Liv Hospital Ulus
Neurosurgery

Parkinson

Parkinson's disease (PD) is a slowly progressive disease in which there is widespread neurodegeneration in the brain to involve dopamine-containing nigrostriatal neurons. The main mechanism in the disease is thought to be related to the pathology of synuclein. It was first described in detail by James Parkinson in 1817. It constitutes 80% of all parkinsonism cases.


 

What are the main symptoms?


The main clinical signs are; It is resting tremor, bradykinesia, rigidity and postural reflex disorder that occurs in the following years. Prevalence studies show that approximately 1% of the population over the age of 65 and 3-4% in the 80s are affected by this disease. The incidence in men is slightly higher than in women (M/F:3/2).

 

 How is Parkinson's Disease Diagnosed?


The clinical diagnosis of Parkinson's disease is based on neurological examination findings and anamnesis. While taking the patient's anamnesis, all clinical details and the drugs used should be recorded one by one. Further examination tests such as cranial MRI are especially useful when atypical parkinsonism or secondary parkinsonism is considered in the differential diagnosis. Some Parkinson's diseases can mimic Parkinson's disease at an early stage. Therefore, the initial diagnosis of Parkinson's disease may change over time. Finalization of the clinical diagnosis is only possible with neuropathology. Differentiating Parkinson's disease from atypical parkinsonisms and other parkinsonian syndromes; It is of great importance in terms of treatment response, treatment options and prognosis. The differential diagnosis should be made meticulously, especially in patients who are candidates for intermediate-advanced treatment options.
If the causes of Parkinson plus syndromes or symptomatic parkinsonism are considered in the differential diagnosis, the current diagnostic criteria specific to those diseases should be considered. Routine cranial MRI and other ancillary examination methods (DAT-SCAN SPECT/ I-131 dopamine receptor imaging, MIBG / iodine-123-metaidobenzylguanidine) may contribute to the exclusion of alternative diagnoses.
 

What is Parkinson's Disease Treatment?


From the point of view of evidence-based data, there is currently no treatment that stops or slows the progression of the disease, the drugs used are symptomatically effective. Since many motor symptoms in PD are due to striatal dopamine deficiency, the basic medical approach in the treatment of the disease is to increase dopaminergic activity.
 

Is there a surgical treatment for Parkinson's Disease?


There is a surgical treatment for Parkinson's disease. But this treatment does not cure the disease.
Depending on the developments in neurosurgery and stereotaxic surgery, lesion (ablation) surgery was initially performed. Today, deep brain stimulation (DBS) is used and successful results are obtained.
 

What kind of surgery is deep brain stimulation (DBS)?


DBS therapy is a system consisting of two electrodes implanted in the neural tissue and a battery placed under the subclavicular skin, which can be programmed and removed if the patient wishes to stop the treatment and remove it.
The most important feature of this treatment is that it does not cause any permanent and irreversible changes in the brain. It aims to treat symptoms in the best way by giving the opportunity to adjust parameters such as the amplitude of the stimulus (Amplitude), pulse width (pulse width), frequency of pulses (Frequency-Rate). Disadvantages include hardware failure/breakage, infection and wound site problems. The symptoms that can occur with stimulation are the adjustment of the stimulation parameters.eliminated with cost.
 

To whom can DBS be applied?

  • Strong motor response to levadopa is a prerequisite for successful DBS.
  • Receiving 5 or more daily doses of levodopa (ie the patient needs to take 5 or more daily doses of levodopa due to stiffness)
  • It should be considered in patients who develop motor fluctuations (if the patient has frostbite/off and stiffness for 2 hours or more during the waking part of the day despite treatment) and dyskinesias (1 hour or more involuntary movements) while under medical treatment.
 

DBS (Deep Brain Stimulation) is used in the treatment of which diseases?

    

     Diseases for which we have successfully applied DBS

  •  Idiopathic Parkinson's disease

  •  Essential Tremor
  •  Primary Dystonia
  •  Tardive dystonia
  •  Myoclonic dystonia
  •  Pantothenate kinase-associated neurodegeneration (PKAN)
  •  Huntington's chorea
  •  Korean acanthocytosis
  •  Tics / Gilles de la Tourette Syndrome
  •  Cerebellar tremor (multiple sclerosis)
  •  Midbrain tremor
  •  Orthostatic tremor
  •  Lesch-Nyhan syndrome
  •  Obsessive Compulsive Disorder

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