Parkinson’s disease is a degenerative disease of the central nervous system. The pathological changes are mainly degenerative necrosis of the nigrostriatal neurons in the midbrain, which produce dopamine, a very important neurotransmitter in the body, which is antagonistically balanced with another transmitter, acetylcholine, enabling the body to move freely and perform fine movements.
Early stages of Parkinson’s disease
Early treatment is divided into non-pharmacological and pharmacological treatments. Non-pharmacological treatment includes understanding the disease, supplementing nutrition, strengthening exercise, firm confidence in overcoming the disease, as well as social and family understanding, care and support for Parkinson’s patients.
In the early stage of Parkinson’s disease, the goal of pharmacotherapy should be to improve motor symptoms and prevent motor complications, and it is recommended to apply dopamine agonists and monoamine oxidase inhibitors alone; those with poor symptom improvement or high social work requirements can combine the application of small doses of levodopa, and use the optimal combination of small doses of multiple drugs to achieve the best efficacy, longer maintenance time, and lower the complication rate of motor disorders. The treatment goal is to achieve optimal efficacy, longer maintenance, and reduced incidence of movement disorder complications. Deliberately delaying the duration of levodopa use is not significant in preventing the occurrence of motor complications.
Parkinson’s progression
In the progressive phase of Parkinson’s disease, patients’ ability to perform daily activities and activities and quality of life are severely impaired by motor complications. The treatment strategy should be to reduce symptoms by medication or even surgery, improve motor complications, reduce the dose of medication, reduce disability and improve patients’ quality of life.
Parkinson’s disease is often associated with movement disorder complications, including symptom fluctuations, ochronosis, “switch phenomenon” and “freeze phenomenon. The mechanisms and treatment strategies for different types of motor complications vary, and defining their types is a prerequisite for appropriate treatment.
At present, domestic and foreign countries have formulated corresponding treatment strategies according to different types of exercise complications, and the specific application is recommended to fully consider the patient’s condition and emphasize individualized drug treatment, which can reduce the exercise complications to the least degree. The following measures can be taken.
1. searching for crossover points, where better efficacy can be achieved without causing anomalies.
2.Increasing the number of doses and reducing the dose per dose, with no change in the daily dose.
3.Change to a controlled dosage form and increase the dose appropriately.
4.Adding other drugs with relatively long half-lives, such as dopa agonists, to provide relatively continuous dopaminergic stimulation, while levodopa dosage can be reduced.
5.Adding catechol-oxy-methyltransferase inhibitors to increase the bioavailability of levodopa.
6.Recommended brain pacemaker therapy.
Warm tips
Before determining the treatment plan, patients with Parkinson’s disease with motor complications and their family members should establish a personal diary to record in detail their clinical symptoms, the time of motor complications, the time of taking medication and the type, dose and frequency of medication.
This information can most quickly help clinicians make accurate judgments about the type and cause of motor complications in order to properly select the appropriate treatment plan.
Advanced Parkinson’s
Patients with advanced Parkinson’s disease develop severe motor complications after taking medication. They cannot move without medication, and taking medication aggravates the dyskinesia, forming a vicious cycle. Pacemaker therapy has brought about a “brighter future” for patients with Parkinson’s disease, especially those with motor complications, interrupting the vicious circle and improving the quality of life of patients. The pacemaker is the biggest advance in the treatment of Parkinson’s disease since the invention of levodopa in the 1960s. At the beginning of this century, the timing of pacemaker treatment was usually chosen in the late stages of Parkinson’s disease, that is, after the onset of severe hyperactivity, “switch phenomenon” and other movement disorder complications, so that the average patient’s disease duration was about 12 years, but now there is a tendency to advance.
Although there are many advantages of pacemaker therapy for Parkinson’s disease, it is not an option for all Parkinson’s patients at any stage of the disease. Our “guidelines” for pacemaker therapy clearly define the indications and timing of the procedure for patients.
Indications
1. Patients with primary Parkinson’s disease.
2.Patients who have been treated with levodopa drugs and are effective.
3.Patients whose efficacy of drug therapy has significantly decreased and who have complications such as motor inability or dyskinesia, which seriously affect their quality of life.
4.Excluding patients with senile dementia and psychiatric diseases.
Timing of surgery
1. Patients with Parkinson’s disease with clear diagnosis.
2. Patients with a disease duration of more than 5 years, some patients with severe tremor and poor effect of medication can be appropriately advanced to 3 years.
3, patients younger than 75 years of age, individual in good physical condition and with normal cardiopulmonary function, can be appropriately relaxed to about 80 years of age after assessment.
4, patients for whom spinodopa treatment has ever been effective
5.Patients with Parkinson’s disease in stage 2.5 to 4.
6. Patients with reasonable expectations of surgery.
Does having a brain pacemaker mean that I can stop taking medication?
No, it does not. Medication is the most basic treatment for Parkinson’s disease. It is very effective in controlling symptoms in the early stage and plays an irreplaceable role even when the disease has progressed to the stage of diminished efficacy of medication in the middle and late stages. However, as the symptoms of Parkinson’s disease become more severe in the middle and late stages, the contradiction between drug efficacy and toxic side effects becomes more and more prominent, and even if the drug dose is increased, the duration of efficacy is very short and limited, and most of the time is in a drug-free state. At this time, patients need to eliminate abnormal excitation of the nucleus accumbens with the help of a brain pacemaker to help them prolong the duration of drug action, reduce the dose of medication, reduce the side effects of drugs such as allodynia, and improve the quality of life. Therefore, the two treatments are not opposed to each other; medication is not meant to be taken without surgery, and surgery is not meant to be taken without medication. The best treatment for patients with advanced Parkinson’s disease should be “Parkinson’s medication in one hand and a pacemaker in the other”!
In conclusion, Parkinson’s disease is a progressive disease with evolving and progressive symptom characteristics. Different treatment strategies should be used at different stages of the disease in order to achieve a more satisfactory treatment effect and slow down the progression of the disease.