Parkinson's Disease is a neurodegenerative disorder which features tremors, muscle rigidity, and slowed movements, with an incidence of close to 20 cases per 100,00 people/year (DMaggd, 2015). Stemming moreover from the degeneration of dopaminergic receptors - both D1 (excitatory), and D2 (inhibitory), much of the previous therapies for Parkinson's Disease have facilitated increased activation of these receptors via dopaminergic therapies (DMaagd, 2015). These pharmaceutical interventions, however, have their side effects. As dopamine is so integral in the affects of multiple different body systems, not simply just the motor system, administration of dopaminergic drugs such as Pramipexole and Ropinirole may have large effects on things such as blood pressure, which may need to be compensated for (Fang, 2017). Many pharmaceutical dopaminergic medications, particularly "Levodopa", can lead to continuous and highly variable periods of symptom return between doses, when the medication begins to wear off, or after external triggers specific to the patient (Michael J Fox Foundation, 2022). These time periods, deemed "off times", can come on suddenly and present differently across breakthroughs, which can disrupt patient daily life. Additionally, Parkinson's disease symptoms are understood to become prominent after about ~50-80% of dopamine receptors are disrupted. Unfortunately, at this point, disease progression is often severe, and symptoms are less likely to be affected by medication (DMaagd, 2015).
Deep Brain Stimulation, abbreviated DBS, has since pulled forward as a promising treatment avenue for Parkinson’s patients who’s symptoms remain life-altering post-medication trial, or who struggle with the medication’s side effects and complications (Groiss, 2009). In this treatment, electrodes are surgically placed on neurological targets, mainly the STN (subthalamic nucleus in the diencephalon) and GPi (globus pallidus in the cerebrum), both of which are part of the basal ganglia, and heavily affect motor control, motor learning, and executive functions (Lanciego, 2012) The electrodes are connected to a regulating device, similar to a pacemaker, and electrical impulses are sent through them. Although the whole mechanism for the deep brain stimulation mechanism is not quite understood, these impulses are believed to regulate the electrical stimulations within these parts of the brain, in turn regulating muscle movement (poorly maintained via neurotransmitters at this point in disease timeline) (The Michael J Fox Foundation, 2022). DBS may be combined with pharmaceutical treatment already highlighted, or may stand alone in a Parkinson’s treatment. Additionally, deep brain stimulation may be used as a treatment option for other diseases, such as medication resistant obsessive compulsive disorder and generalized essential tremor (Fang, 2017). Reversible, and safer in comparison to previous lesioning techniques, deep brain stimulation may continue to be a promising pathway for patients who are unable to find symptom relief with general medication management. Despite generalized risks which surgery presents, DBS ought to be considered for the current overall greatest benefit for Parkinson's patients (beneficence) who continue to suffer with their symptoms.
Groiss, S. J., Wojtecki, L., Südmeyer, M., & Schnitzler, A. (2009, November). Deep brain stimulation in parkinson's disease. Therapeutic advances in neurological disorders. Retrieved October 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002606/
DeMaagd, G., & Philip, A. (2015, August). Parkinson's disease and its management: Part 1: Disease entity, risk factors, pathophysiology, clinical presentation, and diagnosis. P & T : a peer-reviewed journal for formulary management. Retrieved October 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517533/
Lees, A. J. (1989, June). The on-off phenomenon. Journal of neurology, neurosurgery, and psychiatry. Retrieved October 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1033307/
Fang, J. Y., & Tolleson, C. (2017, March 7). The role of deep brain stimulation in parkinson's disease: An overview and update on new developments. Neuropsychiatric disease and treatment. Retrieved October 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349504/
Deep Brain stimulation. The Michael J. Fox Foundation for Parkinson's Research | Parkinson's Disease. (n.d.). Retrieved October 2, 2022, from https://www.michaeljfox.org/deep-brain-stimulation
"off" Time in parkinson's disease. The Michael J. Fox Foundation for Parkinson's Research | Parkinson's Disease. (n.d.). Retrieved October 3, 2022, from https://www.michaeljfox.org/time-parkinsons-disease#:~:text=Examples%20of%20%22off%22%20include%3A,episodes%20of%20significant%20difficulty%20moving.
Lanciego, J. L., Luquin, N., & Obeso, J. A. (2012, December 1). Functional neuroanatomy of the basal ganglia. Cold Spring Harbor perspectives in medicine. Retrieved October 3, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543080/
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