Living well with Parkinson disease
When performed early , deep brain stimulation can improve symptoms of movement disorders
Movement disorders describe a group of neurological diseases that predominantly affect a patient ’ s ability to move and cause abnormal movements . The most well-known are Parkinson disease , essential tremor , and dystonia , which affect millions of people worldwide . Parkinson ’ s alone affects seven million people globally and three in 1,000 above the age of 50 . As the world population ages , this number is expected to double by 2040 .
Medication can control the symptoms for Parkinson disease , such as tremors , in the initial years , but as it progresses , people can become resistant to higher doses of medication , which can also have intolerable side effects . As a result , the benefits from medication often decrease over time .
Another therapeutic option is deep brain stimulation surgery , a minimally invasive procedure .
“ A commonly asked question by people with Parkinson disease is whether deep brain stimulation is suitable for them ,” said Dr Kon Kam King Nicolas , a specialist neurosurgeon at Mount Elizabeth Hospital in Singapore and an expert in deep brain stimulation surgery . “ In general , people should consider deep brain stimulation if they experience decreased benefit from medication despite increasing doses or suffer side effects from medication .”
The procedure involves two steps . A neurosurgeon will first place thin wire electrodes in the specific part of the brain that causes the symptoms . This stage can be done with the patient asleep or awake . Awake surgery allows for intra-operative testing to verify the clinical effects of the procedure , while asleep surgery is convenient and can be completed in a shorter time .
In the second step , the neurosurgeon connects the electrodes to a battery , which functions as a pulse generator . The device is placed under the skin , usually below the collarbone . This is typically done under general anaesthesia .
“ The main symptoms of Parkinson disease , such as tremor , slowness and stiffness , will improve immediately upon switching on the battery . Medication can be reduced concurrently in a delicate balance with electrical stimulation ,” said Dr Kon .
Parkinson disease symptoms are caused by the loss of dopamine-producing neurons in specific parts of the brain . This leads to abnormal signalling between the different regions of the brain . Deep brain stimulation works like a pacemaker for the brain and helps to normalise these abnormal nerve signals , providing 24- hour continuous symptom control . Generally , patients will also need to be on medication but at a reduced dose .
Like any surgery , deep brain stimulation has its risks , which include infection and bleeding in the brain , but is generally a safe and effective procedure for Parkinson disease .
Having the right mindset is important for a successful deep brain stimulation surgery . The most important consideration is not to view it as a treatment of last resort and have it done too late during the advanced stages of the disease . The benefits of deep brain stimulation can be maximised when done early within the golden window of opportunity .
Dr Kon believes that living well with Parkinson ’ s disease is possible with the appropriate treatment .
“ Every individual should have a tailored plan for success . For some people , deep brain stimulation offers life-changing relief . Frequently , people are scared of the idea of brain surgery .
“ Seeing a neurosurgeon doesn ’ t mean you ’ re committing to surgery . Arm yourself with information with which to make your decision . If the time is right for you to consider surgery , see a neurosurgeon to assess your eligibility ,” he said .
Make an appointment to consult a Neurosurgeon at Mount Elizabeth Hospitals
Phone Appointment : + 65 6250 0000 ( Orchard ) Whatsapp Appointment : + 65 8111 7777 ( Orchard ) Online Appointment : www . mountelizabeth . com . sg
Dr Nicolas Kon is a neurosurgeon at Mount Elizabeth Hospital , Singapore . He has a special interest in neurooncology ( brain tumours , awake surgery ), minimally invasive brain surgery ( deep subcortical tumours , brain haemorrhage ), functional neurosurgery ( trigeminal neuralgia , hemifacial spasm , spasticity , spinal cord stimulation ), and deep brain stimulation ( Parkinson disease , tremors and other movement disorders ).
GlobalHealthAsiaPacific . com OCTOBER 2021
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