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Comparison of Medication vs Deep Brain Stimulation for Parkinson’s Disease

Parkinson’s Disease (PD) is a neurodegenerative condition with progressive loss of dopamine-containing cells.  The hallmark is not motor weakness, but rather a loss of control of motor function.  The main symptoms of Parkinson’s are tremor at rest, slowness in movement, decreased arm swing when walking, shortened shuffling steps, a hunched posture, and a mask-like appearance of the face.  There may also be some Parkinson’s Associated Dementia.

The focus of treatment since the process behind Parkinson’s was established has been to replace the lost dopamine with dopamine containing medications (such as Sinemet) or to give medications that “look like”dopamine.  The limitations have been that much of the oral medication is broken down by the GI system before it ever reaches the brain, that the medication “wears off” before the next dose, and that other abnormal involuntary movements, called dyskinesias occur when the nerve cells are exposed to too much of this external dopamine.

A procedure called deep brain stimulation (DBS) of the subthalamic nuclei (STN) within the brain has been a game-changer for many patients, with better efficacy for some, less wearing-off and no dyskinesias. Many studies have shown DBS-STN to restore quality of life (QOL) for many patients with PD.

A recent analysis of the literature claimed that the improved QOL benefit lasted for 3 years after surgery but returned to baseline after five years.  In contrast, all PD patients treated with medication alone had a diminished QOL over time. The motor function and QOL measures are reflected in social contact, activities of daily living (ADL), pain level amount of social stigma.  The medication group exhibited a 50% decline in QOL at 5 years as compared to a stable trend in the DBS group. The most significant difference was a greater improvement in mobility at five years in the DBS-STN group. Motor function in the medication group had dropped by 27% and improved by 47% in the DBS group. On the contrary, speech intelligibility was worse with DBS as compared to medication therapy.

The treatment of Parkinson’s Disease is entirely reliant on the clinical response to different interventions as imaging tests and bloodwork cannot help to evaluate response to therapies and the need to make changes. BeCareLink can help with its remote evaluation of the neurologic exam.  BeCareLink assesses tremor, ambulation, motor strength, cognition and more.

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