Problems with Brain Pacemaker Surgery in Treatment?

Parkinson’s disease as a common neurodegenerative diseases, with the age of increasing prevalence and incidence of a significant increase in the number of new patients in China each year up to more than 100,000, with the arrival of the aging population, the number of patients with Parkinson’s disease in China in 2030 will reach 4,942,000 patients, the patients often have serious movement disorders in the late stage and loss of ability to take care of their own lives, to the patient’s family and the community has brought a heavy burden. Drug treatment is the foundation, but only rely on drug treatment can only solve part of the patient’s problem, so a variety of electrical stimulation, magnetic stimulation, physical therapy equipment treatment is endless, but can really achieve the therapeutic effect of the current deep brain electrical stimulation and repeated transcranial magnetic stimulation technology. Drug treatment can only solve part of the patient’s problem in Parkinson’s treatment, anti-Parkinson’s disease drug gold standard – compound levodopa can make the patient’s motor symptoms in a longer period of time to get effective control, dopamine agonists, levodopa metabolism of the enzyme inhibitors, and other new drugs, for the patient’s treatment has brought more choices. However, with the in-depth study of Parkinson’s disease, it is found that Parkinson’s disease not only has a variety of motor symptoms, but also numerous non-motor symptoms, such as anxiety, depression, sleep disorders, dementia, etc. These non-motor symptoms accompany the entire course of Parkinson’s patients, and even precede the appearance of motor symptoms of Parkinson’s disease, often affecting the patient’s adherence to various treatments and the efficacy of the medication, and even become the main factors affecting the patient’s quality of life. It even becomes a major factor affecting patients’ quality of life. At the same time, with the progression of the disease and long-term drug treatment, patients will develop a series of complications known as symptomatic fluctuations and involuntary movement “isokinetic signs”. At this stage of the disease, it is difficult to achieve a satisfactory outcome and quality of life even with systematic drug treatment. How to improve patients’ non-motor symptoms and motor complications, and how to improve patients’ quality of life are the main issues in the field of Parkinson’s disease research. Parkinson’s disease drug treatment is the foundation, but only rely on drug treatment can only solve part of the patient’s problem, so a variety of electrical stimulation, magnetic stimulation, physical therapy instrumentation treatment is endless, but can really achieve therapeutic effect of the current deep brain electrical stimulation and repetitive transcranial magnetic stimulation technology. Brain pacemaker treatment has strict indications Deep brain electrical stimulation technology provides Parkinson’s patients with a new treatment method other than drug therapy. Deep brain electrical stimulation, commonly known as pacemaker technology, has been developed for 30 years from research to clinical use; it is considered a major milestone in the history of Parkinson’s disease treatment after levodopa. Currently, more than 140,000 patients worldwide have benefited from DBS therapy, and more than 10,000 patients in China have been treated with DBS. DBS can effectively improve the symptoms and complications of Parkinson’s disease patients, and enable the patients to regain their original mobility and self-care ability, and it has become an effective treatment for the intermediate and advanced stages of Parkinson’s disease. The main components of a pacemaker are electrodes, wires and stimulators, and DBS stimulates the relevant neural nuclei in the brain that control movement by delivering weak electrical impulses through electrodes implanted in the brain to inhibit the abnormal brain nerve signals that cause the symptoms of Parkinson’s Disease, thus improving the symptoms and lowering the types and dosages of anti-Parkinson’s Disease medications at the same time. Deep brain electrical stimulation treatment can control the motor symptoms of Parkinson’s disease, such as: tremor, rigidity, movement delay, etc.; reduce the duration and severity of anisotropy, reduce the fluctuation of symptoms, and prolong the open period time; and be able to reduce the dosage of levodopa drugs for Parkinson’s patients in the long term. The control of motor symptoms is effective in the long term, and can improve the quality of life and the ability of patients’ daily life.DBS has the advantages of low surgical risk, minimally invasive, adjustable, reversible, and fewer complications. However, it should be emphasized that it seems that brain pacemaker therapy has become the nemesis of Parkinson’s disease treatment, but in