Question and answer of Parkinson's disease
 
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Question 圖示 What is Deep Brain Stimulation (DBS)? 
Answer 圖示

Deep Brain Stimulation (DBS)

 

Deep brain stimulation (DBS) has been proved to be the most effective treatment for Parkinson’s disease since the discovery of Levodopa in the 1960’s. A number of experiments showed that DBS could increase and maintain the duration of electric activities. Therefore, DBS can help the Parkinson’s disease patients by: (1) improving the variations of drug effects (2) improving tremors, dystonia, or spasm affecting the daily life significantly. In other words, DBS may be considered in the treatment for Parkinson’s disease if drug effects are not steadily sustained or drug related complications occur. However, DBS is unable to cure Parkinson’s disease or interrupt the disease progression. It is also not able to improve the electric activities. The purpose of the stimulation is to improve the symptoms of Parkinson’s disease by using stable electric currents for the improvement of the duration of electric activities. During the clinical visit, the physician will evaluate the needs of the patient and inform the patient of the improvement. The evaluation includes a face-to-face interview and physical examinations. The results in the UPDRS form and the physical examinations will allow the physician to understand the disease progressions before and during use of the drug. If greater than 30% of improvement after the use of the drug is reached, DBS may improve the symptoms of the patient and increase the durations of electric activities. On the other hand, the effect of DBS may be insignificant if there is little improvement after the use of the drug.

 

The DBS devices to be implanted in the body include:

    1. Intracranial Electrodes for the Treatment

    2. Extension Cords

    3. Microcomputer Neural Stimulators

 

Benefits of DBS?

    1. DBS is a reversible, adjustable, and sustainable treatment.

    2. In the event of side effects associated with the stimulation, the stimulator setting can be adjusted or shut off and the electrodes can be removed without causing any sequela.

    3. The therapeutic requirements for the patient may change as time progresses. The DBS treatment setting can be adjusted accordingly to meet the clinical therapeutic requirements.

 

Additional Information of DBS Treatment?

1. Risks Associated with Surgery and Implantation: Surgery may take a long time (approximately 4~12 hours), and the patient’s cooperation is required. The most serious complications include cerebral bleeding, infection, or even death with the incidence rates of 5%. Despite the low incidence rates, the implanted device may cause infection, failure, or injuries that require additional surgery to repair.

2. Post-surgical Follow-ups: Frequent return visits are required to adjust the stimulation points, stimulation intensity, and stimulation frequency 3 months after the surgery. Moreover, the patient is required to return to the hospital to remove the stimulator to change the batteries 3~5 years after the surgery.

3. Costs: The implantation of DBS on both sides costs approximately NTD $980,000. The battery change on both sides costs approximately NTD $650,000.
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Question 圖示 How to evaluation and Diagnosis of Parkinson’s Disease? 
Answer 圖示

    Parkinson’s disease is difficult to diagnose because the symptoms of many degenerative diseases are closely similar to those of Parkinson’s disease. No single test can be used for the diagnosis of Parkinson’s disease directly. The disease can only be fully determined only by cerebral anatomy performed by pathologists. According to the related studies, 20% of the patients with Parkinson’s disease do not actually have the disease. Because different disease progressions may have different drug effects, the accurate diagnosis of the disease will allow the patient to receive the appropriate drug to alleviate the symptoms or even slow the disease progression. Therefore, the patients should seek a neurological specialist for professional experience and observation to correctly diagnose Parkinson’s disease.

