How to maintain Parkinson’s patients after surgery

  Parkinson’s disease is a chronic disease that does not usually resolve spontaneously. The disease may stop progressing temporarily, or it may progress rapidly to total disability within a few years, but most patients can continue to work after the onset of the disease. In the late stages of the disease, patients often die from complications due to generalized rigidity and eventually inability to get up.  Drug therapy can work well in the early stage of Parkinson’s. During the period of taking drugs, a considerable number of patients can get improvement of symptoms, such as taking Medopa, Benadryl, etc. However, there are still 15% of patients with no effect at all, and long-term drug use is associated with reduced efficacy and serious side effects – abnormal involuntary movements, open-close phenomenon, etc. Therefore, in recent years, the surgical treatment of Parkinson’s has received renewed attention and respect. The surgical treatment of Parkinson’s has received renewed attention and respect in recent years.  In order to identify the most effective targets and reduce complications, electrophysiological techniques have been introduced to control tremor, tonicity and motor inability by applying high-frequency electrical stimulation to specific brain tissues, also known as DBS, or brain pacing. Through an implanted pulse generator (IPG), weak electrical pulses are delivered to stimulate the relevant brain tissue in the brain that controls movement, inhibiting the abnormal brain nerve signals that cause the symptoms of Parkinson’s disease, thereby controlling the symptoms of Parkinson’s disease.  It is important for Parkinson’s patients to undergo various assessments prior to DBS surgical treatment. Professionals are required to make a reasonable evaluation of the severity of symptoms, and commonly used scales include the Webster Rating Scale rating scale.  A methadopa shock dose test is performed 2 days before surgery to predict the effect of DBS treatment. Patients are asked to score at the most severe symptoms after discontinuing the drug, then take 1.5 times the regular dose next time, and score again at the least severe symptoms to predict the efficacy of DBS by the percentage of the difference between the two scores and the highest score. Patients’ symptoms can worsen after discontinuation of the drug, which requires active patient cooperation. Patients are also asked to discontinue the medication before the preoperative time beyond the half-life of the drug in order to better regulate the stimulation parameters intraoperatively and postoperatively.  The key to DBS surgery is accurate localization of the stimulation target. In addition to the necessary imaging and stereotactic line anatomical target localization, physiological localization is also required so that the precise location of the electrodes in the brain can be discerned through changes in the impedance of the implanted electrodes and differences in the bio-signals recorded by micro-electrodes in different brain tissues. Intraoperative stimulation of microelectrodes or electrodes can be used to understand the relationship between the area where the stimulated site is located and the electrode position.  In order to achieve optimal symptom control, minimal side effects, and extended battery life with DBS treatment, postoperative program control is a long-term and important task, which requires an experienced programmer to operate. The first start-up time is usually one month after surgery, when the micro-destructive effect of the surgically implanted electrodes basically disappears and can be regulated to the best parameters.  The time for improvement varies from one symptom to another, such as rigidity, “off phase” dystonia and bradykinesia, which are relatively fast and can be seen in seconds, to athekinesia, which is slower and takes days or even months to improve. Therefore, it is important to establish good trust and communication between the programmer and the patient, to fully understand the patient’s condition before each routine program, and to conduct a reasonable assessment in order to achieve good program results.  Patients treated with DBS should still take medications under the guidance of their physicians after surgery, and adhere to the principle of combining long-acting drugs with short-acting drugs, focusing on long-acting or slow-release or controlled-release drugs, and not reducing them prematurely.  In addition, patients should also pay attention to: (1) Try not to exercise strenuously to reduce the stimulator and subcutaneous tissue friction and prevent infection.  (2) Communicate with the appropriate physician before performing MRI to avoid performing strong magnetic scans.  (3) General household appliances will not affect the stimulator, but should not be close to the stimulator.  (4) The use of pacemakers and electric defibrillation is generally not recommended unless necessary.  (5) Turn on and off the machine reasonably under the guidance of the programmable physician, and do not turn on/off the machine frequently to save the battery.