As we look into the future with innovations driving healthcare solutions, PD will become easier to manage with a better awareness of the availability of advanced treatments. Prof (Dr) Paresh K Doshi, Director of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, gives an insight
In 1817 when ‘An Essay on the Shaking Palsy’ by James Parkinson’s was published, recognising Parkinson’s Disease (PD), we were a long way from finding a way to manage it effectively. More than 200 years later, as researchers work towards finding a solution to slow down the progression of the disease, medical advancements are helping ameliorate the symptoms, improving the quality of life for patients. Credit it to the pace of research into the disease, today, we have devices that not only track symptoms but make patients experts in managing their condition. Innovative devices and therapies are making the impossible, possible. Patients are now able to control tremors, stiffness, and walking problems that often come with PD.
To set things into perspective, PD is a progressive neurodegenerative disorder, which has crippled millions around the world. Degeneration of 60 to 80 per cent of dopamine (chemical) producing neurons which are responsible for regulating routine actions of the body causes PD. Even those on medications experience uncontrolled tremors, speech disorder, and impaired balance, especially on days when they miss taking the medicines. And the symptoms worsen with time. Since PD is a stage-wise progression, many patients in the initial stage of the disease are suggested non-pharmacological management approaches such as exercise, yoga, meditation, diet, and lifestyle modification. For patients in the later stage, the reliance on medications alone can be as debilitating as the disease symptoms.
As the disease progresses medicines become less effective and also produce unwanted side effects. The symptoms become more pronounced, impacting all aspects of a patients’ life. The good news, however, is that science is raising hope for those living with PD with significant advancements leading to better clinical management of the disease. Taking a leap from the older generation of treatments like Pallidotomy and Thalamotomy, PD is now being handled by smarter systems like deep brain stimulation. Advancements in the field of neuroscience have replaced earlier intervention techniques with minimally invasive technologies like Deep Brain Stimulation (DBS) to curb the challenges such as tremors, rigidity, stiffness, slowed movement, and walking problems, that are posed by PD.
The DBS system is engineered for precise neural targeting to customise therapy for patients with PD, primary and secondary dystonia, and essential tremor. It works by using electrodes which are surgically implanted inside the brain at specific locations and connecting with the device, i.e., a pulse generator. The nerve cells receive electrical signals to minimise the effects of tremors and restore locomotor skills. A surgeon implants a battery-operated device called neurostimulator which sends electrical to the precise locations through the leads. The lead delivers these stimulation pulses to a specific area of your brain that controls movements.
Until a few years ago, we had devices (pulse generators) with battery life as long as four to five years. Today, innovation has enabled access to pulse generators which are not only engineered for precise neural targeting but also come with a battery life up to 25 years. By providing a long window of 25 years, the new devices are eliminating the risks involved in multiple incisions due to conventional therapies. These are some of the best technologies of our times. The technological advances in the programming capacity has improved the outcome of deep brain stimulation surgery even further.
What’s interesting is that DBS has evolved over the years, helping patients manage their condition better. Simply put, DBS patients experience more control over their bodies.
Science is moving at a fast pace to address the psychological and cognitive effects of Parkinson’s on patients. We now have systems that use just a mild pulse of current and deliver stimulation to specific areas of the brain and effectively stop the tremors, allowing the patients to get full control over their manoeuvrability. Newer features are now helping optimise the stimulation, creating optimal protocols that align with multiple and individual tasks or lifestyles.
These technologies are also shifting perceptions about the lifestyle of a Parkinson’s patient. After all, managing Parkinson’s is not just about measuring the severity of the tremor, but also about the tremors of anxiety and depression that patients fight each day along with their families.
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