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PARKINSON'S DISEASE & PARKINSON'S DISEASE DEMENTIA

Parkinson's disease is a progressive neurodegenerative disorder that is common, age-related and chronic.

It is caused by loss or degeneration of dopaminergic neurons in the substantia nigra of the midbrain.

Onset of symptoms and progression of the disease is gradual.

Motor signs and symptoms include resting tremor, rigidity, bradykinesia and postural instability.

Parkinson's disease dementia indicates loss of intellectual functions including memory, significant deterioration in the ability to carry out day-to-day activities and changes in social behavior are often noted.

Surgical Intervention

Neurosurgery

  • Considered in patients unresponsive to pharmacological therapy

Pallidotomy

  • Unilateral pallidotomy has been shown to be effective in treating symptoms of dyskinesia when administered with oral Levodopa
  • It is unfavorable because of its irreversible nature

Deep Brain Stimulation (DBS)

  • Deep brain stimulation using implanted pulse generators in precise brain locations may be performed with specific indication
  • Both subthalamic nuclei (STN) and globus pallidus pars interna deep brain stimulation have shown efficacy in management of Parkinson's disease general/systemic motor symptoms (eg motor fluctuations, dyskinesia) when administered with oral Levodopa
  • Thalamic stimulation may be considered as an option in people with Parkinson's disease  who predominantly have severe disabling tremor and where subthalamic nuclei stimulation cannot be performed
  • Good candidates for deep brain stimulation include patients whose motor symptoms are not well-controlled by medications or who cannot tolerate side effects of medications, and those who do not have significant active psychiatric or cognitive problems
  • Infection is the most commonly reported side effect of deep brain stimulation
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