Like Diabetes, Parkinson’s ia a treatable NOT curable disease. Patients with Diabetes has Insulin deficiency whereas patient’s with Parkinson’s has dopamine deficit in the brain, replenishing dopamine according to stage & duration of the disease is paramount.
Emerging scientific evidence showing Parkinson’s is a Syndrome NOT a disease.
Depends on which neurotransmitter is heavily involved, some gets Fatigue dominant Parkinson’s, others has Falls as their main symptom, tremor dominant, Akinetic Dominat and mixed PD, treatment also depends disease subtype, I am sure you agree ONE SIZE DON’T FIT ALL.
Parkinson’s is a progressive disease and managing patients with advanced stage is a complex affair, most of the patients by the time they reach advanced stage, they will be on cocktail of oral medications in addition to Parkinson’s medications, most of them will be taking diabetic/BP meds as well, cause of constipation. Delayed gastric emptying, poor levodopa absorption in stomach, cause on & off motor fluctuations means unpredictable stiffness/freezing unable to move, breakthrough tremors etc.
To avoid these motor & nonmotor fluctuations, unpredictable stiffness and freezing, continuous dopamine delivery through jejunum bypassing stomach & duodenum ( Intrajejunal Levodopa) or Subcutaneous Apomorphine infusion via device aided drug delivery to Brain is way forward to manage advanced PD.
We pride ourselves we are the largest centre in Europe for advanced non oral therapies especially subcutaneous Apomorphine infusion and Intrajejunal Levodooa infusion and we been implementing these therapies over a decade.
DBS when compared to other non oral infusion therapies like ( Apomorphine & Duodopa) NOT for all stages and ages, my personal experience with DBS and my personal recommendation is only for those ( Young patients with refractory tremors/ dyskinesias etc) emerging evidence for elderly patients is bleak and can cause significant cognitive problems.
Both Apomorphine & Duodopa are well tolerated, most common side effects we notice with apomorphine is pwerful emetic ( vomiting) howver we do see this during initial days & antiemtic cover will be provided, also like insulin pumps, Apo pump site should be changed regularly ( infusion line site) to avoid nodules and pain.
Where as Duodopa is via PEG/J , site infections and pain can be avoided by meticulous skin care.
NO, ABSOLUTELY NOT, Apomorphine is a dopamine agonist which provides dopamine to brain – unfortunate misnomer.
Excessive Drooling ( Siallhorea) is very common at all stages in Patients with parkinson’s, often it was felt drooling only occurs in advanced stages, its nOT, can be seen even at early stage ( esp in OFF periods) this cause tremendous social consicuos sometime partners complaint they are scared to kiss as fear of infections and can also cause life threatening aspiration pneumonia which is 80% cause for mortality in patients with Parkinson’s .I recommend keeping ice cubes/ chewing gum etc for severe cases Ultrasound guided Salivary gland injections now recommended by NICE UK will certainly help.
When standard oral therapies failed to provide clinical benefit or causing substantial side effects or Contraindicated ( Like in Pregnancy) Interventional therapies like Ultrasound Guided chemodenervation of salivary glands with Botulinum toxin injection for Hypersalivation & Drooling (sialorrhea).
EMG guided Botulinum interventions for range of Cranio Cervical Dystonia ( Laterocollis, antecollis, retrocollis, Dystonic head tremors, dystonic upper &Lower limb Dystonia writers cramp, foot inversion dystonia , abdominal & Palatal Myoclonus, Blepharospasm, Hemifacial spams, etc.
EMG guided Botulinum interventions for Post stroke upper & Lower limb Spasticity, & Paraspinal spasms, (Back pain) Bruxsim (Masseter Hypertrophy/ difficulty jaw opening).
Nerve Blocks (Peripheral & Multiple Cranial nerve blocks ) for refractory migraines in Pregnancy, and also for patients suffering with refractory Neuralgias ( Occipital Neuralgia, Trigeminal Neuralgia) and range of refractory cephalgia SUCNT, SUNA, Paroxysmal Hemicranialis, refractory Migraines, etc.