Neuro Asia Care ~ Neurosurgery Specialist Clinic ~ Singapore

Conditions & Treatments

Some of the conditions that we treat

Parkinson Disease

Parkinson disease is a progressive neurological disorder whose first symptoms affect movement. There is loss of the dopamine producing neurons in the brain. Dopamine is an important neurotransmitter, a chemical messenger responsible for the proper functioning of our brain. An estimated 6.1 million individuals globally have a Parkinson disease diagnosis. It is also more common in men.

Symptoms

The symptoms can be broadly grouped into motor and non-motor categories.

Common symptoms are listed below.

  • Movement related (motor)

    • Slowness of movement, rigidity or stiffness, tremor
    • Balance impairment
  • Non-movement related (non-motor)

    • Loss of smell or decrease
    • Sleep problems
    • Constipation, urinary problems, blood pressure variability
    • Cognition problems
    • Softening of voice

The Hoehn and Yahr scale has been used to classify Parkinson disease into 5 stages.

Causes

  • Most cases have no known cause.
  • In some individuals, there are
    • genetic (family history) and
    • environmental contributions (pesticide, heavy metal exposure)

Diagnosis

  • History and physical examination are the mainstay of diagnosis
  • Sometimes, when the diagnosis is not clear, dopamine transporter single-photon emission computed tomography may be used
  • MRI scan may also be used to differentiate from diseases that may appear to be similar

Prognosis

Progression of Parkinson disease varies. There are both slower and faster progressing forms. Generally, individuals (about 15%) who are at risk of more rapid disease progression have:

  • early cognitive impairment
  • blood pressure that suddenly drops when the person stands (orthostatic hypotension)
  • poor response levodopa medication.

Treatment

Medication

There are many drugs that are used for Parkinson disease. The most commonly used drugs are carbidopa-levodopa, monoamine oxidase-B inhibitors and dopamine agonists. As new symptoms develop, additional medications will be required.

Non-drug treatment

  • Exercise regimen such as gait and balance training, resistance training, aerobic exercise, and dance-based.
  • Tai-chi
  • Occupational and speech therapy
  • Dietary modifications

Surgery

These include deep brain stimulation, focused ultrasound, and enteral suspension gel.

When should deep brain stimulation be considered?

  • Some years after diagnosis, individuals may start to experience periods when
    • the medication wears off (“off periods”) before the next dose, or
    • develops dyskinesias - uncontrolled involuntary movement due to the high medication concentration in the brain.
  • Other patients also have severe tremors that do not respond to medication.
  • Individuals who experience any of these, should consider speaking to their specialist.
  • For additional more detailed information, read more on Deep Brain Stimulation.

Summary

  • Living well with a chronic illness can be difficult but not impossible.
  • Selecting the most appropriate treatment at the appropriate time during the disease course is important.
  • Work with your doctor to come up with a tailored plan.