(Health Korea News / Jang Il) Parkinson’s disease is a disease that occurs when the brain does not produce dopamine, a neurotransmitter. Dopamine regulates muscles, participates in body movement and balance, and acts like a lubricant for machines. Therefore, if dopamine is not produced or does not function properly, the symptoms that occur when the machine lacks lubrication appear. Typical symptoms include shaking hands and feet (tremor), slow movement (bradykinesia), stiffness of the body (rigidity), and unstable gait (gait disorder).
Parkinson’s disease is a disease in which degenerative changes continue to occur and is a representative disease that threatens life in old age, with approximately 85% of all patients in their 70s or older. Recently, the number of patients is gradually increasing along with the increase in the elderly population.
◇Three major geriatric brain diseases along with dementia and stroke… Occurs when dopamine is not produced
Parkinson’s disease is considered one of the three major geriatric brain diseases along with dementia and stroke. The exact cause of Parkinson’s disease is not yet known, but it is known to be caused by genetics in 5 to 10% of all patients. The rest are idiopathic with unknown causes.
The number of Parkinson’s disease patients in Korea is steadily increasing. According to the Health Insurance Review and Assessment Service, the number of people who visited hospitals for Parkinson’s disease last year (2023) was 125,526, up from 100,716 in 2017, an increase of 24.6% in the six years since it first exceeded 100,000.
Parkinson’s disease occurs when dopamine is not produced in the brain. Therefore, when dopamine medication is administered, symptoms improve. However, the period of effectiveness of the drug, called the honeymoon period, generally lasts only 5 to 7 years. After this period, the duration may be extremely short or side effects such as dyskinesia caused by dopamine may appear.
It is pathophysiologically different from ‘Parkinson syndrome’, which has similar symptoms. Parkinson’s disease is mainly caused by degeneration of dopamine neurons in the substantia nigra, and dopamine deficiency is the main mechanism, whereas Parkinson’s syndrome is caused by various causes such as multiple system atrophy, progressive supranuclear palsy, and vascular parkinsonism, and is caused by damage to the dopamine system. It may not necessarily appear in the same way. For this reason, even when dopamine drugs are administered, the treatment response in Parkinson’s syndrome is often weaker than in Parkinson’s disease.
Parkinson’s disease progresses slowly, and symptoms such as olfactory impairment, constipation, and depression do not appear in the early stages, and patients often perceive it as simple aging and visit hospitals late. It is necessary to carefully monitor the health status of your parents or elderly people around you, and if you notice any abnormal symptoms, visit a hospital for a diagnosis.
◇If side effects such as limitations in drug duration appear, deep brain stimulation should be considered.
The main treatment for Parkinson’s disease is medication and exercise therapy. It is recommended that surgery be performed when drug side effects appear. Based on the ‘Hoehn and Yahr scale’, which classifies Parkinson’s disease into five stages according to symptoms, it is recommended to undergo surgery before stage 3, which is the middle stage.
Parkinson’s disease is continuously controlled with medication, but after a certain period of time, the effectiveness of the medication may be shortened due to side effects or long-term medication. At this time, deep brain stimulation may be considered to improve the side effects or ineffectiveness of the drug.
Deep Brain Stimulation (DBS) is a neurosurgical procedure that inserts tiny electrodes into specific areas of the brain to control nerve signals through electrical stimulation. When the DBS device is activated, continuous or intermittent electrical stimulation is provided through electrodes, which can alleviate abnormal motor symptoms and contribute to improving the patient’s quality of life (QoL).
In particular, deep brain stimulation performed on Parkinson’s disease patients is effective in improving motor symptoms that are difficult to control with drug treatment. DBS can help reduce the dosage of Parkinson’s disease treatments and reduce complications of the motor system, such as drug-induced dyskinesias. In addition, DBS significantly improves symptoms of Parkinson’s disease such as tremor, rigidity, and bradykinesia, contributing greatly to improving the quality of life of patients.
In DBS, the electrode insertion site varies depending on the disease. In Parkinson’s disease, the subthalamic nucleus (STN) or the internal globus pallidus (GPi) are usually targeted. The selection of the electrode target site is determined by comprehensively considering the patient’s symptom type, drug response, and side effect profile.
Because Parkinson’s disease is an incurable disease that is difficult to cure, it is sometimes neglected even if diagnosed. However, with the development of treatments and treatment technologies, the quality of life of Parkinson’s disease patients has greatly improved, and the quality of the remaining life is also improving. Rather than feeling the burden of active treatment, it is important to visit a neurosurgeon and find the best treatment through detailed examination and sufficient consultation. (Written by / Professor Jang Il, Neurosurgery, Brain Hospital, Incheon St. Mary’s Hospital, Catholic University)
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