Can Parkinson’s disease only be treated with surgery?

  Parkinson’s disease is a common degenerative disease of the nervous system. It is reported that China currently accounts for about half of the global Parkinson’s patients, about 2 million; about 1.7% of the elderly population over 65 years old in China suffer from Parkinson’s disease. With the aging of the population, the number of Parkinson’s disease patients in China will continue to climb longer, and the treatment of this disease will become increasingly severe.  Since the pathogenesis of the disease is not yet clear, there is a lack of effective means of prevention or cure, and only symptomatic treatment is available. Levodopa remains the “gold standard” for the treatment of Parkinson’s disease. However, Dr. Chen Ling pointed out that levodopa does not provide patients with long-lasting symptom relief, and after a “honeymoon period” of 3-5 years with good efficacy, the disease further worsens and the side effects of drug treatment gradually appear. At this time, many patients appear “movement complications”, on the one hand, the “end-of-dose phenomenon”, that is, the duration of the drug effect shortened, the effect of the last drug often can not be maintained until the next dose, on the other hand, the performance of On the other hand, it is manifested by the “ochronosis”, i.e., involuntary choreographic movements of the hands, feet, head, neck, etc., after the drug has taken effect or worn off.  In the early stages of motor complications, clinicians can address these problems by adjusting the type of medication, dose and duration of administration. As the duration of the disease increases and the motor complications worsen, the patient’s responsiveness to medications decreases and it becomes increasingly difficult to adjust medications. As the symptoms are not effectively controlled, patients lose their ability to work, their self-care ability decreases, and their quality of life is greatly diminished. The presence of non-motor symptoms (such as insomnia, constipation, upright hypotension, anxiety and depression, and decreased intelligence) can cause even greater distress to patients and their families.  In such cases where reliance on medication alone no longer solves the problem, patients may consider surgical treatment. According to Dr. Chao Yang, deep brain electrical stimulation of the thalamic nucleus (STN DBS) is an effective surgical treatment for motor symptoms as well as motor complications in Parkinson’s disease and is more commonly used in developed countries. Although many people are unaware that Parkinson’s disease can be treated surgically, scholars abroad have in fact been exploring surgical treatments for Parkinson’s disease long before the introduction of levodopa. Compared to the past, surgical treatment of Parkinson’s disease has taken a quantum leap in terms of technicality and safety, and its efficacy is comparable to that of medications, with the ability to reduce the dose and thus the side effects of medications. For patients with intermediate to advanced Parkinson’s disease, the combination of surgery and medication is preferable to drug therapy alone.  However, in the past, surgery was not the first choice for early-stage Parkinson’s disease, and it was mostly chosen for advanced patients with refractory motor complications, because these patients were already in the end stage of the disease and it was difficult to observe the progression of the disease even if deep brain electrical stimulation could slow it down. If the time to receive surgical treatment is appropriately advanced, the results we expect may occur, which would have tremendous implications for patients with early to mid-stage Parkinson’s disease.  For this reason, the First Hospital of Sun Yat-sen University (Zhongshan No.1 Hospital) in Guangzhou, the most standardized DBS treatment center in China, led by Zhongshan No.1 Hospital, Prince of Wales Hospital in Hong Kong and Shenzhen No.2 People’s Hospital as the surgery center, and the Fifth Hospital of Sun Yat-sen University, Zhongshan People’s Hospital, the First Affiliated Hospital of Shantou University Medical College, Jiangmen Central Hospital and Guangdong North People’s Hospital as the referral center A clinical trial titled “Comparison of the efficacy of deep brain electrical stimulation of the thalamic nucleus in patients with motor complications in Parkinson’s disease” has been registered and approved by the International Clinical Trials Registry. We have started recruiting volunteers, mainly for Parkinson’s disease patients who have motor complications, and encourage Parkinson’s disease patients who have early motor complications (within 3 years) to participate. Interested patients can inquire at the neurology department or Parkinson’s disease specialist at each of the above-mentioned branches. Post-operative patients may return to the hospital to adjust medications and stimulation parameters as needed. As this is a long-term study, full understanding and cooperation from patients and their families is required – only regular follow-ups will ensure the effectiveness of the procedure.