Parkinson’s treatment beyond medication: A doctor’s guide

Parkinson’s disease is a condition that gradually affects how a person moves. You may notice symptoms like shaking, stiffness, or difficulty in movement. In the early stages, medicines help control these symptoms quite well. But over time, their effect may not last as long or may become less predictable.

As the disease progresses, many patients notice that the relief they get from each dose starts reducing. Earlier, the effect may have lasted for several hours, but later it may last only one to one-and-a-half hours. Some patients also develop side effects from long-term medicines, such as involuntary or jerky movements, called dyskinesia. When this starts happening, it is usually a sign that we need to think beyond medicines alone.

We usually manage Parkinson’s with three important pillars: medication, surgery (Deep Brain Stimulation or DBS), and regular exercise. All three are equally important. If one becomes weak, overall control of the disease is affected.

There comes a stage often around five to seven years after diagnosis when we start evaluating whether a patient, not responding adequately to medications, is suitable for DBS. This decision is not taken lightly. We assess multiple factors in detail before recommending surgery.

In DBS, we place very fine electrodes in specific areas of the brain that control movement. These are connected to a small battery placed in the chest, which works like a brain pacemaker. It sends controlled signals to help improve movement and reduce symptoms.

After surgery, care is very important. For the first few weeks, patients need to take special care of the surgical site. Dressings are usually done on alternate days until the stitches are removed, as the risk of infection is highest during this time. Once recovery is complete, patients should follow a routine of at least one hour of daily exercise, such as walking, to maintain mobility.

Parkinson’s is a progressive condition, so even after surgery, regular follow-ups are necessary. The advantage of DBS is that we can adjust the device settings over time. This is called programming, where we fine-tune the stimulation based on the patient’s symptoms, helping us stay one step ahead of the disease.

A newer advancement is adaptive DBS (aDBS), Unlike traditional DBS, this system can read brain signals and adjust itself automatically. It can sense when symptoms are about to come and increase stimulation to control them, sometimes even before the patient feels them.

This system also adjusts based on daily activity. For example, it reduces stimulation during sleep and increases it when the patient wakes up or starts moving. It can work in different modes, one is to provide smooth changes throughout the day, while another is to respond quickly, especially in patients who have a propensity to develop side effects like dyskinesia.

Technology, including artificial intelligence, is helping at every stage from deciding which patients will benefit from DBS, to improving accuracy during surgery, and making the device smarter after implantation. Managing Parkinson’s disease requires a team approach. Each plays an important role in ensuring the best outcome for the patient.

Parkinson’s treatment is not the same for everyone and changes over time. The key is to recognise the right time to move beyond medicines and consider advanced options like DBS. With the right approach and timely decisions, patients can achieve better symptom control and maintain their quality of life.

This article has been contributed by Dr. Anirban Deep Banerjee, Director - Neurosurgery, Medanta Institute of Neurosciences.

Disclaimer: Issued in the public interest for general awareness and is not intended or implied to be a substitute for professional medical advice or for treatment/cure of any medical condition. The views and opinions expressed in the story are independent professional judgments of the experts, and TIL does not take any responsibility for the accuracy of their views. This article has been produced on behalf of Dr. Anirban Deep Banerjee by Times Internet’s Spotlight team.