For many decades, surgical treatment of Parkinson's was the only means of combating this chronic neurodegenerative disease. The situation was complicated by the fact that the causes of the serious illness were only known to be dopaminergic in nature. The revolution occurred in the sixties, when scientist D. Kotzias developed and successfully put into practice a new drug, L-dopa. The drug has demonstrated high effectiveness in the treatment of parkinsonism, and a carefully selected dosage made it possible to avoid side effects. From that moment on, cases of surgical treatment became rare.
A number of further studies have made it possible to achieve impressive successes in treating the disease using medicinal methods combined with rehabilitation measures. This therapy makes it possible to delay the deterioration of the patient’s clinical condition for a long time. Treatment of Parkinson's disease with surgical methods today is indicated only at a severe stage of the disease, when taking medications is clearly ineffective.
The feasibility of surgical treatment
Levodopa is currently used to treat Parkinson's disease.
They began to be used recently, which reduced the number of cases of surgical intervention.
However, surgical treatment of the disease is still carried out.
After several years of taking levodopa, patients begin to experience complications in the form of drug-induced dyskinesia or muscle fluctuation (purulent inflammation).
This significantly complicates further treatment and leads to disability. It is impossible to cure the side effects, so surgery is the only option.
Surgical intervention is indicated for patients diagnosed with trembling-rigid and tremulous forms of the disease. The age of the patient is of great importance.
In juvenile parkinsonism, the likelihood of a positive effect of the operation is higher and its implementation is more advisable than in elderly patients.
Moreover, patients over 65 years of age have many contraindications to surgical intervention. The decision on the feasibility and safety of the operation is made by a medical council, based on the results of the examination of the patient.
Stages of the disease
As the number of brain cells that produce dopamine decreases, Parkinson's disease progresses more rapidly. The result is a decrease in activity in the areas of the brain that control involuntary movements of the arms and legs.
Parkinsonism is divided into several stages, the main criterion of which is the severity of symptoms. Each of these stages differs in the specifics of treatment and features of manifestation. In this case, the so-called “Hen-Yaru scale” is used, according to which the following stages of pathology are distinguished:
- Zero. Any symptoms of the disease are almost completely absent.
- First. Minor disturbances in the movements of the hands and fingers and trembling of the limbs begin to appear, which disappears only at rest or during sleep. Sleep is disrupted, lethargy appears and depressive moods become more frequent.
- Second. Disorders of the motor system begin to appear on both sides. The functioning of the sweat glands and facial expressions deteriorate. All processes associated with sweating are completely disrupted. The person is capable of performing any daily work. Does this at a much slower pace.
- Third. At this stage, the patient's face becomes more like a mask. Moreover, he takes a certain position in which he will be almost constantly. It is also called the “supplicant pose.” The tone and muscle tension in the human body increases. Motor activity slows down even more.
- Fourth. Coordination disturbances are visible during movement. The ability to maintain balance in any position is significantly reduced. Malfunctions in the functioning of the vestibular apparatus begin. The patient needs constant help and support from loved ones. The first signs of dementia may appear.
- Fifth. More obvious symptoms of nervous system dysfunction are observed. A person completely loses the ability to move independently and eat food. He has absolutely no control over his urination. At this stage, the patient is in complete need of care from his loved ones. The words he speaks are almost impossible to understand and perceive.
Indications and contraindications
Indications for surgical treatment of Parkinson's disease are:
- Persistence of severe symptoms despite correctly selected drug therapy.
- Rapid progression of pathology, which requires increasing the dosage of medications. In this case, many side effects occur that reduce the patient’s quality of life.
- The patient's young age and desire to work, but the manifestations of the disease prevent him from continuing to work.
- Possible rapid loss of ability to work, which will make the patient disabled and dependent on his family.
Like any treatment, surgery has a number of contraindications. These include:
- Serious diseases of the heart and blood vessels.
- Diabetes.
- Presence of a pacemaker.
- Psychical deviations.
- Suicidal tendencies.
- Severe dementia.
- Oncological diseases.
- Severe visual impairment (surgery can lead to complete blindness).
- Severe arterial hypertension.
- Problems with blood clotting.
- Age over 70 years.
Surgery for Parkinson's disease - effect and contraindications:
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Parkinson's disease is a neurological disease that affects the structures of the extrapyramidal system, that is, the parts of the brain responsible for muscle tone and movement.
Because of this, the death of neurons occurs, and the patient develops characteristic symptoms in the form of tremors, muscle weakness, and limitation of movements.
The disease is incurable, with the help of therapy it is possible to reduce the severity of manifestations and improve the patient’s condition.
When is surgery necessary for Parkinson's disease? Surgical treatment is resorted to in case of lack of effect from taking medications and rapid progression of the pathology.
Surgical methods
Currently, invasive and non-invasive surgeries are used. Invasive methods include thalamotomy and pallidotomy.
Thalamotomy
During the operation, partial destruction of the structure of the thalamus (the part of the brain responsible for transmitting sensory and motor information) is carried out.
