Surgical Treatments and Other Therapies
Deep Brain Stimulation
Deep brain stimulation, or DBS, is a surgical procedure used to treat a variety of disabling neurological disorders. It is most commonly used to treat the debilitating symptoms of Parkinson’s disease.
Deep brain stimulation uses an electrode surgically implanted into part of the brain. The electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the symptoms of Parkinson's such as tremor, bradykinesia, and rigidity.
DBS is primarily used to stimulate one of three brain regions: the subthalamic nucleus, the globus pallidus, or the thalamus. Researchers are exploring optimal generator settings for DBS, whether DBS of other brain regions will also improve symptoms of Parkinson’s disease, and also whether DBS may slow disease progression.
Deep brain stimulation usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias and other side effects. It also helps to relieve “on-off” fluctuation of symptoms. People who respond well to treatment with levodopa tend to respond well to DBS. Unfortunately, older people who have only a partial response to levodopa may not improve with DBS.
Complementary and Supportive Therapies
A wide variety of complementary and supportive therapies may be used for Parkinson's disease. Among these therapies are standard physical, occupational, and speech therapies, which help with gait and voice disorders, tremors and rigidity, and decline in mental functions. Other supportive therapies include diet and exercise.
At this time there are no specific vitamins, minerals, or other nutrients that have any proven therapeutic value in Parkinson's disease. Studies are being conducted to find out if caffeine, antioxidants, nicotine, and other dietary factors may help prevent or treat the disease because research has suggested that these factors may be important.
While there is currently no proof that any specific dietary factor is beneficial, a normal, healthy diet can promote overall well-being for people with Parkinson's disease, just as it would for anyone else. A high protein meal, however, may limit levodopa's effectiveness because for a time afterwards less levodopa passes through the blood-brain barrier.
Exercise may help people with Parkinson's improve their mobility and flexibility. It may also improve their emotional well-being. Some doctors prescribe physical therapy or muscle-strengthening exercises to tone muscles and to put underused and rigid muscles through a full range of motion. The effects of exercise on disease progression are not known, but it may improve body strength so that the person is less disabled. Exercises also improve balance, helping people minimize gait problems, and can strengthen certain muscles so that people can speak and swallow better.
NIH has launched a physical activity research program, called Molecular Transducers of Physical Activity in Humans. The program will help researchers identify and learn more about key molecules that underlie the beneficial effects of exercise. Discoveries from this program may lead to an understanding of how physical activity translates into better health across age groups and conditions.
Other complementary therapies include massage therapy, yoga, dancing, boxing, tai chi, hypnosis, and acupuncture. There have been limited studies suggesting mild benefits from some of these therapies, but they do not slow Parkinson's disease and to date, there is no convincing evidence that they help. However, this remains an active area of investigation.