Intervistatore: Si trova bene con la pompa o è [...] troppo grande?
Alma H.: Mi sono abituata alla pompa.
Intervistatore: Ah, ci si è abituati. Ma all'inizio l'hai trovato troppo grande?
Alma H.: Sì.

Una questione di abitudine

Intervieweuse : Es-tu à l'aise avec la pompe ou est-elle [...] trop grande ?
Alma H. : Je me suis habituée à la pompe.
Intervieweuse : Ah, tu t'es habituée [à la pompe]. Mais est-ce que tu l'as trouvée trop grande au début ?
Alma H. : Oui.

Une question d'habitude

Interviewerin: Bist du bequem mit der Pumpe oder ist sie [...] zu gross? 
Alma H.: Ich habe mich an die Pumpe gewöhnt. 
Interviewerin: Ah, du hast dich daran gewöhnt. Aber hast du das am Anfang zu gross gefunden? 
Alma H.: Ja.

Gewöhnungssache

Yolanda

Interviewer: Are you comfortable with the pump or is it [...] too big?
Alma H.: I have got used to the pump.
Interviewer: Ah, you got used to it. But did you find it too big at the beginning?
Alma H.: Yes.

A matter of getting used to

The operation of the Duodopa® pump is carried out by the patient or caregivers, depending on the possibility and the patient's condition. A cassette with Duodopa® (levodopa-carbidopa gel) is connected to the pump device in the morning. The flow rate of the continuously administered dose, the infusion duration throughout the day and the dose of the extra doses can be individually set and adjusted. Finding the optimal setting can be a challenging task, especially for relatives. In order to avoid inflammation, the tube leading to the pump must be cleaned (rinsed) regularly. This is also done either by relatives or by the patients themselves, depending on their possibilities and condition. The pump itself is also perceived as annoying due to its size and weight, but it is also reported that this is a matter of getting used to it.

The device

Parkinson's disease is a progressive neurodegenerative disease affecting both the central and peripheral nervous system. Symptoms are very heterogenous and include motor (e.g., tremor, slow movements, muscle rigidity) and non-motor symptoms (e.g., depression, sleep disturbances, anosmia). Parkinson's disease can lead to a loss of autonomy and self-esteem, altered relationships and social isolation.Communication impairment is also common and is associated with both motor and cognitive disturbances. Many people who suffer from Parkinson's disease increasingly lose their ability to work and their mobility is more and more restricted. Parkinson's disease is a challenge not only for the patients, but also for family caregivers, who must balance their own needs with caregiving responsibilities. Two important treatment options for Parkinson's disease in the advanced stage are deep brain stimulation and the Duodopa® pump. Deep brain stimulation is a brain modulation technique that works like a heart pacemaker and requires neurosurgical intervention. The Duodopa® pump consists of a continuous infusion of levodopa-carbidopa gel via a pump across the intestinal wall into the intestine.
For the DIPEx module on Parkinson's, we conducted 32 interviews with people with Parkinson's disease and family caregivers. Interview excerpts in the form of texts, video or audio clips, as well as drawings, make it possible to experience how the disease and its therapy affect the daily lives of those affected and their relatives.

