Tuesday, 18 June 2019

Parkinson's: Which treatment works best for you?

18 December 2018 | Features | By Dr. Aravinda RV

Currently in eligible patients who are not tolerating the medicines have Deep Brain Stimulation (DBS) surgery as a life changing option.

image credit- news-medical.net

image credit- news-medical.net

Parkinson's disease is a common neurological disorder. It is no more an unknown disease to the public. With the increased availability of health care facilities, patient education services, multimedia etc., patients often report to the Neurologist with self made proper diagnosis of Parkinson's disease.

It is to be kept in mind that all trembling hands are not Parkinson's disease. Symptoms such as shaking or stiffness of limbs, slowness of actions are features of a group of disorders called parkinsonism. And again, all parkinsonisms are not Parkinson's disease; though it is one of the most common causes of parkinsonism. In a significant proportion of patients it is difficult even for an experienced Neurologist to pin point the diagnosis of parkinsonism and its cause. The Neurologist will examine and may take the help of several investigations to arrive at a proper diagnosis.

Interestingly, the response to the conventional anti-parkinsonian medicines will also help the Neurologist in this regard. Once the diagnosis is made, then it opens up the basket of medical and surgical options. With the current availability of medical information, almost every patient of Parkinson's disease and their caregivers know about the pills used in this condition. When it comes to Parkinson’s disease, what is not very well known or common is about the surgical options.

Currently in eligible patients who are not tolerating the medicines have Deep Brain Stimulation (DBS) surgery as a life changing option. This surgery is intended to reduce the dose of conventional medications and hence their related adverse affects particularly the abnormal incontrollable movements, what is called as dyskinesia.

DBS is not very popular in India because of its cost. But it is a well accepted mode of treatment in the western world. As with the medications, this works well for tremors and to a certain extent for slowness and stiffness. It is a procedure with not many complications. In this simple procedure the stimulating electrodes are inserted into the specific part of the brain and connected to the battery device placed under the skin over the upper part of the chest which can be turned on and off. The intensity and frequency of stimulation can also be adjusted depending upon the clinical response. The patient himself can switch it on or off depending upon his requirements. The life of the battery depends upon the company make and the intensity/frequency of stimulation.

Not many centres in India perform this procedure due to many factors. It is the time now to upgrade our armamentarium for Parkinson's disease. There is a need of collective efforts from the government and non-government organisations to make it available and affordable.

With the huge disease burden in India it is essential that all of us become aware of the available treatment options and choose them rationally. For those affected with Parkinson’s disease it is best to consult your Neurologist to know if DBS works for you.

 

Dr. Aravinda RV, Consultant Neurologist, Brains Hospital, Bengaluru

 

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