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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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In addition to drug treatment, specific surgical options are available that may be used in patients that have severe symptoms of the disease or when medication is no longer able to give symptomatic relief. Early surgical treatments involved removal or destruction of the thalamus to reduce tremors but had little or no effect on symptoms of bradykinesia or rigidity. Pallidotomy and subthalamotomy, two surgical operations that remove parts of the brain (globus pallidus interna and subthalamus, respectively) have shown improvements in many of the symptoms of Parkinson's disease. However, these techniques often do not reduce all of the symptoms which may continue to progress and may have many different complications when the brain tissue is destroyed; in some patients, the outcomes versus the risks of these surgeries is still considered.

The current surgical procedure of choice is termed deep brain stimulation. Electrodes are placed in the brain and connected to a battery-stimulator that stimulates tissues with an electrical current. Patients selected for such surgery are those that still have a good response to levodopa medications but have complications of dyskinesia even with medication or in whom medication doses can no longer be adequately maintained over about 12 to 16 hours. Patients and surgeons choose this option because it does not destroy brain tissue, it's reversible, it can be adjusted as the disease progresses and it can work on both sides of the brain tissue. It is mainly done on the subthalamic nucleus and the globus pallidus interna. There are only a few centers that do this type of surgery, and outcomes are not always favorable. However, for some few patients, the success of this technique encourages surgeons to further study and refine this surgical treatment for PD patients.

New studies involving modified liposomes or various types of modified viruses that contain genes may offer yet another method to reduce or even eliminate the symptoms of PD. Briefly, these therapies involve injection of liposomes or modified viruses that are capable of delivering genes to human brain cells. The brain cells allow and facilitate the injected genes to function. The injected genes then start to produce specific compounds such as precursor chemicals that become dopamine. Some studies are being done in animal models, but a few have progressed to early clinical trials. Preliminary results seem promising, but further human trials will be needed before gene therapy techniques are approved for therapy for PD patients.

Some studies claim that eating velvet or fava beans help with symptoms (they contain levodopa), but these studies were not deemed conclusive. Vitamin E and coenzyme Q have been claimed by some to be neuroprotective but are not a currently recommended treatment. A high fiber diet has been recommended to reduce the constipation that usually is seen in many PD patients. Exercise has been suggested to help PD patients; studies suggest that many PD patients benefit from exercises that stress flexibility, leg strength, and cardiovascular conditioning.

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