La malattia di Parkinson è una malattia neurodegenerativa progressiva che colpisce il sistema nervoso centrale e periferico. I sintomi sono vari e comprendono sintomi motori (ad esempio tremore, movimenti lenti, rigidità muscolare) e non motori (ad esempio depressione, disturbi del sonno, anosmia). Il morbo di Parkinson può comportare una perdita di autonomia e di autostima, alterazione delle relazioni e isolamento sociale. Anche i disturbi della comunicazione sono comuni e sono associati a disturbi motori e cognitivi. Molte persone con malattia di Parkinson sono sempre più limitate nella loro capacità di lavorare e nella loro mobilità con il progredire della malattia. La malattia di Parkinson rappresenta una sfida non solo per la persona affetta, ma anche per i familiari che la assistono e che devono trovare un equilibrio tra le proprie esigenze e quelle del paziente.
Due importanti trattamenti clinici attuali per la malattia di Parkinson avanzata sono la stimolazione cerebrale profonda e la pompa Duodopa®. La stimolazione cerebrale profonda è una tecnica di modulazione dell'attività cerebrale che funziona in modo simile a un pacemaker e richiede un intervento neurochirurgico. Con la pompa Duodopa® , un'infusione continua di un gel di levodopa-carbidopa viene erogata tramite una pompa attraverso la parete intestinale nell'intestino tenue.
Per il modulo DIPEx sulla malattia di Parkinson, abbiamo condotto interviste con 32 persone affette da Parkinson in fase avanzata e con i loro familiari. Gli estratti delle interviste, sotto forma di testi, video o clip audio e disegni, mostrano come la malattia e la sua terapia influenzino la vita quotidiana delle persone colpite e dei loro familiari.

Malattia di Parkinson: stimolazione cerebrale profonda e pompa Duodopa

La maladie de Parkinson est une maladie neurodégénérative progressive touchant plusieurs régions du système nerveux central et périphérique. Les symptômes divers comprennent des symptômes moteurs (p. ex. tremblements, mouvements lents, rigidité) et non moteurs (p. ex. dépression, troubles du sommeil, anosmie). La maladie de Parkinson peut entraîner une perte d'autonomie et d'estime de soi, une modification des relations et un isolement social. Les difficultés de communication sont également fréquentes et sont associés à la fois aux troubles moteurs et cognitifs. De nombreuses personnes atteintes de la maladie de Parkinson se voient restreintes dans leur mesure de travailler ainsi que dans leur mobilité au fur et à mesure que la maladie progresse. La maladie de Parkinson présente un défi non seulement pour les patient·e·s, mais aussi pour les proches aidants, qui doivent concilier leurs propres besoins et leurs responsabilités en matière de soins. Pour les formes graves de la maladie de Parkinson, les deux principaux traitements sont actuellement la stimulation cérébrale profonde et la pompe Duodopa®. La stimulation cérébrale profonde consiste à moduler l'activité cérérbrale tel le ferait un pacemaker pour le cerveau, impliquant une intervention neurochirurgicale. La pompe Duodopa® consiste en une perfusion intrajunale continue de gel de lévodopa-carbidopa via une pompe traversant la paroi intestinale.
Le module DIPEx sur la maladie de Parkinson rapporte les expériences de 32 personnes qui soit sont atteintes de la maladie de Parkinson et ont été traitées par stimulation cérébrale profonde ou par la pompe Duodopa®, soit sont des proches aidants. Des extraits d'entretiens sous forme de texte, de vidéo ou de clip audio, ainsi que des dessins donnent un aperçu de la façon dont la maladie et son traitement affectent le quotidien des personnes atteintes de la maladie de Parkinson ainsi que celui de leurs proches.

