Stage 1 of Parkinson’s Disease (Mild)

• Symptoms are mild and may only affect one side.
• Daily functioning is not impaired although tremors create difficulty.
• Slightly evident changes in balance, posture, movement and facial expression.

Stage 2 of Parkinson’s Disease (Moderate)

• Symptoms are bilateral – affecting both sides.
• Mild difficulty in movement – walking, balance and posture.
• Impairment in completing daily physical activities.

Stage 3 of Parkinson’s Disease (Difficult)

• Difficulty in maintaining balance and posture.
• Impairment of walking or standing although sufferer is usually able to do so independently.
• Physical movements are noticeably slow.

Stage 4 of Parkinson’s Disease (Severe)

• Unable to maintain balance or posture.
• Instability when walking or standing and requires assistance.
• Tremors usually reduce in this stage although independent completion of daily physical tasks is usually not possible.

Stage 5 of Parkinson’s Disease (Advanced)

• Almost complete inability to function independently.
• Walking or standing usually not possible.
• Constant attention and nursing care required.
• Confusion, dementia and other mental disturbances may occur in some cases.

Differentiating stages of Parkinson’s varies among cases, with certain individuals showing signs of two stages simultaneously. Therefore the guideline is intended to outline and identify the progression of the disease in accordance with level of functioning rather than the onset of symptoms of Parkinson’s disease. In certain cases, a Parkinson’s sufferer may skip the first two stages especially if the condition was not being monitored closely. However the slow progression of Parkinson’s disease means that the shift to the latter stages does not occur overnight and may be delayed with effective treatment.

Dexterity and coordination are the primary factors for daily functioning in the life of a Parkinson’s sufferer. Changes in either factor may affect individual Parkinson’s sufferers to varying degrees with some coping better than others. However with time, the level of dexterity and coordination is sufficiently impaired to render Parkinson’s disease sufferers incapable of taking care of themselves.

When medication has ceased to be effective or the side effects from them have become no longer tolerable, surgery might be an option your Doctor will consider and advise to help alleviate your symptoms and improve your quality of life. However not all sufferers of Parkinson’s will be a candidate for surgery, an example would be a person who didn’t respond very well to Levodopa treatment.

Of all the people suffering from this disease it is thought that only around 10% of them could be classed as possible suitable candidates for surgery. Another factor to consider when thinking of surgery is that while improvements could be gained there is also the risk factor to take into account that surgery of any kind has.

There is also the risk that the surgery might not make any improvements and could in fact make the symptoms worse. There are three main types of surgery which can be used in the treatment of Parkinson’s disease; these are ablative, stimulation, deep brain stimulation, transplantation and restorative surgeries.

Ablative surgery

This type of surgery aims to locate, target and then destroy the defined area of the brain which is affected by the disease. The aim is get rid of all the tissue which produces the abnormal electrical or chemical impulses which in turn produce the symptoms of tremor in the patient.

This type of surgery is performed by inserting an electrode into the part of the brain affected by the disease; this method is often very difficult to guess correctly for if too much tissue is taken then it could lead to stroke or paralysis while if too little is taken the tremor might not be eliminated or could return.

The patient will remain awake during this procedure with a local anaesthetic being given to dull the feeling in the outer part of the brain. The brain itself cannot feel pain so it can be probed without any discomfort to the patient.

Deep brain stimulation

This type of surgery specifically targets the subthalamic nucleus; it is a part which is extremely difficult to reach and is found below the thalamus. This type of surgery doesn’t destroy tissue but instead renders it inactive.

An electrode is connected via a wire which is inserted below the skin and attached to a stimulator and battery pack in the patient’s chest. The operation is totally reversible and the risk of stroke is reduced and allows for more precise control of symptoms.

Transplantation or restorative surgery

This type of surgery relies on the implantation of dopamine producing cells being implanted directly into the striatum. Cells used for this process are taken from a variety of sources which include the patients own body, human embryos and pig embryos.