Deep brain stimulation advancing as a treatment for Parkinson's disease

THE SPECIALIST: DR. RON ALTERMAN ON PARKINSON’S DISEASE AND DEEP BRAIN STIMULATION

As the director of functional and restorative neuro-surgery at Mount Sinai, Alterman performs minimally invasive operations that seek to normalize brain activity. One of these surgeries, deep brain stimulation (DBS), involves implanting electrodes to treat disorders such as tremors, Parkinson’s disease and dystonia.

THE BIG STORY:

This year, the Journal of the American Medical Association published the results of a large study done in the VA system comparing Parkinson’s patients who received the best drug treatments to patients who received deep brain stimulation. “The patients who received surgery did better than the patients who did not,” says Alterman. “This randomized, double-blind trial is the best proof we have that surgery does a better job than medicine alone when treating some PD patients.”

WHO’S AT RISK:

Upwards of 1 million Americans are living with Parkinson’s disease, a chronic, progressive illness that affects the nervous system and impairs movement. “Basically everybody in the general population is at risk,” says Alterman. “Parkinson’s is the second most common neurodegenerative disease in humans, after Alzheimer’s.” The major risk factor is age. “The average age of onset in the U.S. is 62 — though as we know from Michael J. Fox, people can develop it at a younger age,” says Alterman. Men are at a slightly higher risk than woman.

The symptoms mostly result from a lack of dopamine, a chemical messenger, in the brain. This occurs when the brain cells that make dopamine die or cease to function. No one has been able to identify the root cause, however. Parkinson’s has been associated with rural living, so some hypothesize that well water or other environmental factors may put people at risk.

SIGNS AND SYMPTOMS:

The disease develops gradually. “The cardinal features of Parkinson’s are tremor, stiffness (doctors call it rigidity) and bradykinesia, which refers to slowed movements,” says Alterman. “But one doesn’t have to have all three symptoms to be diagnosed.” As Parkinson’s progresses, it can lead to problems with walking, balance, sleeping and memory, which can look a lot like Alzheimer’s.

Patients and family members often notice that the symptoms are worse on one side of the body than the other. “The disease usually affects both sides of the body, but in an asymmetric way,” says Alterman. “It tends to start on one side, and that side typically remains worse than the other.”

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