Dealing With Parkinsons Disease: What are my Surgical Options?

There will be the following impacts: Reduced taking of medication Movement is Easier Relief from Bad Tremors Rescue from Pain

When medication Fails to kick in Wears off unexpectedly Is required more frequently Gives intolerable side effects When symptoms Become unresponsive to medication Interfere with daily activities Reduces the quality of life

This is again a very common question for people who are considering DBS, and if you are selected, we pick the participants very carefully. Usually, we achieve a very high success rate, meaning that they feel it is a very great help to them and they will even recommend it to their friends with Parkinson's disease. I think in terms of failure, taking in mind the complications we expect, there is a risk of serious complication about 1% and a risk of infection about 3%.

So, DBS can be performed with the patient awake, meaning that at least through the critical part of the surgery we can test their movement and get them to do things to see if the DBS is optimally positioned. This is why they are kept awake rather than sleeping and sedated most of the time. The surgery can also be done while the patient is completely asleep. We decide based on the patient. So for patients with a lot of anxiety as their main symptom, we recommend having it done asleep, whereas for patients who are fine being awake then the surgery will be done awake.

Depends on what you mean by TCM, so if you mean acupuncture in the form of traditional medicine, we know that in Singapore for example, about 40% of patients have acupuncture at some stage in their illness. Quite a number of people will try it. Generally speaking, our feeling is that it is mainly helpful for fatigue. Patients may experience some fatigue from Parkinson's disease, and it can help so much with the motor symptoms of Parkinson's disease. If the question relates to traditional herbal medication it's more challenging because there is a possibility of interference with the medication.

Madopar can make patients feel sleepy and can induce sleep in some patients because they are uncomfortable at night. If they have symptoms at night they may have to take Madopar to help them for the night. So it really depends on what symptoms affect the sleep; they might need this to help them through the night.

Infrared lights directed at the same nucleus within the brain that is used for DBS, can have some effect. So, the infrared light directed inside the structures of the brain may have a neuroprotective effect and may in fact improve the symptoms of Parkinson's disease. The answer is yes but we'll usually have to use surgery to direct it in the correct location in the brain.

Part of the care is the kind of protocol people use to treat Parkinson's Disease. I think some doctors might not be too familiar with DBS as a treatment, therefore if you are not too familiar with DBS, it is much harder to offer. Sometimes there are misconceptions on the risk. Some people think it's extremely risky, but I think it really depends on your surgeons. If your surgeon has done a lot of this procedure and does it routinely, I would say it is a relatively safe procedure.

Essentially, the main thing to consider is if you have insurance or not, some patients have insurance that can partially cover the cost and in Singapore, Medisave might pay for some of that as well. There are some factors looking at the cost of DBS, best to speak to the clinic.

Parkinson's Disease is a diagnosis, meaning that it is important to assess the patient in person and it is common for some patients to experience symptoms that might not be typical, especially younger patients when they first present these symptoms, it may not be the typical tremors, shuffles and movement, thus it is important to assess patients before making the diagnosis.