Parkinson’s: surgical treatment may be considered for those who are not well treated with medication

  Shaky hands, shaky feet, and slowed movement may well indicate the arrival of Parkinson’s disease. It has been reported that there are about 2 million patients with Parkinson’s disease in China, which has accounted for about half of the total number of patients worldwide. With the advent of an aging population, about 1.7% of the Chinese population over the age of 65 has the disease. For patients with Parkinson’s disease who have “motor complications”, it is difficult to control the disease with medication alone, and various treatment modalities such as surgery and rehabilitation training can be considered.  Parkinson’s disease, a common chronic degenerative brain disease, is rooted in the dramatic degeneration of cells in the part of the brain called the substantia nigra, which is unable to produce sufficient amounts of the neurotransmitter dopamine, resulting in a decline in the brain’s ability to direct muscle movement and coordination. This leads to a decrease in the brain’s ability to direct muscle movement and coordination. The treatment of Parkinson’s disease patients should be individualized and graded. According to the Hoehn-Yahr Staging Scale, there are six stages of Parkinson’s disease. stage 0: asymptomatic. Stage I: unilateral lesions only. Stage II: Bilateral mild lesions. Stage III: Bilateral lesions with early balance disturbance. Stage IV: Severe lesions requiring substantial assistance. Stage V: confined to a bed or wheelchair and completely unable to care for oneself. He emphasized that patients with Parkinson’s disease have relatively slow disease progression from stage I to stage III, which is the golden period for treatment. If this stage is not taken seriously and treated in a timely manner, the subsequent disease can worsen dramatically.  For patients who have just started or have mild disease, i.e., patients in stages I to II, drug therapy can improve symptoms better and is the preferred treatment option for early stage Parkinson’s patients, which is also known as the “honeymoon period”. This period refers to the first few years after the onset of Parkinson’s disease, when the type and amount of medication is small, but the results can be more satisfactory. After the “honeymoon period” of about 5 years, 50%-75% of patients will develop various unbearable complications, such as “end-of-dose phenomenon” – shortening of the drug effect, “isokinetic disorder” – dancing These complications make Parkinson’s disease more difficult to treat. These complications add to the suffering of Parkinson’s patients, and many of them are at a loss as to what to do and how to seek treatment.  When Parkinson’s disease progresses to stage II-III and some complications exist, surgical treatment is recommended in a timely manner. Today’s surgical treatment has entered the era of precise and minimally invasive treatment, and surgery can be tolerated by patients of advanced age. Currently, there are two types of Parkinson’s surgical treatment, one is brain stereotactic DBS implantation and the other is stereotactic radiofrequency destructive surgery. The neurotransmitters such as acetylcholine and dopamine are rebalanced. Both procedures can immediately improve the patient’s symptoms of tremor and stiffness, and remove or reduce drug complications.  For patients with the same severity of symptoms in both limbs, DBS is recommended; for patients with unilateral symptoms or bilateral symptoms predominantly on one side, radiofrequency disruption technique is recommended. The two procedures are different: DBS treatment is more expensive and requires frequent visits to the hospital for parameter modulation to avoid activities within a strong magnetic field; RF treatment is less expensive, does not require parameter modulation after surgery, and daily activities are not affected by strong magnetic fields, etc.  It is important to emphasize that, despite the patient’s own intention to have surgery, the availability of surgical treatment requires a clear diagnosis and guidance from a physician. First, the diagnosis should be confirmed as primary Parkinson’s disease and not secondary to traumatic brain injury or secondary Parkinson’s disease caused by other diseases; second, the patient has been treated with medication for a period of time and has experienced a decrease in treatment effects and an increase in side effects; third, the patient is physically able to cooperate with the doctor to complete the surgery.