Parkinson’s disease (PD) is a neurological disorder caused by the degeneration of dopaminergic neurons, leading to reduced levels of dopamine in the brain. It affects nearly 1% of people, especially in Western countries, above the age of 50 years, with a higher prevalence in men (male/female ratio 3:2). The disease leads to symptoms such as tremors at rest, rigidity of the limbs, and slowing of movements (bradykinesia). Other symptoms include postural instability, micrographia, and a mask-like facial expression. The gait is also abnormal, characterized by small shuffling steps (marche à petits pas). This disease is named after an English doctor, James Parkinson, who described it in 1817.

PD is a type of movement disorder where symptoms begin gradually, often on one side of the body, and later affect both sides. As the symptoms worsen, patients develop trouble walking, talking, or performing simple daily tasks. Depression, sleeplessness, or difficulties with chewing and swallowing can also occur. While there is no cure for this disease, various medications can help patients improve dramatically. In severe cases, especially those unresponsive to medical treatment or those experiencing significant side effects, surgery and deep brain stimulation (DBS) can be beneficial.

 Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a minimally invasive surgical procedure used to treat debilitating symptoms of Parkinson’s disease (PD) such as tremor, rigidity, stiffness, slowing of movements, and gait disturbances. DBS involves the use of a surgically implanted, battery-operated medical device called an implantable pulse generator (IPG). Similar to a heart pacemaker, the IPG, approximately the size of a stopwatch, delivers electrical stimulation to specific brain areas that control movement. This blocks the abnormal nerve signals causing the symptoms of Parkinson’s disease.

At Hannah Joseph Hospital, our experienced neurosurgeons use MRI or CT imaging to identify and locate the exact target within the brain for surgical intervention. The commonly targeted areas are the thalamus, subthalamic nucleus, and globus pallidus. The DBS system has three components: the lead (also called the electrode), the extension (insulated wire), and the IPG. The electrode is inserted through a small opening in the skull, and its tip is positioned within the specific brain area. The insulated wire connects the electrode to the IPG, which is placed subcutaneously near the collarbone in the upper chest. Once the system is in place, electrical impulses are sent from the IPG to the electrode (lead) inside the brain. These impulses block the abnormal electrical signals, alleviating Parkinson’s symptoms.

Most patients experience a considerable reduction in their motor symptoms after DBS and can reduce their medications. DBS also reduces dyskinesias induced by long-term use of Levodopa. While DBS changes the trigger pattern in the brain, it does not slow the progression of neurodegeneration. Researchers continue to study DBS and develop ways to improve it.

Spine Tuberculosis: A Treatment Protocol

Tuberculosis (TB) is one of the most common diseases affecting the spine. Although prevalent in the Eastern part of the globe, it is also present in the Western hemisphere. Its incidence is high among poorly nourished people living in crowded or substandard conditions. It also affects the immunocompromised, elderly, and diabetic populations.

The first documented case of spine tuberculosis dates back 3000 years to Egyptian mummies. In the modern era, a British surgeon named Percival Pott described the first case in 1779, leading to the term “Pott’s disease” for spinal tuberculosis. Though spinal involvement with tuberculosis occurs in less than 1% of TB patients, it can pose significant problems, causing neurological deficits and spinal deformities. The lower thoracic and upper lumbar vertebrae are the most commonly affected spinal regions, although the cervical spine and craniovertebral (CV) junction can also be involved.

Pott’s disease usually results from the spread of the tuberculous bacillus from other parts of the body through the bloodstream (hematogenous route). The infection reaches the edges of the vertebral bodies and spreads to the adjacent disc. If left untreated, the disease leads to vertebral body destruction and ultimately deformity and paralysis. Neurological deficits develop in 10 to 47% of patients with spine tuberculosis.

Diagnosis and Treatment

Diagnosis

1. Blood Tests: Elevated ESR (Erythrocyte Sedimentation Rate) and increased WBC counts.
2. Tuberculin Skin Test: Positive in 90% of Pott’s disease cases.
3. Imaging: CT spine, bone scans, and MRI can detect early disease affecting the spinal column.

Treatment

Most patients can be treated with antituberculous (ATT) drugs along with analgesics and various immobilization methods using braces and collars. Despite the use of antituberculous drugs in proper doses and schedules, 10% of patients will need surgery to:

1. Drain a tuberculous abscess (psoas abscess)
2. Debride the epidural granulation compressing the spinal cord
3. Perform corpectomy (removal of the diseased vertebral body) with spinal stabilization (fusion) using titanium implants

At Hannah Joseph Hospital, we emphasize early diagnosis and adequate medical treatment with ATT for all spine tuberculosis patients. Compliance with the treatment protocol is crucial, especially when the spine is involved. Patients with poor response to conservative management, progressive neurological deficits, and spine deformities should seek neurosurgical intervention promptly for a good outcome.

Trust Hannah Joseph Hospital for Expert Neurosurgical Care

At Hannah Joseph Hospital, we are committed to providing the highest quality care for patients with Parkinson’s disease and spine tuberculosis. Our dedicated team of neurosurgeons, radiologists, and rehabilitation specialists work together to ensure the best possible outcomes. We offer state-of-the-art facilities and a patient-centered approach to deliver personalized care tailored to each patient’s unique needs.

If you or a loved one is experiencing symptoms of Parkinson’s disease or spine tuberculosis, contact Hannah Joseph Hospital today. Let us help you navigate your healthcare journey with confidence and care. Your health is our priority.