Parkinson's Disease Health Article

Surgery

Surgery may be used to help manage severe or debilitating PD symptoms when drug treatments fail.

Pallidotomy uses an electrical current to destroy a small amount of brain tissue in the globus pallidus, which is over-stimulated by the corpus striatum in PD. Pallidotomy may relieve tremors and slow, rigid movements, and decrease dyskenisias caused by drug therapy, by interfering with the neural pathway between the globus pallidus and the thalamus (a major transmission center in the brain). The benefits often do not last and the surgery may cause slurred speech, disabling weakness, and vision problems, particularly with a double pallidotomy (surgery on both sides of the brain).

Thalamotomy reduces hand and arm tremors by destroying small amounts of tissue in the thalamus. Because a double thalamotomy leaves patients extremely weak and with slurred speech, it usually is performed on only one side of the brain, relieving tremors on the opposite side of the body.

With deep brain stimulation (DBS), a device similar to a heart pacemaker sends signals to fine electrodes implanted in the subthalamic nuclei or the globus pallidus (Activa Therapy). The electrical pulses appear to interrupt signals from the thalamus that are involved in tremors. DBS restores a balance between excitatory (tending to excite) and inhibitory (interfering or retarding) signals in brain signal transmission centers, thereby decreasing or abolishing dyskinesias without slowing normal movement. Patients use a magnetic device to adjust stimulation in one or both halves of the brain, as the response dictates. DBS usually results in a significant improvement in some motor symptoms, including tremors and peak-dose dyskinesias, and improves motor function and mobility. It also enables patients to take higher doses of levodopa.

The implantation of fetal cells to replace the dopamine-producing cells of the substantia nigra appears to benefit only patients under age 60. It can have serious side effects and about 15% of patients later develop severe dykinesia due to dopamine-overproduction.

The use of stem cells derived from embryos discarded by infertility clinics is a potentially useful treatment for PD. However, it remains morally and ethically controversial.

Prognosis

There is no way to predict the course of PD. Many people live active, productive lives for 12 to 15 years. However, in others the disease progresses rapidly. Regardless of treatment, PD symptoms worsen with time and become less responsive to drug therapy. Most people with PD experience some additional problem every year. A small number of patients eventually become completely incapacitated. Although PD is not fatal, its effects can lead to fatal accidents or illnesses.

Prevention

There are no clear risk factors or preventions for PD. Central body obesity may increase the risk. Some studies have found that coffee drinking or hormone replacement therapy (HRT) in postmenopausal women may decrease the risk of PD. However, heavy coffee drinking in combination with HRT appears to increase the risk of Parkinson's disease.

BOOKS

Federoff, Howard J., et al., editors. Parkinson's Disease: The Life Cycle of the Dopamine Neuron. New York: New York Academy of Sciences, 2003.

Foltynie Thomas, et al. Parkinson's Disease: Your Questions Answered. New York: Churchill Livingstone, 2003.

Kondracke, Morton. Saving Milly: Love, Politics, and Parkinson's Disease. New York: Public Affairs, 2001.

Mittel, Charles S., editor. Parkinson's Disease: Overview and Current Abstracts. New York: Nova Science, 2003.

Mosley, Anthony D., and Deborah S. Romaine. The Encyclopedia of Parkinson's Disease. New York: Facts on File, 2004.

Pahwa, Rajesh, et al., editors. Handbook of Parkinson's Disease. 3rd ed. New York: Marcel Dekker, 2004.

Weiner, William J., et al. Parkinson's Disease: A Complete Guide for Patients and Families. Baltimore: Johns Hopkins University Press, 2001.

PERIODICALS

Ascherio, A., et al. "Caffeine, Postmenopausal Estrogen, and Risk of Parkinson's Disease." Neurology 60, no. 5 (March 11, 2003): 790–95.

Powers, K. M., et al. "Parkinson's Disease Risks Associated with Dietary Iron, Manganese, and Other Nutrient Intakes." Neurology 60 (June 2003): 1761–66.

Van Camp, Guy, et al. "Treatment of Parkinson's Disease with Pergolide and Relation to Restrictive Valvular Heart Disease." Lancet 363, no. 9416 (April 10, 2004): 1179–83.

ORGANIZATIONS

American Parkinson Disease Association, Inc. 1250 Hylan Blvd., Suite 4B, Staten Island, NY 10305. 800-223-2732. apda@apdaparkinson.org. <http://www.apdaparkinson.com>.

Michael J. Fox Foundation for Parkinson's Research. Grand Central Station, P. O. Box 4777, New York, NY 10163. 800–708–7644. <http://www.michaeljfox.org>.

National Parkinson Foundation, Inc. 1501 NW Ninth Ave./Bob Hope Road, Miami, FL 33136–1494. 800–327–4545. <http://www.parkinson.org>.

Parkinson Alliance. P.O. Box 308, Kingston, NJ 08528-0308. 800–579–8440. admin@parkinsonalliance.org. <http://www.parkinsonalliance.net>.

Parkinson's Action Network. 1000 Vermont Ave. NW, Washington, DC 20005. 800–850–4725. 202–842–4101. info@ parkinsonsaction.org. <http://parkinsonsaction.org>.

Parkinson's Disease Foundation. 710 West 168th Street, New York, NY 10032-9982. 800–457–6676. 212–923–4778. info@pdf.org. <http://www.parkinsons-foundation.org>.