By: Havshelet Schwartz, zap doctors reporter, 26/01/14

Parkinson's disease, or by its Hebrew name, tremor, is a disease in which there is degeneration of nerve cells in the nervous system, and as a result, various motor disorders occur such as slowing of movement, involuntary tremors, balance and walking disorders, and muscle stiffness. The disease is usually diagnosed after the age of 50 and its prevalence increases with age.

The causes of the development of Parkinson's disease combine genetic, environmental, age and behavioral factors. In the last decade, a huge worldwide research effort has been invested in understanding the causes of the disease in order to develop preventive treatments or those that will stop the rate of its progress. How is Parkinson's disease treated? Prof. Nir Giladi, the director of the Department of Neurology and the Center for the Diagnosis and Treatment of Parkinson's Disease at the Tel Aviv Medical Center, explains: "Today there is a wide variety of drug and non-drug treatments on the market, which have been proven to be effective in improving the motor function of Parkinson's patients. The treatment is given mainly through pills that improve mobility, relieve the stiffness of the muscles and reduce the tremors. Medicines are also used to improve the low mood characteristic of the disease, help sleep disorders, improve the ability to concentrate, memory and thinking, and even work to improve sexual function which is greatly affected by the disease. The drugs in question have an effect throughout the years of the disease, but over the years A partial resistance develops in the body, which requires in some patients the administration of a large number of drugs in frequent doses during the day. It is important to note that the effectiveness of the drugs is maintained throughout the many years of the disease and even in its advanced stages."

What are the new treatments available today for Parkinson's patients?

"These treatments try to bypass the sick stomach and ensure that effective amounts of medication are delivered to the brain. The new treatments include medications in a one-time injection or continuous instillation under the skin, a patch on the skin that slowly releases the medication throughout the day, as well as direct instillation through a pump and a special tube, directly into the intestine The trigger while bypassing the paralyzed stomach. The goal: improving the quality of life of the patients and maintaining maximum independence, mobility, clarity of mind and mood. Another direction that has developed in recent decades is a more invasive intervention in the brain by stimulating with electrodes or burning with sound waves the areas of the brain responsible for part from the movement disorders and this is in order to improve the quality of life of the patients. If in the past Parkinson's patients were confined to wheelchairs and in a nursing situation for years, today this image has completely changed and following the great revolution that has occurred in the effectiveness of treatment, we allow many patients 10-20 and more years of functional independence and quality of life Good. Apart from drug treatment, we found that the most effective treatment for preventing the disease as well as for slowing down its progression is physical activity. Physical activity slows down the progression of the disease through the release of important substances from the active muscle to the foreign body. from the blood and from there to the marrow. These substances influence the brain to create new nerve cells, new connections between the cells and even to create new blood vessels. Parkinson's patients who devote themselves to daily physical activity significantly alleviate their disease and significantly optimize their drug treatment."

What do you think will be the future generation of Parkinson's drugs?

"I assume that the future activity of new-generation Parkinson's drugs will be to slow down the rate of progression of the disease and not only to treat its symptoms, and perhaps even to vaccinate against it. Even today, the treatment of Parkinson's is very developing, and gives a lot of room for hope."

In addition to all these, these days an innovative treatment for Parkinson's was inaugurated at the Rambam Hospital, which is performed by burning an area of ​​the brain to relieve tremors.

Prof. Menashe Zaror, Director of the Department of Neurosurgery at Rambam, tells about the treatment of the symptoms of the disease: "Rambam Hospital formed a collaboration with the Israeli company Insitec, which created the 'Focus Ultrasound' facility which, in fact, treats the symptoms of Parkinson's by burning focused on the center of the tremor in the brain and this without the need to open the pulley but with the help of sound waves and navigation in the brain with the help of the MRI machine. This burning greatly relieves the tremor but does not help the other motor and non-motor signs of the disease."

How is the innovative surgery performed?

"The treatment itself is carried out for four hours, during which the patient lies in the MRI facility, without general or local anesthesia. The ultrasound waves are focused on a specific point in the brain (thalamus) that is responsible for the involuntary tremor phenomenon in Parkinson's disease. The heating of the point in the brain during an MRI examination creates a small scar in the thalamic nucleus and improves the tremor until it ceases. The treatment is also good for primary tremor symptoms that are not due to Parkinson's.

"The treatment itself is carried out in stages, and is monitored by a high-power MRI. The device informs the surgeon of the intensity of the heating in the brain and the cooling rate of the place where the burn is made. In this way and in the stages, the treatment progresses until the required final result. During the operation, there is communication with the patient who is neurologically examined and asked about his well-being one in ten During the treatment, the patient does not feel pain and lies comfortably.

"It is important to note," adds Prof. Zaror, "that Parkinson's disease itself does not have a treatment that solves it, but this innovative treatment can make the patient's life much easier. The tremor phenomenon greatly affected the quality of life of the Parkinson's patient, especially in the embarrassing social aspect of it."

Regarding the results of the treatment and the conclusions from it, Prof. Zaror explained that this innovative treatment already exists in Switzerland and around 140 experimental treatments and various neurological phenomena have been performed in the world. The results of the treatments were very good with a minimum of side effects. In Israel, the treatment only exists for a few weeks, but it will treat and help the feelings of many Parkinson's patients in the future.