctuations, dystonias, and dyskinesias. Deep brain stimulation requires comprehensive evaluation by a team of neurologists, neurosurgeons, and psychologists.

Deep brain stimulation therapy is best for candidates who have had a diagnosis of Parkinson’s disease for at least four years and, even when responsive to medications, still have motor problems. If the patient has dementia, undergoing this treatment is not recommended, as it can worsen memory or cognition problems.

Deep Brain Stimulation

Deep brain stimulation surgery is performed under local anesthesia with sedation or under general anesthesia. A small hole in the skull is made. Electrodes are transplanted in the target areas of the brain.

A week or so after, the pacemaker device (an implantable pulse generator) is also placed just below the skin of the collarbone. The connecting wire is tunneled under the skin behind the ear to the neck leading to the neurostimulator.

The settings of the pacemaker device will depend on the symptoms of the patient and the treatment plan.

Recovery can take a few weeks. Stitches and staples are removed after two weeks, and the patient is not allowed to shampoo until then. They can wash their hair with a damp cloth, but they need to keep the incision sites dry and covered.

Patients must avoid over-stretching their neck or raising their arms above their shoulders. They may go back to light activities after two weeks, but no heavy lifting or strenuous exercises should be performed for up to six weeks. They will be scheduled for follow-up appointments, which must not be missed.

Set Up Your Consultation

Learn more about Parkinson’s disease in Dallas and Fort Worth—contact Dr. Pouratian today to schedule your consultation.

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