Parkinson’s disease inevitably accompanies long-term fights on the part of patients. Therefore, efforts are being made in and out of the medical community to raise patients’ survival rates and improve their quality of life.

“Percept PC,” developed by Medtronic using deep brain stimulation (DBS), is also a product that fits the latest treatment trend. Percept PC draws attention because it detects brain signals and makes personalized DBS possible.

Then, what is the significance of brain signal detection technology in treating Parkinson's disease using DBS? And is "customized treatment" really possible for Parkinson's disease?

To seek answers to these questions, Korea Biomedical Review met with Professor Yoon Jin-young of the Department of Neurology at Samsung Medical Center, who also serves as the educational director at the Korean Movement Disorder Society, and heard about the advantages and disadvantages of DBS in the treatment of Parkinson's disease and the implications of the emergence of brain signal detection technology.

Meanwhile, the basic treatment for Parkinson's disease is levodopa medication. However, if levodopa is used for a long period, it causes side effects, including dysphagia, adversely affecting the patient's quality of life. Therefore, doctors use surgical methods, such as DBS, to treat motor complications in Parkinson's disease patients.

Question: About 300 Parkinson’s disease patients receive the DBS procedure a year. Is that small by international standards? If so, why?

Answer: The number is small compared to foreign countries. Korean patients also spend longer than foreigners deciding on the procedure because they tend to regard brain surgeries as taboo. On average, patients think about it for a year, but doctors advise them to have sufficient time to respect their intention. However, some patients experience the aggravation of the disease due to the long decision time and are forced to receive the procedure. In that case, it is regrettable because they enjoy a shorter period of benefits from the procedure.

Q: Is there concern about the side effects of surgery behind patients' reluctance to perform surgery?

A: It is a lie if I say there are no side effects. However, the rate has been greatly reduced with the development of technology. In the past, it was 4 to 5 percent, but based on the current data of Samsung Medical Center, it is about 1 percent. Above all, the incidence of a fatal cerebral hemorrhage in patients dropped, which accounts for a high percentage of the side effects of DBS. In addition, advances in robots and surgical techniques have significantly reduced the incidence of side effects compared to hand surgery.

Q: What are patients’ responses after the DBS procedure?

A: The best words I heard from patients are, "I almost forgot the time to take medicine." Parkinson's drug loses effects after some time when patients begin to suffer from stunted energy and reduced quality of life, lying in bed all day. So, some Parkinson's disease patients are afraid of such situations and develop an addiction to drugs. However, if they forget to take medicine, the surgery goes well. So I feel most pleased and rewarded to hear those words.

Receiving DBS also can reduce irregularities in medicinal properties. For example, you can make a meal appointment with a friend a little later than usual, and life can be more comfortable.

Q: Who are more eligible for DBS?

A: When operating on a patient who suffers greatly when the drug's energy is low, the effect and satisfaction are good. It is most important to give patients and guardians realistic expectations for DBS. DBS doesn't make their medication any better. So, before surgery, the patient is asked to list five difficult symptoms in order. For example, DBS is not a priority for patients with the most difficult sleep disorder. On the other hand, DBS helps them wake up from a lack of energy during sleep. We do not prioritize DBS for dementia patients, either.

Q: Can DBS prolong the effectiveness of drugs used by Parkinson's disease patients?

A: Yes. Some say surgery is necessary for patients who cannot see the effects of drugs, but they are only half right. That “drug doesn't work” means it works, but its duration continues to shorten. If the drug does not work at all, such patients are not subject to the consideration of DBS.

Parkinson's disease has various treatments but generally has a short half-life. With DBS, continuous electrical stimulation can keep the patient's condition as constant as possible. As a result, the patient feels better, even if the medication is down. However, there are cases where they don't feel a big change, even when medication time is over.

Q: What symptoms can be particularly effective with DBS?

A: Although it varies slightly depending on the surgical site, it is most effective for muscle stiffness, followed by tremors and slow motion. Walking disorders are less likely to be effective than other symptoms. Nevertheless, we recommended the procedure because patients are more likely to improve.

Q: How long do the effects of DBS surgery last?

A: The surgical effect itself lasts while the device is on. Sometimes, the device is removed due to the risk of inflammation or infection after surgery, and most of the removed patients want to have surgery again. Even if it seems ineffective, they feel there is a difference between the state without the device and the state in which it is present. DBS is not an operation to live “long” but one to live “well.”

Q: Do you see the need to improve situations while treating patients with Parkinson's disease?

A: It would be nice if an environment is created where we can see patients longer. It's a pity that there are many restrictions on treatment hours, even if I want to do more for patients. To see the patient for a long time, the act of seeing the patient must be prescribed. Prescriptions are now available up to four times a year. If the patient is not in good condition, we need to see him more often, but it takes work. In addition, patients who have received DBS need continuous control. Therefore, it is important to evaluate and calculate treatments properly and improve policy in this direction. Otherwise, even if new technologies are developed, they may be inapplicable to patients due to a lack of time.