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Vital Signs: Tailor Parkinson’s treatment to the individual

By: Dr. BINIT B. SHAH, www2.dailyprogress.com

Tremors, stiffness and slow, awkward movements — these are the visible signs typically associated with Parkinson’s disease, a neurodegenerative disorder that alters portions of the brain that control movement. Despite decades of research, the exactcause of PD still is unknown; however, certain risk factors have been identified.

Paramount among these risk factors is advanced age. Similar to Alzheimer’s disease, the risk for PD increases greatly after age 60. In addition, men are somewhat more likely to be diagnosed with PD than women. Those with a family history (a parent or other first-degree relative with PD) also have a slightly elevated risk, though the overall risk remains low. If there is a genetic link, with multiple members of one family affected, that risk increases further.

Making a diagnosis

In the absence of a definitive blood test or imaging scan that can identify PD, physicians utilize these risk factors and a complete health history and neurologic assessment to diagnose the disease. Often, it is family members who notice the first signs of change in a person with PD. They may be subtle — like a decrease in facial expressions or softening of voice — or more overt, such as a tremor.

Other symptoms of PD include muscle rigidity, slowness of movement andinstability. Once the disease advances, cognitive deficiencies may occur. Because early symptoms of PD can resemble many other conditions — including other degenerative disease of the brain, a stroke and effects of certain drugs — one of the first steps in diagnosis is ruling out these other options.

Tailoring treatment to the individual

Not all patients with PD will progress at the same rate, and some may not experience physical effects as debilitating as those experienced by others; therefore, the approach to treatment is specific to the individual. There is no cure or method to slow the progression of PD, but there are treatments available that lessen the severity of symptoms significantly, especially when the disease is diagnosed early.

Medical therapy is the mainstay of treatment. Drugs are used to replace dopamine, the neurotransmitter lost in the brain as a result of PD, which successfully relieves the physical symptoms of rigidity and tremor in many patients. Over time, these drugs may begin to wear off too soon or cause challenging side effects, forcing some to seek out other options for treatment.

The original surgical approaches to treating PD — thalamotomy and pallidotomy — involve altering the brain by creating a burn-like lesion that interrupts the pathways of brain function that are adversely interfering with movement. Because of the impact and potential risk of open surgery, alternative approaches currently are under study, including new research at University of Virginia Health System examining the use of focused ultrasound waves to create a lesion in the brain, rather than an open incision.

The primary surgical treatment for treating PD symptoms, however, is deep-brain stimulation, a procedure that carries with it greater opportunities for customization to maximize benefits and reduce side effects. Unlike thalamotomy and pallidotomy mentioned above, deep-brain stimulation can be used to treat both sides of the body.

In this procedure, electrodes are placed deep within the brain and are connected to a pacemaker-type device located in the chest. The device is programmed to release electric currents that stimulate portions of the brain and relieve tremors. The voltage and frequency can be adjusted based on a patient’s individual response.

Catching it sooner  Read the rest of the article here.

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