At 62, can brain stimulation cure my Parkinson’s disease?

Question

Hello doctor,

I am 62 years old and have been suffering from Parkinson’s disease since three years. I am on levodopa-carbidopa medication, but recently, I have started experiencing stiffness during evening hours and difficulty with right-hand tremors. I have heard about the concept of motor fluctuations and possibly the use of a COMT inhibitor from my neurologist. I would like to know,

Is deep brain stimulation premature for me?
Am I having any symptoms of cognitive impairment?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

What you describe here are stiffness and shaking coming back before the next administration of the Carbidopa-levodopa combination. This may be what is known as "wearing-off motor fluctuations" and is relatively common after several years of being treated with Levodopa.

The addition of a catechol-O-methyltransferase COMT inhibitor (Entacapone/Opicapone), as well as an MAO-B inhibitor, can increase the duration of the effect of each dose of levodopa and reduce fluctuations. It can be useful at times to make adjustments in dosing times or even split levodopa into smaller portions administered more frequently.

Deep brain stimulation therapy is a potential treatment method if medications continue to relieve symptoms but lead to problematic fluctuations and dyskinesia that cannot be controlled through medication. At three years post-diagnosis, DBS can be considered if there are already significant fluctuations, but usually not as the first line of treatment. You and your neurologist can reconsider the matter after optimizing the current medication regimen.

When it comes to cognition, some individuals diagnosed with Parkinson’s disease experience cognitive changes but not necessarily everyone.

The following conditions can be really helpful:

Staying mentally active.
Socially engaged.
Exercising regularly.
Control of any other medical condition, such as sleep disorders, depression, or vascular risk factors.

Your neurologist will be able to test for early signs through regular check-ups.

I hope this information helps you.

Feel free to ask further queries.

Thank you.