for Parkinson’s disease
By Vidushi Seneviratne
Parkinson's disease is seen more
often in men and women over fifty. "Anyone can contract it
and the cause is unknown," says Dr. Colvin Samarasinghe, Senior
Consultant Neurosurgeon, describing it as crippling to both the
patient and everyone else involved.
various aspects of the disease and the medical options available
were discussed at a recent press conference held at Ward 9 of the
National Hospital, Colombo.
carry out any action, it is essential to have Dopamine in the brain.
It is the lack or degeneration of Dopamine -(a chemical substance
that regulates movement) releasing cells in deep areas of the brain,
that causes the body to lose control even when doing basic activities,"
said Dr. Samarasinghe. "The most common symptoms of the disease
are tremors, stiffness or unsteadiness usually in one arm, difficulties
in walking, softening of the voice, reduced facial expression and
reduced blinking. The patient usually walks with a stoop, takes
small steps and does not swing his or her arms. The tremor seems
more like a pin rolling movement of the thumb and fingers,"
for Parkinson's disease can be initiated with medication that is
relatively inexpensive (such as Benzexhol or Artane). But after
a time, these drugs might turn out to be ineffective and even have
side effects. Newer drugs such as Levodopa that can be converted
to Dopamine in the body are also available, but are more expensive
and with time, might have unfavourable side effects too.
a surgical procedure now being done at the National Hospital, Colombo
is considered an extremely effective and cost worthy solution for
Parkinson's. Here, a stereotactic frame is first fixed onto the
patient's head under local anaesthesia. Following this is the accurate
locating of the area of destruction within the brain (the pallidal
target) using Magnetic Resonance Imaging (MRI). Since CT scans alone
are inadequate for the localisation of the target, ideally a combination
of CT and MRI images are fed into a computer workstation, for extreme
accuracy before the surgery begins. Once the exact spot is located,
that particular part of the globe's pallidotomy is destroyed.
have to ensure accuracy upto 1mm. If not, there could be severe
results such as paralysis, partial loss of vision and speech. But
if carried out correctly, the results are extremely satisfactory
to the patients," he said.
in 1998, Dr. Samarasinghe says that about twenty patients have had
pallidotomy at the Neurosurgical Unit 1 of the National Hospital
with the assistance of Dr. S. Warunashantha, Registrar in Neurosurgery
and Lionel Dissananyake, senior radiographer.
had a tremor in my body and I used to fall quite often. I tried
out various medications and treatments such as acupuncture, but
nothing cured me," says Mary Kodipillai, a patient with Parkinson's
disease, who described herself as someone who used to sleep a lot
and have uncoordinated actions. "But after I had the surgery,
I feel completely alright and even do all the work at home. I feel
like a different person," she said.
Dassanayake, another patient whose condition has improved tremendously
after surgery said that earlier he was not able to even do basic
tasks like wearing the sarong or shirt on his own, but "now
I'm doing great".
only at the National Hospital, the surgery takes about two to three
hours and any general practitioner could refer a patient to Ward
9 of the hospital to be treated for this condition. Dr. Samarasinghe,
however points out that though pallidotomy is a successful method
of countering Parkinson's disease, it is not the most suitable.
"In more developed countries, pallidotomy is not done now as
it involves cell destruction which is an irreversible process. Instead
they use a form of therapy named Deep Brain Stimulation (DBS) which
is much more effective from a medical point of view. But with our
limited resources and pallidotomy being a relatively less costly
method, it can change the lives of these patients in an extremely
positive way," he said.