Parkinson: depression therapy is effective for the disease – 04/11/2024 – Balance and Health

Parkinson’s symptoms in Carlos Alberto Palheta, 41, began just under four years ago. A resident of Parauapebas, a city 721 km from Belém, in Pará, he felt stiffness in his cervical spine and, later, he also started to feel it on the right side of his lip.

Six months ago, Carlos Alberto began treatment with a non-invasive neuromodulation technique called transcranial magnetic stimulation, proven to be effective against depression, but which has recently attracted attention due to its results in patients with the disease. Parkinson’s causes the degradation of neurons that produce a substance called dopamine, important for movements and emotions.

This treatment involves stimulating areas in the brain that control speech and movement, which are affected by the disease. With equipment on the patient’s scalp, without surgical intervention, it is possible to map and stimulate areas that are dysfunctional.

Studies still need to evaluate whether there is an improvement in the quality of life in patients with the disease, but analyzes already point to the effectiveness of transcranial magnetic stimulation in improving the daily activities of people with the disease.

“Neuromodulation greatly improved my gait and speech. I couldn’t get up from the chair”, says Carlos, after undergoing 15 treatment sessions. Associated with this, he does physical exercises and physiotherapy regularly and takes medications such as Prolopa and Sifrole, indicated for the disease.

Access to the technique, however, is hampered by high prices — between R$750 and R$1500 per session — and the low dissemination of the practice. Carlos must come to São Paulo every 6 months to undergo treatment, which is unavailable in the SUS (Unified Health System). Your health plan denied reimbursement, claiming that the treatment is not included in the ANS (National Supplementary Health Agency) list.

Maintaining the entire treatment together has been expensive for the patient. “I have a degree in administration and I have always saved a lot. I can do so because I have an emergency fund and my colleagues at the company organized a fundraiser to help me”, he says.

Health professionals are working to include the technique in the public system. PL (bill) 5376/2023, authored by deputy Maria Rosas (Republicans), is being processed by the Health Committee of the Chamber of Deputies and calls for the inclusion of neuromodulation in the list of SUS procedures.

The PL was written in partnership with neuroscientist Carolina Souza, who is part of the movement disorders group at Hospital das Clínicas, USP Faculty of Medicine. “The stimulus enhances what we call neuroplasticity [capacidade que o cérebro tem de aprender e se reprogramar]. Stimulation modulates brain activity and activates neurons that are less active due to the disease. It would be wonderful if it were available on the SUS”, she says.

According to experts, the technique should be applied in association with conventional therapies, such as physiotherapy and speech therapy, essential activities for patients with the disease.

For physiotherapist Erica Tardelli, current president of the NGO Associação Brasil Parkinson, the biggest problem lies in the fact that it is rare to even find professionals in these categories in the SUS who are specialized in Parkinson’s.

“Here in São Paulo, patients still find some rehabilitation, it is difficult, but they do. But in other places, the obligation of speech therapists for Parkinson’s is not even regulated, and the evolution of the disease includes difficulty swallowing. In these cases, the “A patient can have bronchoaspiration and the food goes into the lungs. It’s important that we discuss the incorporation of new treatments, but many patients don’t have the basics,” he says.

In speech therapy, a globally recognized treatment for Parkinson’s is the Lee Silverman method, aimed at speech rehabilitation. The disease causes muscle weakness and can cause hoarseness and reduced speech speed. Therapy is also not offered by the public system.

Despite the limitations, today, the SUS offers neurological health care, through the National Policy for Care for Patients with Neurological Diseases. There are some therapies available for Parkinson’s, such as deep brain stimulation surgery (DBS), indicated for moderate cases of the disease.

The surgical procedure consists of implanting a type of pacemaker in the brain to reduce motor symptoms, such as tremors, stiffness and difficulty walking. A battery powers the electrode and, after a few years, the device, if it is not rechargeable, must be changed. The patient must also be monitored every three months to adjust the device.

Although the mainstay for treating the disease today are still oral substances, it is important that they are associated with adjuvant therapies such as these, says neurologist specializing in Parkinson’s, Sara Casagrande.

“The medicine that would be most effective would be levodopa, available on the SUS, which actually turns into dopamine in the brain. The problem is that, today, it doesn’t last very long. The person has to take it three times a day and, as time goes by, time, it lasts less and less and the patient starts having to take it every two, three hours, as the disease progresses. It also doesn’t work well if taken with food and has side effects, such as involuntary movements in the body”, he states.

It is still expected that a medicine applied subcutaneously, already available in the United Kingdom, will arrive in Brazil next year, which releases the substance 24 hours a day, in a similar way to an insulin pump for diabetics.