Brains Super Speciality Hospital
Parkinson
Parkinson

Parkinson’s disease the commonest degenerative disease that affects brain. It is believed that 1% of population are affected after the age of 60. The incidence is gradually on the raise all over the world including in India. Hundred years of persistent reasearch has brought in many changes in its understanding, dopamine deficiency, accumulation of alpha synnuclein as the patho genesis, the associated brain changes, refinement in diagnosis, treatment, and supportive therapies. This also paved the way for the newer concepts in understanding and treating Parkinson’s disease. Involvement of genetics has explained the younger onset of the disease with variable profile and autoimmunity to explain the differential progression of the disease. Understanding of gut microbiome and their interactions with brain has brought new theory of such initiation or induction of the illness. This opens new research and also the need for early diagnosis. However the Parkinson’s disease appears quite complex and needs many combinations of approaches and therapies to make one better.

The four cardinal symptoms are Tremor (shaking of the hand or leg) Rigidity( stiffness of the body), Bradykinesia ( slowness of all movements) and Mask-like face (loss of all facial expressions). These may not be there in everyone together hence it is important to diagnose and also to avoid mis diagnosis if only one symptom is there. Many undergo psychological trauma assuming the disease.

There are many conditions that look very similar at least in the initial stages of the diseases. Those need to be identified, because the line of treatment is completely different.

Radiological imaging has advanced phenomenally in the recent years. Though there is no definitive imaging, it is performed to exclude many other known causes. Then it becomes secondary Parkinsonism. This helps in making the treatment individualised and tailor made.

Recent reasearch has discovered a set of abnormal genes on Parkinson’s disease called Parkin genes. Many such genes have been identified. They seem to play a role in type, onset, modification in profile of illness as well as response to treatment. For example people with definite gene abnormalities can have the disease start very early in life called juvenile Parkinsonism or young onset Parkinson’s disease.

A bunch of immunological abnormalities can either induce Parkinson’s disease or modify its course and response to treatment. It is mandatory to conduct those battery of tests in order identify these subgroups to offer appropriate treatment.

It is also the new awareness that any malignancy in the body can manifest as Parkinson’s disease apart from the features of malignancy. Evaluating and identifying such rare problems will help immensely in treatment.

Many newer metabolic Dy functions are known to be associated with Parkinson’s. Their importance and relevance in treatment is still not well established. However screening for such metabolic abnormalities might be of help in future to alter the course of the illness.

Since majority of Parkinson’s patients are elderly it is inevitable that many co morbid conditions can be associated. Detection of such abnormalities will ply a crucial role in overall efficacy of treatment and maintaining good quality of life. They include diabetes, hypertension, dislipidemia, renal dysfunction, liver dysfunction, lung function abnormalities or bronchial asthma. Simultaneous treatment will contribute to their good health. This will be done by a general Physician.

All the biochemical and molecular abnormalities can be evaluated by various blood tests that are available. This helps in detecting the existing abnormalities and also the hidden unknown problems. It also helps in identifying all the possible deficiencies in the body and correct them timely and periodically.

Periodic clinical assessments is mandatory in Parkinson Disease. This will be done by qualified experienced Neuro physicians. This will help to detect the progression, and the known fluctuations that can happen in the disease. In addition all known complications can be anticipated and diagnosed early to avoid their long term consequences. Since the medical treatment is life long periodic titration and adjustments of drugs and their dosages is very much crucial in the management.

Many other degenerative conditions such as PSP, MSA, FRONTO BULBAR SYNDROMES can resemble Parkinson’s disease very much initially. The definitive treatment and the associated problems completely differ. Hence recognising them will help in a big way in planning the treatment.

In initial stages many conditions mimic Parkinson’s making the diagnosis itself a challenge. DOPA SCAN can establish the diagnosis with reasonable accuracy to go ahead with definitive treatment.

Includes initiation of drug treatment and constantly adjusting the combination and dosages to suit individual requirements. This is the major challenge in Parkinson’s disease. One must choose right drug and adjust the dosage based on the individual functional requirements. Many drugs are available now and many newer ones are in the pipeline. The main goal is to main the quality of life of an individual.

Apomorphine is a morphine derivative that is very effective in relieving the symptoms of Parkinson’s disease almost instantly. It is the only injectable drug available for this condition. The action starts in 2 minutes and all the symptoms will be relieved. But the action is very short lived hence it need to be administered very frequently. Ideally through a pump and delivered subcutaneous route as a constant slow infusion. Then only we can sustain the benefit. So it has certain distinct advantages. When some one is intolerant to available medicines this can be a good supplement. If the benefit from drugs is insufficient it can be a good compliment. When some one can’t take oral Medi Paine due to peri operative period or any gastrointestinal disturbance it is a great substitute. How ever the dosage and administration has to be closely monitored.

Though Parkinson’s disease affects motor movements predominantly, a variety of non motor problems supersede as the course of the illness progresses. This includes postural instability, autonomic disturbances, urinary disturbances, constipation, back pain, sexual disturbances, psychological disturbances, depression, and memory disturbances can complicate the Parkinson’s at any time. They all need diagnosis and effective treatments.

