1. What is Parkinson’s disease? Parkinson’s disease is a neurodegenerative disease that is common in middle-aged and older people, and is one of the most common neurological disorders. It is named after Dr. James Parkinson of England who first published a medical paper documenting the disease in 1817. Parkinson’s disease is caused by the rapid functional deterioration of the “substantia nigra” part of the brain, which is unable to produce the neurotransmitter “dopamine” (dopamine), causing the brain’s ability to direct muscle activity to be inhibited to varying degrees, which greatly hampers the patient’s ability to move around. The “dead” patients are not able to produce the neurotransmitter “dopamine”. Once more than 50%~80% of the “dead” nigrostriatal cells, other areas of the brain involved in motor control can no longer function together, and the patient’s movement will become messy and uncontrollable. According to the statistics of domestic authoritative organizations, the incidence rate of Parkinson’s disease among the elderly over the age of 65 in our country is 1.7%, and there are currently more than 2 million people suffering from Parkinson’s disease. According to domestic authorities, the prevalence of Parkinson’s disease in China is 1.7% in elderly people over 65 years old. Although the majority of Parkinson’s disease patients are elderly people, there are also patients who develop the disease at the age of 30 to 40. Therefore, with the aging of the population and the increasing number of young patients, the number of Parkinson’s disease patients will increase. 2, Parkinson’s disease symptoms: Parkinson’s disease symptoms with the aggravation of the disease, in different stages will appear different symptoms; different patients may also have different external manifestations, can not be generalized; in general, the disease will gradually aggravate with the passage of time. Initial symptoms: Tremors are characterized by uncontrollable tremors of the hands and feet, especially at rest. The tremor usually starts on one side of the hand or foot and then slowly spreads to the same side of the body. Stiffness: The muscles of the hands and feet become rigid. When the patient straightens or bends his/her hands or feet, he/she finds that there is a greater resistance in the area, and the movement seems to be as difficult as turning a cogwheel. This stiffness can lead to muscle soreness or an inability to straighten the body. These symptoms include a range of phenomena: Difficulty writing, smaller and smaller letters, difficulty sitting for long periods of time without changing sitting position, difficulty starting and stopping, lack of facial expression, mid-stage symptoms, symptoms that progress from one side of the body to both sides of the body, a “switching off” of medication (loss of activity between doses because the medication does not work), and a “greenish”, like turning off of power. (greenish color, like turning off the power) Walking and posture are affected, e.g., inability to lift the feet when walking, loss of balance when walking on the ground, easy to fall down. Lack of swinging of the hands when walking, so the patient used to rush forward with a sharp, broken step after starting to maintain the center of gravity The speed of turning the body slows down, but the patient still maintains the ability to take care of himself/herself Late-stage symptoms The condition further deteriorates, walking is obviously affected, and the patient even loses the ability to move altogether The patient loses the ability to take care of himself/herself The patient has difficulty in talking and swallowing The patient develops some “involuntary movements”, i.e., the body has some “involuntary movements”. Dysarthria: the patient’s speech is affected and the patient’s voice is too low, too fast, or difficult to pronounce. Dysphagia: difficulty eating, swallowing, drooling, watering, and swallowing. Difficulty swallowing: eating, drooling, choking when drinking, etc. Excessive secretion of skin oils, such as greasy surface joint swelling weight loss severe constipation urinary incontinence impaired sexual ability often doze off cramps and muscle pain depression night sleep often wake up 3, the treatment options There is still no cure for Parkinson’s disease, but through the use of internal medicine, surgery and other ancillary rehabilitation combined with a comprehensive approach to treatment, can greatly slow down the symptoms, so that the patient independent of the disease, and the patient’s ability to achieve the goals of the disease. There is no cure for Parkinson’s disease, but through a combination of internal medicine, surgery and other complementary rehabilitation methods, it is possible to greatly slow down the symptoms and allow patients to live independently and maintain a good quality of