fact, it is a complex project. First of all, the patient is strictly evaluated by a Parkinson’s disease specialist, and must have a clear diagnosis of Parkinson’s disease, undergo a rigorous evaluation of the efficacy of medications, and choose the right patient and timing of treatment before choosing the brain pacemaker treatment. To address the issue of timing of brain pacemaker treatment, in 2012 China formulated the Chinese Expert Consensus on Deep Brain Electrical Stimulation Therapy for Parkinson’s Disease, which includes the criteria and indications for surgical treatment of Parkinson’s disease. Parkinson’s disease is a chronic progressive disease, and the timing of DBS treatment is particularly important. Surgery is generally most appropriate after the honeymoon period of medications and when motor complications occur. When Parkinson’s disease progresses to an advanced stage and patients develop mid-axis symptoms, such as balance disorders, frequent falls, swallowing and dysarthria, cognitive deficits, psychiatric abnormalities, and visual hallucinations, it suggests that the timing of surgery for brain pacemakers is too late, with limited benefit to the patient and increased risk. Parkinson’s disease symptoms are complex and varied, easy to misdiagnose, only primary Parkinson’s disease is an indication for surgery; and patients taking compound levodopa used to have good efficacy, but now the efficacy has been significantly reduced or serious motor fluctuations or anisotropia, affecting the quality of life. Except for dementia and severe psychiatric disorders, patients with a disease duration of more than 5 years and younger than 75 years of age have a better outcome. Selection of brain pacemaker therapy must be careful “brain pacemaker therapy, only to choose the correct target, and the electrode implanted accurately in the deep brain of the target point, in order to play a therapeutic role, deviation from the target point can not achieve therapeutic effect, but also bring side effects, and the size of the deep brain nucleus pulposus is often only a few millimeters in size range, the electrode implantation process of a tiny fraction of the difference. ” The treating physician for DBS consists of at least a neurologist, surgeon, and, if necessary, an internist, psychologist, and psychiatrist. A multidisciplinary approach is essential to determine the suitability of the individual patient for surgery, the risks and near- and long-term efficacy of the procedure, and the optimal surgical target. DBS treatment needs to be performed in a regular hospital with a standardized treatment team to avoid unnecessary losses to the patient for the sake of a quick fix. DBS treatment is a double-edged sword, properly applied, the therapeutic effect is good, inappropriate application, may bring unnecessary trouble and burden to the patient. Repetitive transcranial magnetic stimulation therapy technology has a promising brain pacemaker therapy for Parkinson’s disease patients has brought the gospel, but drug therapy is the foundation, correct diagnosis is the premise, standardized surgery, fine regulation and postoperative management is the guarantee of the success of surgery. In addition, brain pacemakers are expensive and require close regulation and management before and after surgery, which severely limits their promotion and application. Therefore a new type of transcranial magnetic stimulation therapy has attracted the attention of Parkinson’s disease treatment experts. Repetitive transcranial magnetic stimulation is the use of pulsed magnetic field on the human brain to induce the induction current generated in the brain to stimulate or inhibit a certain region of the cerebral cortex, to regulate the role of cortical activity. As a non-invasive and practical technology that has seen rapid development in recent years, rTMS has been widely used as a tool to study brain function, not only for the study of motor, visual, and language functions, but also for the study of various dysfunctions in brain pathology, making it a promising therapeutic tool. Research has confirmed that rTMS can improve not only motor symptoms such as bradykinesia and gait disturbance in Parkinson’s disease patients, but also many non-motor symptoms such as depression and sleep disturbance associated with Parkinson’s disease, which has a broad application prospect. Although rTMS therapy is a kind of magnetic stimulation, which achieves the effect of electrical stimulation of the cerebral cortex and subcortical nerve nuclei through the principle of magnetic-electric conversion, the stimulation target and the setting of stimulation parameters are very important, and there are certain differences in different symptoms and stimulation targets for Parkinson’s disease. Therefore, it needs professional technicians and doctors to give the stimulation target positioning and stimulation parameter setting.