Parkinson's Disease
Parkinson's disease is a chronic neurological disorder primarily caused by a reduced level of dopamine, a key neurotransmitter in the brain. The decline or injury of dopamine-producing cells, often linked to the ageing process, leads to the characteristic motor symptoms of Parkinson's, such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability.
Who is Particularly at Risk?
Parkinson's disease predominantly affects the elderly. Symptoms usually manifest when 60 to 80% of the brain's dopamine-producing neurons are lost. The average onset age is between 62 and 65 years, with an incidence rate of approximately 2-3 per 1,000 individuals. The risk increases tenfold after the age of 70, with the prevalence rising to around 0.5-2% in this age group. The younger the onset of the disease, the more pronounced the progression tends to be, often resulting in a more severe prognosis.
What is the Prevalence of Parkinson's Disease in Turkey?
Unfortunately, there is no comprehensive scientific data on the exact number of Parkinson's disease patients in Turkey. However, it is estimated that approximately 100,000 people are living with Parkinson's in the country.
Is Parkinson's Disease Preventable?
Regrettably, there is no diet, lifestyle modification, or exercise regimen proven to prevent the onset of classical Parkinson's disease, also known as Idiopathic Parkinsonism, which constitutes the vast majority of cases. Excluding the very rare genetically predisposed cases, the lifetime risk of developing Parkinson's disease for individuals over 65 years of age is around 0.3%.
How is Parkinson's Disease Diagnosed?
The diagnosis of Parkinson's disease is primarily clinical, based on the presence of key symptoms. These include the characteristic 'pill-rolling' tremor in the hands, typically beginning in one limb, bradykinesia, a lack of coordination between arm and body movements, a stooped posture with diminished arm swing, a masked facial expression with reduced facial mimicry, and a shuffling gait. Early identification of these symptoms should prompt an immediate consultation with a neurologist.
Support from Family and Friends is Crucial
Parkinson's disease, though challenging, is not an insurmountable condition. It is akin to managing diabetes; with early intervention through medications or, when necessary, surgical approaches, patients can maintain a near-normal lifestyle. It is essential for family members and friends to provide support, ensuring the patient remains engaged in social activities, adheres to prescribed treatments, and avoids social isolation. As the disease progresses, careful consideration must be given to selecting the most appropriate treatment strategies to preserve the patient's quality of life.
Impact on Social Life
The bradykinesia associated with Parkinson's disease can severely limit a patient's ability to perform daily tasks independently, often leading to increased reliance on others. As the disease progresses, patients may withdraw from work and social activities, compounding their emotional distress and increasing the risk of depression. This social withdrawal, coupled with the physical symptoms, can have a profound effect on a patient's overall well-being.
Neurostimulation: A Path to Independence
Among the most effective treatments for Parkinson's disease, neurostimulation has shown significant promise in improving patients' quality of life. This treatment offers a lifeline to those who have not responded well to medications, particularly those experiencing severe tremors or intolerable side effects from drug therapy. However, careful patient selection is crucial to ensure the best possible outcomes from the surgery.
Interacting with the Patient During Surgery
When Parkinson's disease does not respond well to medical treatment, surgical options may be considered. These typically involve either unilateral lesion surgery or the implantation of a neurostimulator. Notably, during these procedures, the patient is kept awake and can interact with the surgical team, allowing for real-time monitoring of the brain's response to the intervention.
Frequently Asked Questions
Is Medical Treatment the First Line of Defence Against Parkinson's Disease?
Yes, the first-line treatment for Parkinson's disease is typically medication, and a large proportion of patients respond well to this approach. Around 80-85% of patients experience significant symptom relief for many years, particularly during the initial stages of the disease. However, over time, as the disease progresses, the effectiveness of medications may diminish, and patients might develop drug intolerance. This period of effective treatment, often referred to as the “honeymoon phase," generally lasts for the first 4-5 years, with optimal symptom management typically seen in the first 2-3 years.
When is Surgery Considered Necessary?
Surgery becomes an option when medication no longer provides adequate symptom control, even at higher doses or frequencies, and when side effects such as dyskinesias (involuntary movements) become problematic. Approximately 10-15% of all Parkinson's patients may be candidates for surgery. Those with prominent tremors often do not respond well to medication from the outset and may benefit from earlier surgical intervention. For younger patients, neurostimulation is increasingly preferred over initiating dopamine therapy early, due to the long-term side effects associated with these medications.
The Safest Surgical Methods
For Parkinson's disease, there are two main surgical options. If symptoms are confined to one side of the body, a unilateral lesion surgery using a laser technique may be performed, akin to “burning" the affected area. However, for bilateral symptoms, a neurostimulator is usually implanted to provide relief. The most reliable and successful surgical approach is the "Micro-electrode Recording and Stimulation Technique," which allows for precise targeting of the affected brain regions, significantly reducing risks and enhancing the accuracy of the procedure.
Engaging with the Patient During Surgery
The "Micro-electrode Recording and Stimulation Technique" allows for detailed mapping of the brain's electrical activity, targeting specific neurons involved in Parkinson's disease. This requires the patient to be awake during surgery, enabling the surgical team to assess real-time responses to stimulation and accurately pinpoint the areas requiring intervention. The patient's active participation is crucial during the first 3-4 hours of the procedure, as their feedback helps guide the surgical process, ultimately leading to more effective outcomes.
Neurostimulation: Restoring Quality of Life
Neurostimulation surgery can effectively "turn back the clock" on Parkinson's disease, offering patients significant relief from symptoms and restoring much of their previous level of function. Postoperatively, patients often experience a marked reduction in tremors, with up to 85-90% improvement. The procedure involves placing electrodes in the affected areas of the brain, connected to a battery implanted in the chest wall. This system, once fine-tuned, enables patients to regain independence and resume normal daily activities.
A Beacon of Hope for Parkinson's Patients
For many patients, neurostimulation represents a return to life as they knew it before Parkinson's. The surgery offers a renewed sense of independence, enabling patients to perform daily tasks such as eating, dressing, and writing, which may have been impossible preoperatively. The goal of neurostimulation is not just to alleviate symptoms but to restore a meaningful and independent life to patients who have been struggling with the debilitating effects of Parkinson's disease.
Neurostimulation offers a transformative option for patients with Parkinson's disease, particularly those who have exhausted the benefits of medical treatment. By meticulously mapping and targeting the affected brain regions, surgeons can achieve remarkable improvements in patients' quality of life, offering them a renewed sense of independence and the ability to re-engage with their daily lives.
