First, drug treatment: most of the early Parkinson's disease has a very good therapeutic effect on levodopa, which is called "honeymoon period" because most Parkinson's patients can get satisfactory results after drug treatment, and their symptoms can be perfectly controlled and kept in good condition all day. These drugs include: compound levodopa preparations such as Madopar, carbonized levodopa (Xining), Dalingfu, etc. Dopamine receptor agonists, such as olfactory cryptochrome, pramipexole, piribedil, ropinirole, etc. Monoamine oxidase B inhibitors, such as selegiline and rasagiline; COMT inhibitors, such as entacapone; Anticholinergic drugs such as trihexyphenidyl tablets (Antan tablets); Dopamine release enhancers such as amantadine.
Second, surgical treatment: After early drug treatment, most patients with Parkinson's disease gradually develop a certain tolerance to drugs, and gradually appear some drug-related complications, such as switching phenomenon, fluctuation of drug efficacy, dyskinesia and so on. At this time, drug treatment is no longer the main treatment, and some patients with severe Parkinson's disease will obviously affect their daily life and make their lives unable to take care of themselves. Therefore, in addition to drug treatment, further surgical treatment is needed.
Surgical treatment includes deep brain nucleus destruction, deep brain nucleus stimulation (implantation of brain pacemaker) and stem cell transplantation. At present, it is considered that the minimally invasive and most effective operation is brain pacemaker implantation. This operation is to implant two electrodes of about 1mm into bilateral brain nuclei by minimally invasive method, and then implant the pulse generator into the subcutaneous tissue below the clavicle of the chest, and adjust the stimulation effect on the nerve nucleus by adjusting the stimulation parameters.
So what kind of Parkinson's patients are suitable for deep brain stimulation?
China Parkinson's disease deep brain electrical stimulation expert * * * pointed out that the surgical indications of deep brain electrical stimulation include:
1.？ Primary Parkinson's disease;
2.？ Taking compound levodopa once had a good effect;
3.？ The curative effect is obviously decreased or there is serious movement fluctuation or abnormal behavior, which affects the quality of life;
4.？ Except for dementia and serious mental illness.
For the choice of patients, there are certain requirements:
First of all, in terms of age, it is generally not more than 75 years old, and it can be relaxed to 80 years old if physical conditions permit;
Second, the course of disease is generally more than 5 years. If the patient's symptoms are mainly static tremor, the effect is not obvious after standardized treatment, and the family members strongly demand that the operation can be relaxed to 3 years;
Third, the severity of illness should be based on H&; Y stage 2.5-4;
Fourth, in terms of drug efficacy, regular and sufficient drug treatment is needed. In the past, the curative effect of compound levodopa was good, but at present, the curative effect is declining, or there are drug-related phenomena, such as the on-off phenomenon, fluctuation and change of drug efficacy, which seriously affects the quality of life of patients.
Under the leadership of Professor Song, Shanghai Brain Hospital, through the close cooperation of neurosurgery, neurology, rehabilitation, anesthesiology and radiology, can solve the problems of early diagnosis, drug treatment, surgical treatment, postoperative program control and postoperative rehabilitation in one stop. Under the leadership of Associate Professor Kong Xiaodong, the Department of Neurology is responsible for the diagnosis, drug treatment, preoperative evaluation and postoperative program control of Parkinson's disease. Under the leadership of Professor Song, neurosurgery presides over the surgical treatment of Parkinson's disease, mainly deep brain electrical stimulation, which has the following advantages: 1, less trauma, about 3-5cm on each side of the surgical incision, drilling a bone hole with the size of about 1.4 mm in the skull, and then slowly implanting electrodes with the size of about 1mm into the relevant nucleus under electrophysiological monitoring. 2. adjustability: after the electrode is implanted, the stimulation parameters of the electrode can be adjusted by the program control device, and the stimulation effect can be adjusted by adjusting the parameters, thus improving the symptoms in different degrees; 3. Reversibility: Deep brain stimulation is a non-destructive operation. If the patient has serious stimulation-related complications, he can stop turning off the computer and stopping electrical stimulation, and deep brain nucleus destruction is a destructive operation, which will be irreversible once it is destroyed. Professor Sun Feng led the rehabilitation department of our hospital to carry out rehabilitation training for Parkinson's disease, focusing on limbs, language and gait. Multidisciplinary cooperation mode is not only used to treat Parkinson's disease, but also applied to functional diseases such as epilepsy, essential tremor, dystonia, Alzheimer's disease, etc., forming a distinctive multidisciplinary cooperation team, which is different from the single-department combat mode in other hospitals.