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Parkinsons Disease

A New Life – No, Their Old Life Back
for Parkinsons Patients

An estimated 1.5 million Americans suffer from Parkinsons Disease, which causes tremors, rigidity, difficulty balancing and

walking, difficulty initiating action, slowness and, in some people, intellectual deterioration. It is a degenerative disease which slowly steals away a person’s quality of life and independence.

Since 1997 more than 14,000 Parkinson's sufferers with advanced and disabling symptoms, have received dramatic relief after implantation of Medtronic’s Activa Parkinsons Control Therapy, also known as deep brain implants. Thousands of people have been given back the quality of their lives.

It isn’t suitable for all Parkinsons patients and there have been “adverse events” and mechanical failures.

If you don’t suffer from Parkinsons or know someone who does, try to imagine what it must be like to have a “freezing incident” while crossing the street.

You would be frozen in place, literally like a deer in the headlights, totally aware of the oncoming traffic but unable to move out of the way.

Or imagine being in a crowded restaurant with friends, trying to get food to your mouth while your head or hands jerk uncontrollably.

My uncle, who was not even in the advanced stages of Parkinsons, once haltingly and painfully told us how he used to be the life of the party (we remembered it well) and now he couldn’t even put the words together to tell a good joke. He said, “My life is over.”

Deep brain implant surgery might have given him his life back.

Parkinson's Disease Cause and Diagnosis

Parkinsons is thought to be related to dopamine deficiency in the central nervous system and, in fact, dopamine deficiency is the most definitive test for Parkinsons as opposed to other neurological disorders with similar symptoms.

If a patient exhibits primary symptoms of Parkinsons and responds positively to a levodopa (L-Dopa) drug, the cause of symptoms is most likely Parkinsons.

Dopamine is one of the key neurotransmitters that control voluntary movement. If production of dopamine declines, stronger signals than required are allowed to pass to the muscles, resulting in involuntary movements and increasing inability to direct one’s own body.

L-Dopa is a precursor in the production of dopamine by the central nervous system. It is one of the primary drug treatments in the arsenal against Parkinsons. By stimulating the body’s production of dopamine with L-Dopa, more natural movement is restored.

Unfortunately, this only works for a while – perhaps because of the progression of the underlying disease.

Eventually most patients experience dyskinesias, which are uncontrollable jerking and writhing movements which compound the patient’s movement abnormalities. When L-Dopa loses its effectiveness or if a patient cannot tolerate L-Dopa, the patient is a good candidate for deep brain implants.

How are the Devices Implanted?

Activa Parkinsons Control Therapy does not cure the underlying condition but dramatically ameliorates some of the symptoms of Parkinson's disease and improves function.

If the therapy is discontinued, the patient's symptoms will return.

Deep brain implants are mechanically similar to cardiac pacemakers. Two electrodes are implanted deep in the midbrain, one for each side of the body.

Since the brain contains no pain receptors, the patient is awake during the procedure and assists in the proper placement of the electrodes. The lead wires are snaked under the skin usually to the patient’s collarbone area.

In a second surgery, this time under general anesthesia, the battery packs are placed deep under the skin and connected to the lead wires. In a day or two the patient is released and schedules an office appointment with his neurologist for the devices to be turned on and calibrated. The calibration may take two or three appointments and is done non-invasively with a small magnet.

The patient is given a similar magnet with which he can turn the device on and off as needed.

How Do the Implants Work?

The tiny electrical pulses delivered to precise areas of the brain block the involuntary motor signals that cause the disabling motor symptoms of Parkinsons. As a result, many patients achieve greater control over their movements.

The pulse generator and battery must be replaced every three to five years, the life of the battery. Similar to cardiac pacemakers, external electronic devices can disrupt the signals or cause uncomfortable or shocking levels of stimulation.

Theft detectors and security screening devices may cause stimulation to switch on or off, and may cause some patients to feel a momentary increase in stimulation.

If this occurs, the patient can correct the situation by “switching” the device one or two times with the magnet.

But It’s Brain Surgery!

Life with Parkinsons becomes so difficult that few patients, if they can afford it, hesitate when told they are good candidates for deep brain implants. Living with the disease is more frightening to them than the thought of undergoing brain surgery.

The devises are very expensive (about $50,000 each), but some insurance policies already provide partial coverage. Also, competitors are rushing into the market, so it is hoped that the cost will drop relatively quickly as it did for cardiac pacemakers.

On the Horizon: Clues to the Cause of Parkinsons

As mentioned earlier, there is no definitive test for Parkinson's. The diagnosis is presumed when a patient exhibits the primary symptoms of Parkinsons and experiences a lessening of symptoms when given a levodopa drug. Improvement with a levodopa drug implies dopamine deficiency.

On autopsy, a definitive diagnosis of Parkinsons is made if significant lesions are found in a specific area of the midbrain called the substantia nigra.

The substantia nigra is a layer of large pigmented nerve cells that produce dopamine. It is not yet known what causes the dopamine deficiency or how, or even if, the decrease in dopamine is the immediate cause of neuronal death in the substantia nigra.

Researchers needed a model substance which causes such brain damage in order to determine how it occurs. From that knowledge can come discovery of the causative agent(s) and hopefully a true cure for Parkinsons.

Some researchers are optimistic that they have such a model in the neurotoxin MPTP (methyl-phenyl-tetrahydro-pyrodine).

MPTP appears to be selectively toxic to the cells in the substantia nigra and can very rapidly produce all the primary symptoms of Parkinsons. In 1976, a 23-year old chemistry grad student was synthesizing MPPP in the school’s chem lab.

MPPP (methyl-phenyl-propionoxy-piperidine) is a synthetic opioid with action similar to heroin.

The unfortunate young chem student unknowingly made a mistake in the synthesis and injected the result. Within three days he was severely Parkinsonian. The National Institute of Health investigated and discovered that the compound he made was contaminated by MPTP. They studied the neurotoxic effects of MPTP by testing it on rats.

The young man was initially diagnosed as schizophrenic. The onset of symptoms was so sudden that doctors at first couldn’t conceive of it as Parkinsons.

Eventually the patient was put on a levodopa drug and responded well, just as a true Parkinsons patient would. Two years later, the young man committed suicide.

The autopsy showed cell destruction in the substantia nigra, the same as is found in Parkinsons patients.

MPPP continued to be made and sold as synthetic heroin. In 1982 the inevitable happened once again.

Seven young people in California were diagnosed with Parkinsons after using MPPP contaminated with MPTP. Neurologist J. William Langston realized that MPTP was the cause and successfully treated three of the seven using experimental drugs, and adrenal and fetal implants.

He subsequently wrote a book, The Case of the Frozen Addicts about his search for a cure.

There are differences between drug-induced Parkinsons symptoms and Parkinsons Disease. Drug-induced Parkinsons sypmtoms are severe within a matter of days after taking the drug and, upon autopsy, all neural damage is found in the substantia nigra.

In Parkinsons disease, progression is gradual and other areas of the brain are also affected. However the conclusion remains that most, if not all, of the motor symptoms of Parkinsons are produced by damage in the substantia nigra.

New Developments in Parkinsons Cures

Doctors are now experimenting with a new procedure to cure Parkinsons. It involves cutting two small holes in specific areas of the cranium and injecting a virus into the brain that is believed to stimulate the growth of dopamine. If this research pans out, it will provide a new life for Parkinsons suffers.

Other researchers have found a way to halt the disease's progress through the use of adult stem cells, while other doctors are working on a way to stimulate the production of dopamine in Parkinson's sufferers that is non-invasive.

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This article is for informational purposes only. It does not purport to offer medical advice.

 

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