Thalamotomy can only be performed on one side, so it is used in cases of unilateral tremor.
In 95% of cases, the tremor disappears, however, with this type of therapy, serious complications often develop in the form of speech impairment or its complete disappearance, abulia (lack of will), aspraxia (impaired purposeful movements).
Pallidotomy
This method is used if the patient has predominant movement disorders on one side of the body. The essence of the procedure is to insert a needle into the globus pallidus . The globus pallidus is the part of the brain in which the focus of movement disorders is formed.
During the operation, connections between this department and the thalamus are destroyed.
The effectiveness of pallidotomy is very high, more than 95% of patients report the disappearance or significant weakening of symptoms. In this case, the incidence of complications does not exceed 2%.
Deep brain stimulation
Among minimally invasive techniques, the method of deep brain stimulation has gained the greatest popularity. A neurostimulator is implanted into the patient's area under the collarbone.
It is connected to electrodes that are inserted into the deep structures of the brain that control movement. The patient can adjust the stimulator settings himself depending on his own feelings.
The advantages of neurostimulation over other methods are obvious:
- Ability to adjust settings.
- No need for medications.
- Reversibility (the device can be removed if necessary).
- The operation is also performed for bilateral symptoms.
- Lack of rehabilitation period.
The disadvantages of the method include high cost and the need to replace the device after 6-8 years.
Parkinson's treatment - deep brain stimulation (DBS), surgery, cost:
Stem cell transplantation
This treatment method has not been studied enough and is therefore not widely used. The essence of the treatment is the transplantation of neurons into the brain.
Neurons are obtained after differentiation of stem cells. They replace dead cells, which leads to the restoration of motor and other functions.
Currently, drug development is underway that can target Lewy bodies, which are the main markers of Parkinson's disease and dementia. However, this is still a distant prospect.
Read about other treatments for Parkinson's disease:
- admissibility of using folk remedies;
- effectiveness of hardware procedures;
- additional methods used at home.
Consequences after surgery for Parkinson's
Destruction of affected areas of the brain can lead to verbal impairment, which is manifested by a slowdown in speech speed and loss of clarity of pronunciation. Patients may experience general weakness and local decreased sensitivity.
During the operation, complications such as stroke, hematomas, and swelling of brain tissue are likely. These lesions cause increased tremors, blurred vision, paralysis of the limbs and other neurological pathologies.
The danger is posed by infections that provoke postoperative meningitis.
Statistics show that 95% of surgical interventions are successful. In 5% of cases complications occur, 1% of which are fatal.
Preparation for the procedure
Before surgery, the patient must undergo all examinations to confirm the absence of contraindications.
You should not eat or drink 15 hours before the procedure.
The operations are performed under local anesthesia.
The patient is fully conscious and in contact with the doctor . With invasive methods, a burr hole with a diameter of up to 1.5 cm is made in the skull.
Then, under X-ray control, a destruction instrument is inserted into the brain. The procedure lasts 1-2 hours. The clear consciousness of the patient gives the surgeon the opportunity to verify the correctness of the manipulations.
For many patients, symptoms of the disease disappear already in the operating room. Some take several months to recover.
The installation of the neurostimulator takes place in two stages, also under local anesthesia. For the stimulation mode to be set correctly, the patient must be fully conscious.
First, electrodes are inserted into the brain and test stimulation is performed. The patient tells the doctor about his feelings. If the result is positive, the neurostimulator is implanted under general anesthesia.
Restrictions after deep stimulation
The installation of a neurostimulator limits MRI diagnostics, as well as therapeutic procedures carried out using electrical currents.
The neurostimulator can cause problems when passing control systems at the border, at airports, and government agencies. Monitoring systems may affect the device settings, so if the device is turned on, do not go near metal detectors or detectors.
The patient is issued a special medical certificate with an identification barcode. The certificate contains information about the patient’s identity, contacts of the attending physician and information that allows medical workers to quickly access the medical history.
Postoperative period and complications
After invasive operations, the patient spends 10-15 days in the hospital.
The electrical activity of the brain is monitored on the 7th day, then after 3, 6, 12 months.
After treatment, the doctor adjusts the drug therapy.
Manifestations of the disease disappear over a period of several days to several months.
This depends on the stage of parkinsonism and the health status of the person being operated on.
There are no complications after neurostimulation. Unless the wound becomes infected if sanitary rules are not followed.
As for invasive techniques, the most dangerous is thalamotomy. The complication rate reaches 12%.
The most common side effects that occur are:
- dysarthria (distortion of pronunciation);
- dysphasia (disappearance of speech);
- abulia (lack of will, inability to perform actions and make decisions);
- memory impairment.
Possible complications of pallidotomy:
- intracranial hemorrhage;
- loss of voice;
- the appearance of convulsive seizures;
- depression;
- limb weakness.
Fortunately, these complications occur in only 2% of those operated on.