It is but natural that these patients go through a variety of psychological problems including depression. They need motivation, and appropriate and timely counselling so that they come out of those problems. Often the misinformation and misconceptions are responsible for this . Those are are treatable effectively provided they are identified.

Those who had reached maximum dosages of medicines,not able to tolerate the medicines, significant side effects with medicines, inadequate benefit with medicines are the ideal candidates for surgery. Surgery can relieve majority of the symptoms and enhance their quality of life. Though surgery always follows adequate medical treatment traditionally, the timing of surgery depends on many factors predominantly the quality of life. Deep brain stimulation ( DBS) has become the gold standard for advanced Parkinson’s disease all over the world. This needs proper evaluation and selection before the procedure is contemplated.

After the surgery all the patients require programming of the system to adjust perfect stimulation settings to reap the best benefits. This again depends on the age, stage of the disease, degree of medication, type of symptoms and individual needs. Periodic programming may be needed to get the best results. Now a days rechargeable battery systems are available. But in case folder systems replacement of the battery can be done as an outpatient procedure.

To get the optimum results and to slow down the progression of the disease effective rehabilitation is mandatory. This includes a variety of therapies that keep them fit and active. They include Physiotherapy, Speech therapy, Swallow therapy, Dexterity Therapy, Gait Therapy, Balance therapy and Occupational Therapy. Some may require Aqua Therapy in addition. All these are I,portent to maintain the integrity of muscles, joints and ligaments as well as to maintain a good posture.

Nutrition plays a significant role in the overall management of Parkinson’s disease. Their well-being ultimately depends on the quality of nutrition. To maintain the body mass index, muscle mass, bone strength balanced nutrition will help. In addition to combat several digestive disturbances including constipation and malnutrition can managed by following good dietary practices. In addition maintaining the gut microbiome and its harmony seems to be of utmost importance in modifying the course of the disease.

It has been along interest either to protect or replace the dopamine secreting cells in the brain so that the disease can be arrested or reversed. Many attempts are in progress. The cell therapies seem to be very promising and coming Ip in a big way. We are also doing active reasearch in this area. Very soon many better solution can come into practice.

Since the origin of Parkinson disease seems to be multifactorial, the new approach BRAINS HOSPITAL is adopting is Wholistic treatment for Parkinson’s disease. This involves identification of all possible factors in each and every patient and correct them to the best extent possible.

Since genetic testing is possible to screen all the high risk individuals in the family is possible today. This might help in modifying certain specific factors that help to prevent or postpone the onset of the disease in future.

Parkinson’s disease is a complex problem that involves, many variations, fluctuations, altered progression and psychological challenges. This requires good social and family support to keep them going. In addition such a support can keep them active and effective for a long time. Parkinson’s is not life threatening. It can be disabling if all these factors are not addressed properly. In addition the disease can have many facets that confuse the families. This can lead to unnecessary misunderstandings and social complications. By educating the family particularly the care givers majority of these problems can be eliminated.

This special clinic at BRAINS HOSPITAL will provide long term support to all these patients who are registered. There are several benefits by registering to the clinic. Consultations at subsidised prices, priority consultations, round the clock medical help, round the clock medical assistance, home drug delivery, free access to any information, free access to all programmes related to Parkinson’s disease and periodic updates on ongoing reasearch and current developments in the world.

This is the first time such a Comprehensive clinic has been established in Bangalore for Parkinson’s disease. We hope we will be able to educate the society, train the care givers and serve the needy patients with Parkinson’s disease. This apart we will continue all our efforts in ongoing research to find a bio marker for early diagnosis before the symptoms appear, screening the high risk group and innovate good permanent treatment solutions. Incidentally developed India’s first stereotactic frame in association with Mahalasa technologies that can bring down the cost of DBS surgery. This is a completely indigenous innovation in the interest of service dedicated and launched by Smt Nirmala Sitaraman. Many more innovative approaches are being tried with a goal to provide an effective quality of life to our needy patients. Several small gadgets to improve certain mundane day to day activities such as eating, dressing and combing etc will also be provided for those who are registered to this clinic.

PD support group has been established at BRAINS HOSPITAL with an aim to have group meetings to patients along with their families and care givers. This in our experience has eliminated the fear and apprehension that they are not alone in having this illness. They automatically gain moral support from each other. The families can have interactive discussions that can clarify many psychological apprehensions and doubts. They relate to each other, learn from each other and help each other. Many a times it can boost their courage to face the situation and move forward. More over it can be be a good platform for education and training. They can also have good social interactions, cultural activities and helps in dispelling misconceptions. Many restarted their professions after such interactions. All those who register to this clinic will become members of the support group automatically.

euro Physcicians, Neuro surgeons, Neuro Radiologist, Gen Physician, Speech Therapist, Rehabilitation Specialists, physiotherapist, occupational therapists, psychologist and specialists in the hospital as when needed.

THE BENEFITS OF REGISTERING TO THE CLINIC ARE INNUMERABLE. HURRY UP AND REGISTER TO REAP THE LONG TERM BENEFITS.

HELP LINE - 8073012345 has been established as a help line round the clock. One can utilise the services for REGISTRATION, APPOINTMENTS OR ANY OTHER MEDICAL SERVICE AND ASSISTANCE REQUIRED.

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