Maladie de Parkinson : stimulation cérébrale profonde et pompe Duodopa

Morbus Parkinson ist eine fortschreitende neurodegenerative Erkrankung, die das zentrale und periphere Nervensystem betrifft. Die Symptome sind vielfältig und umfassen motorische (z.B. Tremor, langsame Bewegungen, Muskelstarre) und nicht-motorische Symptome (z. B. Depression, Schlafstörungen, Anosmie). Morbus Parkinson kann zu einem Verlust an Autonomie und Selbstwertgefühl, veränderten Beziehungen und sozialer Isolation führen. Kommunikationsstörungen sind ebenfalls häufig und sowohl mit motorischen als auch mit kognitiven Störungen verbunden. Viele Menschen mit Parkinson sind im Verlauf der Krankheit zunehmend in ihrer Arbeitsfähigkeit und ihrer Mobilität eingeschränkt. Eine Parkinson-Erkrankung ist nicht nur für die Betroffenen selbst eine Herausforderung, sondern auch für betreuende Angehörige, die ein Gleichgewicht zwischen eigenen Bedürfnissen und den Bedürfnissen der Patienten finden müssen.
Zwei wichtige aktuelle klinische Behandlungen der fortgeschrittenen Parkinson-Krankheit sind die tiefe Hirnstimulation und die Duodopa®-Pumpe. Die tiefe Hirnstimulation ist eine Technik zur Modulation der Hirnaktivität, die ähnlich wie ein Herzschrittmacher funktioniert und eine neurochirurgische Intervention voraussetzt. Bei der Duodopa®-Pumpe erfolgt eine kontinuierliche Infusion eines Levodopa-Carbidopa-Gels via eine Pumpe über die Darmwand in den Dünndarm.
Für das DIPEx Modul zu Parkinson haben wir Interviews mit 32  Menschen, die in einem fortgeschrittenen Stadium an Parkinson erkrankt sind und betreuenden Familienangehörigen geführt. In Interviewausschnitten wird in Form von Texten, Video- oder Audioclips sowie anhand von Zeichnungen erfahrbar, wie sich die Krankheit und deren Therapie auf das tägliche Leben der Betroffenen und deren Angehörigen auswirkt.

Parkinson-Erkrankung: Tiefenhirnstimulation und Duodopa-Pumpe

Parkinson's disease: deep brain stimulation and duodopa pump

Kristina

Alma H. feels labeled after her treating physician refers her to a psychiatrist for her symptoms.

Some doctors have labeled me. They told me I should see a psychologist or a psychiatrist, that I had nothing. Then I said, "It can't be. I can't sweep the whole thing under the rug. I do make mistakes, but not that many."

Referral to the psychiatrist

The diagnosis of Parkinson's disease is made on the basis of the neurological examination findings and, if necessary, by means of imaging procedures (e.g. SPECT). A positive L-dopa test also indicates a typical Parkinson's disease. For those affected, the path from noticing the first signs to an official diagnosis of Parkinson's varies. Although, according to the literature, the first formulated diagnosis is correct in the majority of cases, patients and relatives in the early stages of the disease also report medical misjudgements, misdiagnoses and mistreatments. A prolonged uncertainty about the cause of the symptoms is experienced as difficult and the receipt of the diagnosis of PD on the one hand as devastating, but on the other hand also as a relief that there is clarity. Disputes with cost units about the assumption of diagnostic examinations are also reported.

The path to diagnosis

After the pills stopped working well, Alma H. was recommended treatment with the Duodopa® pump.

Alma H.: Then I only had pills, yes.
Interviewer: Okay. But the pills no longer worked well?
Alma H.: No, they no longer worked well.
Interviewer: And that's why you got the pump?
Alma H.: Yes, exactly.
[..]
Interviewer: why did you choose the Duodopa® pump?
Alma H.: [...] It was recommended to me.

Doctor's recommendation

Medical reasons for treatment with the Duodopa® pump are usually related to a decrease in the effect of the medication taken and are based on a doctor's recommendation. Among the personal reasons for deciding on treatment with the Duodopa® pump, patients and relatives also draw comparisons with deep brain stimulation. The less invasive nature of treatment with the Duodopa® pump also plays a decisive role here.

Decision making

Alma H. has more over-movements since she got the Duodopa® pump.

Alma H.: Over-movement, over-movement, over-movement.
Interviewer: Overmovement. But less or more?
Alma H.: More, more.
Interviewer: More than before the pump?
Alma H.: Yes, yes.

Excessive movements

After starting treatment with the Duodopa® pump, patients report improvements in Parkinson's symptoms. Among other things, the decrease in blockages, the improvement in mobility and the disappearance of tremors are mentioned. The fact that treatment with the pump often eliminates the need to take medication is experienced as a great relief in everyday life. However, side effects are also described, such as an increase in over-movement.

Alma H.

A matter of getting used to

Related experiences

Other experiences by Alma H.

Alma H.