What is Parkinson’s disease and what are the symptoms? Parkinson’s disease has been recorded in history for nearly two hundred years now, but twenty years ago Chinese people are still very unfamiliar with Parkinson’s disease, over the years we have heard more and more, why? Why? Because Parkinson’s disease is a disease of the elderly, and after the aging of the population, this disease is becoming more and more common. In the normal population, there is one Parkinson’s disease patient in every 1,000 people, but in people over 55 years old, there is one Parkinson’s disease patient in every 100 people, the incidence has increased tenfold. Parkinson’s disease typically manifests itself in three ways: tremors, stiffness, and slowness. But Parkinson’s is a syndrome, a collection of many symptoms, not a single symptom, and shaking is only one of its very typical symptoms. So why is it called Parkinson’s disease? It comes from a London doctor named James Parkinson. Parkinson, who first described the symptoms of the disease in 1817, and later named it after him. The name he gave to the disease at the time was tremor paralysis, indicating that he found that the primary manifestation of the disease was also tremor. It was later discovered that not all Parkinson’s patients exhibit tremor; about 1/3 do not exhibit tremor and show very pronounced stiffness and slowness. I often see some elderly people with tremors in their hands when they hold things, how is this tremor different from the tremor of Parkinson’s disease? This is a question we often encounter. Patients or friends may ask: My hand shakes a little, is it considered Parkinson’s? From a professional point of view, there are many kinds of shaking, and these types have different forms of expression. For example, this kind of shaking in Parkinson’s is a resting tremor, that is, one hand or both hands will shake up when it is quiet, and it usually develops unilaterally first, and then progresses to the other side, and there can also be mouth shaking. When you pick up something, you don’t shake when you pick it up, but you start to shake when you put it back, and this is called resting tremor. This is why it is said that if the hand tremor is Parkinson’s, an experienced doctor will know if it is with one glance. For example, if an old classmate meets for dinner and his or her hands keep shaking, it is definitely Parkinson’s disease. If you shake when you pick up the chopsticks for dinner and don’t shake when you put them down, it’s an age-related tremor. Parkinson’s disease is a visit to neurology, neurology or neurosurgery. This leads us to the question of whether the problem of this disease is in the brain. Two hundred years ago the English doctor James Parkinson was a very serious man. Parkinson, a very conscientious doctor, recorded six cases of tremor paralysis. At that time, Dr. James Parkinson did not immediately realize that the disease was related to a part of the brain. But later, when many people gradually began to study Parkinson’s disease, it became clear that it was a disease of the brain, that there was something wrong with a part of the human brain, so that these manifestations would occur. Why exactly is it wrong? The brain is the smartest, most complex, and most incomprehensible organ in the universe, and the development of science and technology nowadays can only give a general understanding of it. There are still some questions about the onset of Parkinson’s that are not well understood. I think that patients can unnecessarily pursue this issue in depth, trust the experienced doctor, and follow his treatment. What is pacemaker therapy? In the treatment of Parkinson’s disease, the first step is to clarify the diagnosis, and the second step is medication. After medication comes surgery. The pacemaker is one of the newest forms of treatment and represents the highest level of scientific and technological development. What is a pacemaker? We say that a pacemaker is called deepbrainstimulation – deep brain electrical stimulation therapy. When a computer dies, we reboot, and this therapy is like rebooting our brain. How is the surgery for the brain pacemaker done and how does it work? It comes down to the pathogenesis of Parkinson’s disease. After years of research, it was discovered that there is a nucleus accumbens in both the left and right hemispheres of the brain, which was given the name substantia nigra because of its dark color. The cells in this substantia nigra are dopaminergic, and what is dopamine? What is dopamine? It is a chemical that is stored in the cells, and it usually acts as a messenger, producing dopamine to regulate our activities, so that our hands can do fine movements, run faster, and walk in a more coordinated way. With its regulation, our muscles are not very stiff and our hands do not shake. So, what happens when it gets sick? If a patient has Parkinson’s disease, it means that more than 70-80% of dopamine cells have been lost in the substantia nigra. How is this surgery done? The nigrostriatal cells are not working properly, the cells are apoptotic, and the dopamine produced is not directing the brain properly, thus causing the physical activity to be affected. We drill a small hole through the top of the head and put an electrode half the thickness of a matchstick (about 1 mm in diameter) through this small hole. Depending on whether the patient has unilateral or bilateral onset, the electrodes are either unilateral or bilateral. After the electrodes are inserted, there is a wire that is drilled under the skin and connected to the pacemaker. This machine, also known as a pacemaker, is buried under the skin of the chest and generates electrical impulses, which are transmitted through the wire to the electrodes, which discharge and stimulate the two