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.

Deep brain stimulation is a surgical procedure which can help greatly with the symptoms most commonly associated with Parkinson’s disease such as rigidity, stiffness, slowed movement and problems with walking and movement. However deep brain stimulation at the present is only an option for those sufferers whose medication doesn’t adequately control their symptoms.

What’s involved with deep brain stimulation?

The surgery is performed by inserting a battery operated device which is called a neurostimulator, the stimulator then sends out pulses to targeted areas of the brain that control the patients movement. This in turn blocks the abnormal brain signals which cause the tremors commonly associated with Parkinson’s disease.

Before the surgery can be performed the neurosurgeon will perform an MRI scan to determine the area within the brain where nerve signals generate the symptoms of Parkinson’s. The areas which are generally targeted are the thalamus, subthalamic nucleus and the globus pallidus.

The entire system used for the stimulation consists of three major parts the lead or electrode, the extension and the neurotransmitter itself. A small opening in the skull is made and then the electrode is inserted and implanted into the brain, with the tip of the electrode positioned within the targeted area of the brain.

The extension is then passed just underneath the skin of the neck, head and shoulder and attached to the neurostimulator. The neurostimulator which is the source of energy or the battery pack is then located under the skin near to the collar bone, or in some cases in the chest.

Having made sure the entire system is in place electrical impulses are then sent from the neurostimulator along the extension and lead up to the brain. These impulses then block the signals that cause the symptoms of Parkinson’s disease.

What is the prognosis?

Many patients who have undergone the surgery do say that their symptoms are considerably reduced and while they can significantly reduce the amount of medication needed they still need to take it. The actual amount of reduction varies greatly from person to person but all have said it has been a considerable amount.

Research

Currently research is continuing in deep brain stimulation to determine its reliability, safety and effectiveness as a treatment for Parkinson’s disease. Scientists are in particular studying the areas of the brain where the surgery would be most effective in the reducing symptoms.