life. At the same time, the treatment of Parkinson’s disease should be individualized. If you are unable to control your movement disorders even after trying various medications, or if you are experiencing intolerable side effects from medications, you may want to try Medtronic DBS therapy. The treatment of Parkinson’s disease includes: Medication: The symptoms of Parkinson’s disease are mainly caused by the degeneration of some of the nerve cells and the lack of dopamine. All current anti-Parkinson’s medications only relieve these symptoms, and no treatment has been shown to be effective in slowing down the degeneration or regenerating the degenerated nerve cells. Early stage Parkinson’s disease patients have only mild symptoms, and if the symptoms do not interfere with their daily lives, they may not need to take medication to improve their mobility, or a lower dose of medication may be sufficient. For most people with Parkinson’s disease, the more potent levodopa (LDOPA) medication is often needed when symptoms worsen. LDOPA is currently the most effective treatment for Parkinson’s disease, and many patients experience gastrointestinal symptoms such as nausea and vomiting when they first start taking it, which can be resolved by changing the dosage of the medication or by changing their medication habits. Many patients will experience a gradual decrease in the efficacy of the drug and an increase in the dosage after taking the drug for a period of time; some patients will also experience “anisotropia” (movements of the body that cannot be controlled by the body) and “on/off” cycle changes in the efficacy (i.e., the efficacy of the drug is not maintained until the next dose). Some patients also experience “anisotropy” (uncontrolled movements of the body) and “on-off” cycling (where the drug’s effectiveness is not maintained until the next dose, leaving the patient immobilized for a period of time, as if the power was turned off). These side effects can be very disruptive to patients with advanced Parkinson’s disease. Dopaminergic agonists are less likely to cause these problems, but may not work as well in some patients. In younger patients, physicians often start with dopamine agonists in the hope of reducing or delaying the use of levodopa in order to avoid the development of anisotropy and “on-off” changes in the drug’s effect. When “on-off” effects or “anhedonia” occur, the dosage of levodopa needs to be adjusted and other medications used to minimize these side effects. For example, a B-type monoamine oxidase inhibitor or a catechol oxygen methyltransferase inhibitor can be taken along with levodopa to increase the stability of levodopa in the blood and prolong the effectiveness of the drug. Commonly used drugs in the treatment of Parkinson’s disease and their effects: u levodopa levodopa is metabolized into dopamine in the brain, is the main drug to control the symptoms of Parkinson’s disease; u dopamine agonists, a class of dopamine receptor agonists, can replace the insufficient secretion of dopamine secretion of the brain to exercise the role of the; u B-type monoamine oxidase inhibitor (MAOB inhibitor) has been the dopamine breakdown metabolism, prolonging the role of dopamine in the body u Catechol oxygen methyltransferase inhibitors (COMT inhibitors) inhibit the catabolism of levodopa and dopamine, and increase the amount of dopamine in the brain; u Anticholinergic drugs, a muscarinic drug for younger patients with prominent tremor; u Amantadine dopamine release enhancers, which can improve the early mild symptoms and reduce the “anisotropy” caused by levodopa. Surgical treatment. Surgery: Destructive surgery: Destructive surgery, which uses stereotactic surgery to cauterize and destroy some of the nerve cells in the brain, is effective in patients with hemiplegic tremor and rigidity, but does not last long. This is a destructive and irreversible treatment, which is almost no longer used due to its less than ideal efficacy, higher surgical risk, and more surgical complications. DBS (Deep Brain Stimulation): In recent years, DBS has been a breakthrough in the surgical treatment of Parkinson’s disease. It uses minimally invasive neurosurgery to implant electrodes into a predetermined target area of the brain, which are then connected to a neurostimulator through a connecting wire. The neurostimulator is usually implanted under the skin of the chest and is similar in size to a pacemaker. This technique has been well established both at home and abroad, and many studies have shown that it is highly effective, with many patients taking significantly less medication and becoming more active after the procedure. The Department of Neurosurgery at Qilu Hospital of Shandong University was the first to perform this type of surgery in Shandong Province, and has accumulated more successful experience.