nuclei. Originally the nigrostriatal mass was in a natural state, but now this nucleus is releasing less and going into abnormal activity, we stimulate it by electrode discharge to bring it back to its natural state and suppress its overactivity, so that the hands don’t shake so much and the body doesn’t get so stiff. This small box buried under the skin of the chest contains mostly batteries and a small part is a pulse generator, which is used to generate pulse waves, and the batteries are inside the machine to maintain the operation of the system. The operation is basically the same for bilateral and unilateral surgery, right? There is a figurative analogy, just like when we install air conditioning in our home, whether it is a single unit or one to two. It’s the same thing. Bilateral means that two stimulation leads go out of the machine, one into the left nucleus and one into the right nucleus. The pacemaker treatment is to stimulate it with an external disturbing force to bring it back to a relatively normal state when the natural state is no longer normal, is that how you understand it? Yes, that’s right. Parkinson’s disease is a functional brain disease, unlike cancer, where the site of the lesion can be detected by CT or MRI. It is like a computer that has been poisoned, the machine is fine on the outside and inside, but it is not working properly because there is a virus. To make it work properly, you have to kill the virus and reboot the machine. The pacemaker stimulates the nucleus for a similar reason. Is pacemaker surgery safe? Does it have a high success rate? The safety of the treatment has to be the first priority, safety first and effectiveness second, both of which are equally important. My answer to this question is that the implantation of a pacemaker is a very, very safe procedure. Just as I always tell patients’ families, don’t force me to say that there is no problem, but what if? It’s like having a bad meal, let alone a surgery. Are there factors that influence the outcome of treatment? Yes, there are. First, the treatment must be right. There are patients who come from far and wide for this surgery. The surgeon must first determine if the patient has Parkinson’s disease, and if not, then the surgery will not be effective. In this case, no matter how urgent his desire for treatment is, we can’t do it. So accurate diagnosis is the first thing. Second, the surgical technique. Let’s say a watermelon has such a big head, we need to find a place as big as a watermelon seed in it, and put the electrode in that place, as long as it is off by one or two millimeters, its effect will be greatly reduced, and if it is off by one centimeter, then it will have no effect at all. It requires excellent technique to put such a fine electrode in the exact position. Otherwise, it is not only the risk of surgery, but also the economic burden, plus the fatigue of running for thousands of miles to see the doctor, but in the end there is little effect. Therefore, the surgical technique is only a matter of basic skills for the doctor, but for the patient it is a factor that affects the success rate of the surgery. Is there a difference between imported and domestic pacemakers, and is there a difference in the therapeutic effect? From the scientific point of view and in terms of technical maturity, it takes longer time to improve the domestic pacemakers compared to the imported ones. In 1952, a woman scientist first proposed the concept of brain stimulation, and it took more than half a century for it to become a mature technology and enter the market. in the late 1990s, brain pacemakers began to be used as an implantable device for disease treatment, and it took 40 years of research and development to enter into real clinical application. It takes time to verify the use of the device, whether it is stable, safe, and durable enough. On the whole, the domestic ones are not as good as the imported ones. The therapeutic effect of pacemakers is so good that besides improving the symptoms, patients hope that it means a cure for the disease. Many people are concerned about a cure, but it’s really not as simple as people think. Parkinson’s disease and other diseases such as Alzheimer’s disease and brain atrophy are manifestations of brain aging, which is a natural law, and it has been said that if people live indefinitely, sooner or later they will get Parkinson’s disease. To reverse this aging process, to return to the old age? I’m sorry, it can’t be done. For an individual, it’s just a matter of his part going wrong first, leading to his Parkinson’s disease, and others having problems with that part leading to other problems. Just like a car running, some cars have problems with the brakes first, some fuel lines leak, some wipers do not work ……, but as a whole, any car has been driving it is impossible that the fuel lines do not leak, the brakes do not need to be replaced for a million kilometers? When it comes to healing the problem is actually a question of regeneration back to the old age. Scientists have been working on, for example, whether stem cells can cure Parkinson’s, but so far no attempts have been made to do so. Can the symptoms continue to improve after the pacemaker is installed? As long as the indications are correct, the surgery is done beautifully, and the target is placed very accurately, the improvement should be sustained. If the improvement is not sustained, and if the symptoms are not the same a few days after the surgery, then these two aspects are the most problematic. Then there are other possible situations, such as the machine may have fatigue, may be wired to break, the battery is dead, etc., then change the lead for the battery to find the cause. Scientifically speaking, surgery can get a sustained improvement in symptoms.