Clearing Up Doubts: Frequently Asked Questions About Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that affects patients’ quality of life and often leads to many concerns. Here, we address some of the most frequently asked questions to help patients and their families understand the disease and manage it effectively.
 
What causes Parkinson’s disease?
The exact cause is unknown, but it is believed to result from a combination of genetic and environmental factors. About 10-15% of cases are hereditary, while the majority occur in individuals without a family history of the disease.
 
What are the stages of Parkinson’s disease?
Parkinson’s affects individuals differently, and not all patients experience the same symptoms or progression rate. Generally, the disease is categorized into five stages:

1. Stage 1: Mild symptoms, including tremors and movement difficulties on one side of the body. Changes in posture, walking, and facial expressions may also occur.
2. Stage 2: Symptoms worsen and affect both sides of the body, including the neck and torso. Patients may experience difficulty walking and occasional speech problems.
3. Stage 3: Balance issues become more noticeable, increasing the risk of falls. However, patients can still manage daily activities independently.
4. Stage 4: Patients may still stand and walk but require assistive devices like a cane or walker. They need close supervision for daily activities.
5. Stage 5: Severe stiffness prevents patients from standing or walking. They may require a wheelchair or be bedridden, needing full-time care.

Patients are under observation during these stages, as disease progression varies among individuals.
 
Can Parkinson’s disease be cured?
There is currently no cure for Parkinson’s disease. Current treatments focus on symptom management and slowing disease progression to maintain a good quality of life for as long as possible.
 
Can Parkinson’s disease be fatal?
Parkinson’s itself is not directly fatal, but complications can increase the risk of death. Examples include:

• Falls and injuries
• Swallowing difficulties, leading to aspiration pneumonia

 
What are the treatment options?
Treatment options include:

• Medication: Levodopa and dopamine agonists are commonly used. While they work well initially, long-term use may lead to fluctuating responses (motor fluctuations), wearing off effects, or dyskinesia (involuntary movements).
• Device-aided therapy:
  • Continuous apomorphine subcutaneous infusion to stabilize dopamine levels and bypass GI tract
  • Deep Brain Stimulation (DBS) to improve motor symptoms.
• Rehabilitation: Physical therapy, exercise, stretching, and speech therapy help maintaing patients’ mobility and communication.

 
When should continuous apomorphine infusion be considered?
This treatment is beneficial when:

• The patient experiences motor fluctuations (uneven response to oral medication).
• Levodopa’s effectiveness wears off too soon.

Apomorphine infusion provides consistent dopamine levels, leading to better symptom control.
 
Who is a good candidate for Deep Brain Stimulation (DBS)?
DBS is suitable for patients who:

• Have reduced responsiveness to oral medications.
• Experience motor fluctuations, wearing off phenomenon
• Medication-resistant tremor
• Intolerance to medications such as severe dyskinesia
• Do not have severe dementia, severe emotional disorders, or major balance issues.

A thorough neurological and psychological evaluation is required before considering DBS surgery. It must be performed by a specialized multidisciplinary medical team.
 
If I undergo DBS, will I still need medication?
Majority of the patients can reduce the need for medication after the DBS surgery. However, most patients still require some medication alongside DBS therapy.
 
If a patient develops memory loss or walking issues after DBS, should the device be removed?
No. DBS does not cure Parkinson’s, and the disease continues to progress over time on itself. If memory or walking problems develop, movement disorder specialist can adjust medication and fine-tune the device settings rather than removing it.
 
The Bumrungrad Parkinson’s and Movement Disorders Clinic
The Bumrungrad Parkinson’s and Movement Disorders Clinic is staffed by specialist neurologists, rehabilitation experts, psychiatrists, physical therapists, occupational therapists, speech therapists, and nutritionists. The team provides comprehensive diagnosis, treatment, and care plans tailored to each patient’s needs.