‌Preoperative Evaluation and Postoperative Maintenance for Parkinson’s Patients

Parkinson’s disease is a chronic condition that rarely resolves spontaneously. While progression may temporarily halt or rapidly advance to severe disability within years, most patients retain some capacity to work post-diagnosis. In advanced stages, systemic rigidity often confines patients to bed, ultimately leading to fatal complications.

‌Pharmacotherapy and Surgical Interventions‌

During early stages, medications such as Madopar and Selegiline provide symptom relief for many patients. However, approximately 15% remain unresponsive to drugs, and long-term use often diminishes efficacy while triggering side effects like dyskinesia and the on-off phenomenon. Consequently, surgical approaches, notably ‌Deep Brain Stimulation (DBS)‌, have regained prominence. DBS involves implanting a pulse generator (IPG) to deliver electrical impulses to specific brain regions, modulating aberrant neural signals responsible for tremors, rigidity, and akinesia.

‌Preoperative Assessment‌

A rigorous preoperative evaluation is critical for DBS candidacy. Specialists employ tools like the Webster Scale and UPDRS to quantify symptom severity. A ‌Madopar challenge test‌ is conducted 48 hours pre-surgery: patients are scored at peak symptom severity after withdrawal, then re-evaluated post-administration of 1.5x their standard dose. The percentage difference between scores predicts DBS efficacy. Patients must discontinue medications preoperatively (beyond the drug’s half-life) to optimize intraoperative and postoperative parameter adjustments.

‌Surgical Precision and Postoperative Programming‌

Accurate ‌target localization‌ is paramount. Surgeons combine imaging, stereotactic anatomy, and electrophysiological mapping—using microelectrode impedance and bio-signal variations—to pinpoint electrode placement. Intraoperative stimulation tests further refine positioning.

Postoperatively, ‌programming the IPG‌ demands expertise to balance symptom control, side-effect minimization, and battery longevity. Initial activation occurs one month post-surgery, allowing microlesion effects to subside. Improvements in rigidity and off-period dystonia may manifest within seconds, while dyskinesias require weeks to months to stabilize. Regular follow-ups and patient-provider communication ensure optimal outcomes.

‌Postoperative Guidelines‌

1. ‌Medication Management‌: Continue prescribed drugs under medical supervision, prioritizing long-acting or extended-release formulations. Avoid premature dosage reduction.
2. ‌Activity Restrictions‌: Limit strenuous exercise to prevent device-tissue friction and infection.
3. ‌MRI Precautions‌: Consult specialists before undergoing MRI; avoid high-magnetic fields.
4. ‌Device Care‌: Maintain distance from household electronics; avoid concurrent use of pacemakers or defibrillators unless critical.
5. ‌Battery Optimization‌: Follow clinician instructions for device activation/deactivation to preserve battery life.