Patient Info


What is Parkinson’s disease:

Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.

Symptoms include:

  • Tremor, mainly at rest and described as pill rolling tremor in hands. Other forms of tremor are possible
  • Bradykinesia or slowness of movements
  • Limb rigidity
  • Gait and balance problems

While Parkinson’s itself is not fatal, disease complications can be serious.

Additional Movement Symptoms that develop as a part of disease progression include but are not limited to

  • Cramping (dystonia): sustained or repetitive twisting or tightening of muscle.
  • Drooling (sialorrhea): excessive saliva or drooling may result due to a decrease in normally automatic actions such as swallowing.
  • Dyskinesia: involuntary, erratic writhing movements of the face, arms, legs or trunk.
  • Festination: short, rapid steps taken during walking. May increase risk of falling and often seen in association with freezing.
  • Freezing: gives the appearance of being stuck in place, especially when initiating a step, turning or navigating through doorways. Potentially serious problem as it may increase risk of falling.
  • Masked face (hypomimia): results from the combination of bradykinesia and rigidity.
  • Micrographia: small, untidy and cramped handwriting due to bradykinesia.
  • Shuffling gait: accompanied by short steps and often a stooped posture.
  • Soft speech (hypophonia): soft, sometimes hoarse, voice that can occur in PD.

Although there is no cure, treatment options vary and include medications and surgery.


Levodopa (also called L-dopa) in combination with Carbidopa is the most commonly prescribed medicine for Parkinson’s. People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual dancing movements (Dyskinesias) within a few hours of taking the medicine. Other commonly used drugs in Parkinson’s Disease include ropinirole, pramipexole, rotigotine, tolcapone, entacapone, rasagiline, seligiline, trihexphenydyl and amantadine.

Over a period of time, as the disease progresses, the dosage regimen may be adjusted so as to give the patient best symptomatic relief possible


Deep Brain Stimulation is an option if a person had the disease for 3 years or more with motor symptoms, UPDRS off score of 30, the difference between On and Off scores of 30% and not getting enough relief from medicine.

A DBS system has three parts implanted inside the body

  • A thin wire, called a lead, that's placed in the brain
  • A battery that sends tiny electrical signals to the lead placed in the brain. This battery will last for few years depending on the amount of current and it needs to be replaced.
  • A wire that connects the lead to the battery.
  • Lead Placement: A frame is fixed into the skull after scalp has been numbed which is followed by a DBS MRI. After the MRI is taken, planning is done during which the surgeon will calculate the location of the target where the leads must be placed in the brain. The actual surgery starts after the planning and is done under local anaesthesia where only a local scalp block is given initially during the surgery. A dime-sized hole is made in the skull.The lead is placed in the target.The hole in the skull gets closed up with a plastic cap. A post DBS MRI is taken after the surgery to ensure that the leads placed are in the correct location.
  • Battery placement: Battery is usually placed in the right chest pocket under the skin. An extension wire runs from the caps to the battery.
  • The battery needs to be turned on and programmed.


DBS offers a multitude of benefits.

  • DBS plus medications will increase the “on” hours without dyskinesias with reduction in on and off fluctuations.
  • It will offer 60% to 80% symptomatic improvement.
  • DBS results in a nearly 50% average reduction in medication compared to medical therapy alone.
  • DBS reduces dyskinesia by reducing side effects caused with medication.
  • DBS slows the rate of progression of disease.
  • Improvement in quality of life of in activities of daily living
  • DBS may extend life for Parkinson’s patients.

Symptoms that don’t improve with DBS:

  • Freezing of gait, postural instability or dysarthrophonia persisting during best medical-ON state revealed no significant improvement after STN-DBS.
  • Cognition will not improve post DBS


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