 

Clinical Diagnosis

When the patient and the doctor meet for the first time, the doctor will determine the possibility of Parkinson’s disease based on the clinical diagnosis. The major clinical signs of Parkinson’s disease include rigidity, tremors, bradykinesia, and postural instability. During the diagnosis, the doctor will determine the possibility of Parkinson’s disease based on the following observations:

1.          Are the patient’s fingers or toes agile?

2.          Can both arms of the patient fully swing when walking? Can the patient stride?

3.          Do the hands or feet of the patient tremble when at rest?

4.          Does the patient experience any difficulty when turning around?

5.          Does the patient appear rigid, as if stuck to the floor?

6.          Does the patient’s facial expression appear lively? Does the patient speak clearly?

Moreover, the doctor will examine the disease progression, the family history, and the histories and medicine used for other diseases as the references for the diagnosis. The diagnosis of Parkinson’s disease is a great disappointment for most people. The medical caretaker plays an important role in fighting the disease. Therefore, family members should accompany the patient to meet the doctor for the clinical diagnosis. The doctor must acquire a more comprehensive understanding on the conditions of the patient based on the third party’s observations.

Examinations

If the clinical diagnosis is unable to confirm Parkinson’s disease, the doctor will use various examination tools to make the final judgment. A blood test, urine test, X-ray, CT, or MRI may be required to exclude the possibilities of other diseases. Sometimes PET or SPECT scans or the patient’s responses to levodopa will be required to exclude or confirm Parkinson’s disease.

Nevertheless, these examinations may not be necessary. The symptoms of the most Parkinson’s disease patients are very noticeable. The doctor does not need to go through a lot of trouble to confirm the disease. Some doctors believe that it is necessary to wait for a certain period of time to observe the disease progression in order to determine the disease. However, some patients notice other patients receiving CT, MRI, PET, or SPECT scans or their friends or family members go to the large hospitals to see the professors for the examinations and decide they should also do so. Some patients even think the doctor’s medical skills are no match for the delicate instruments and believe they should receive the medical examinations. In fact, Parkinson’s disease is a custom-made disease. Every patient has a different disease progression and it is not necessary to compare the clinical examinations or drugs.

CT and MRI Scans:

Because the site of Parkinson’s disease is too small and located in the center of the brain, it is rather difficult to examine by the traditional neurological imaging such as CT or MRI scans. They are mostly used to exclude the possibilities of other brain diseases.

 1.Computerized Tomography (CT)

The CT scan uses the scanner to acquire the X-ray images of the cerebral sections from different angles. These X-ray images are processed to generate the 3D images of the brain by the computer. The CT scan can help detect the brain tissue atrophy, brain tumors, cerebral haemorrhage, or hydrocephalus.

 2. Magnetic Resonance Imaging (MRI)

MRI uses a scanner to capture the excitation of the hydrogen atom of the water molecules in the body by the magnetic field to generate the images of the organs. The resolution of the MRI images, especially of the soft tissues, in the brain is higher than that of the CT images without using the radioactive substances. However, MRI is unable to recognize the dopamine cells of putamen in the brain of the Parkinson’s disease patient. It is more suitable for the determination of stroke or the diseases of the brain or spinal cord.

 3. Positron Emission Tomography (PET)

PET uses a radioactive drug synthesized from the radioactive isotope that emits positrons to detect the metabolic reactions in the organs of the body. The signals are used to generate the images of the disease progression. By using the radioactive drug, the PET images are able to display the activities of glucose, levodopa, and dopamine in the brain. The progression of Parkinson’s disease is thus detected. PET is the most sensitive method for the determination of the reduction of dopamine secretion.

 4. Single Photon Emission Computed Tomography (SPECT)

SPECT uses a radioactive drug that emits gamma radiation to reach the disease site in the body via oral or intravenous administration. After the administration, the tomographic images of the disease site are generated by the scanner at the appropriate intervals to detect the disease. SPECT is more commonly used than PET. It can be used to detect the dopamine activities but is not as sensitive as PET.

The applications of PET and SPECT are not regular examinations for the diagnosis of Parkinson’s disease. They are mostly used for the medical or scientific research. In fact, they have made very valuable contributions to the studies of the new drug or treatment for the increase of dopamine. Although PET or SPECT can display the images of the disease progression, they do not have the related anatomical locations for comparison. Therefore, they are unable to pinpoint the exact location of the disease. Currently, scanners that combine the PET or SPECT images with the CT images by computer programs to locate the exact location of the disease are being developed.

 
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