THE prevalence of Parkinson’s has doubled in the last 25 years according to the World Health Organisation and in 2019, there were over 8.5 million individuals living with this condition which presently has no cure.

Parkinson’s commonly affects people of an older age and usually presents with several movement-related problems such as shaking/tremors, stiffness or slowness in movement, says UM Specialist Centre a quaternary care hospital consultant neurologist Associate Professor Dr Tan Ai Huey.

Some patients may also have non-movement related problems, which they may not associate with Parkinson’s, such as difficulty sleeping, declining memory, hallucinations, constipation, urinary issues, fluctuations in blood pressure or pain and sensory problems.

“Not every patient will experience every symptom. Some may find certain problems more challenging, while others don’t,” says Dr Tan.

While most people associate the disease with tremors, only about 70 per cent of patients actually have tremors.

“If you don’t have tremors, it doesn’t mean you don’t have Parkinson’s. You may present with other symptoms such as slowness in movement.”

Since symptoms are similar to ageing-related problems, this leads to patients in the older age group being underdiagnosed, adds Dr Tan.

Most patients develop Parkinson’s after aged 60, but in five to10 per cent of cases, it happens before 50, known as early onset Parkinson’s.

If a patient has early onset, then genetic factors play a more substantial role in the cause of the disease.

Dr Tan adds that worldwide, only 10 to15 per cent of patients with Parkinson’s were found to have a genetic factor and about one in 10 patients seen in clinics have a positive family history of the disease.

But cases have risen dramatically in the last two decades and are projected to keep rising, she says and Malaysia is no exception as we are heading towards the status of an ageing nation and Parkinson’s is an age-related disorder.

Environmental factors, including exposure to pesticide and chlorinated solvents and even air pollution, have also been linked to a higher risk of Parkinson’s.

DIAGNOSIS AND TREATMENT

Clinical criteria are used to aid the diagnosis of Parkinson’s and Dr Tan stresses that it’s important to see a specialist so the diagnosis is accurate.

Other investigations may also be done. For example, brain imaging may be conducted to rule out certain conditions, which mimic Parkinson’s.

Patients are usually treated with medications that aim to replace the levels of dopamine in the brain.

Dr Tan says this is because they have a degeneration of the nerve cells in the brain that produce dopamine. Dopamine is an important neurotransmitter in the brain. Other non-dopamine related pathways in the brain can also be affected. Its causes are multifactorial.

“Parkinson’s is the result of a complex interplay between genetic, environmental factors and ageing.”

A variety of good treatment options are now available, she says.

Many different medications can be given to help patients improve both movement and non-movement-related problems.

However, treatment must be personalised based on the patient’s profile and preference.

“You need to see the patient as a whole, understand what some of their most difficult symptoms are and try to provide treatment options to manage those challenges.”

Besides medication, additional treatment strategies include physiotherapy, occupational and speech therapy, and even psychiatric support.

You need to see the patient as a whole, understand what some of their most difficult symptoms are and try to provide treatment options to manage those challenges, says UM Specialist Centre consultant neurologist Associate Professor Dr Tan Ai Huey.

GOING DEEP

For some patients with Parkinson’s a surgical option known as deep brain stimulation or DBS may offer significant relief from movement-related symptoms.

UM Specialist Centre consultant neurosurgeon Associate Professor Dr Kalai Arasu Muthusamy says DBS is not a new procedure. It was first performed in Malaysia in 2003.

It uses implanted electrodes and electrical stimulation to help patients have better control of their symptoms.

Dr Kalai explains that electrical stimulation to specific parts of the brain help improve motor function or movement.

“It must be stressed that DBS is not primarily done to improve non-motor functions. Neither is it a cure for Parkinson’s,” he says.

Electrical stimulation to specific parts of the brain helps improve motor function or movement, says UM Specialist Centre consultant neurosurgeon Associate Professor Dr Kalai Arasu Muthusamy.

Some patients experience an 80 per cent reduction in their movement-related symptoms, while others may have a 40 to 70 per cent reduction.

Results are immediate, but the outcome depends on the patient’s disease progression.

In general, 10 to 20 per cent of Parkinson’s patients may be suitable candidates for DBS.

Neurologists, who are also movement disorder specialists and have been treating these patients for years, would determine their suitability for DBS.

Patients with motor response complications can be considered for DBS. These patients experience a shorter duration of benefits from their oral medicines so they go into periods of “on” and “off”.

During the “on” period, which may last a few hours, they can function well, but once the medication benefits wear off, they experience all the challenges of their condition.

With the duration of medication effectiveness getting shorter, these patients need to take more frequent doses throughout the day, which poses an added challenge.

Patients with tremors which can’t be controlled even with medication, those experiencing side effects from medicines and patients with early onset Parkinson’s are among probable candidates.

Dr Kalai says usually, when all avenues involving different medications or different combinations of medications have been fully optimised and still patients struggle, then DBS may be an option.

While this option involves advanced technology and associated costs, it is a valuable investment in patient care. As with any surgery, there are risks, but patients will receive a thorough briefing to ensure they have a clear understanding of the expected outcomes.

After surgery, most patients would still need to take Parkinson’s medication but at reduced dosages.

DBS is basically about balancing chemical treatment (medication) with electrical stimulation in the brain so symptoms improve.

“DBS improves motor function and results are immediate but the other, non-dopamine related problems would still need medicines to be addressed.”

But it does ensure that patients can have a fairly good quality of life and resume their daily routine.

Even if they are not able to be who they were before their diagnosis, the results offer hope for Parkinson’s patients.

Source: New Straits Times