Surgical Procedures for Parkinson’s Disease
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Several surgical procedures are available for the treatment of ]]>Parkinson’s disease]]>. None of them cure the disease. Rather, they may help relieve symptoms at least for a period of time.
During these surgical procedures, you will be sedated, but kept awake. This is important so that the surgeon can test various areas of the brain to avoid injuring normal tissue and to make sure that only abnormal tissue is handled during the procedure. You may be asked to describe sensations or to move parts of your body during the course of the procedure.
It is important to remember that not every person with Parkinson’s disease is a candidate for surgery. Your physician can help you get an expert opinion as to whether or not you are a good candidate for any of the procedures listed below.
Thalamotomy is a procedure in which part of the thalamus, an area of the brain involved in movement, is destroyed. Newer imaging techniques and a special frame that holds the patient's head in a fixed position have helped make thalamotomy more precise. Destruction of part of the thalamus is accomplished with either heat (delivered through an electrode) or gamma-knife radiosurgery.
Thalamotomy can help improve the tremors of Parkinson’s disease. It doesn’t appear to have much effect on other Parkinson symptoms. Patients who experience improvement often still have relief ten years after the procedure. This procedure is less commonly performed currently.
Pallidotomy is a procedure in which part of the globus pallidus, an area of the brain involved in movement, is destroyed. Newer imaging techniques and a special frame that holds the patient's head in a fixed position have helped make pallidotomy more precise. Destruction of the globus pallidus is accomplished with either heat (delivered through an electrode) or gamma-knife radiosurgery.
Pallidotomy can help improve many of the symptoms of Parkinson’s disease, including:
- Slowness of movement
- Shuffling walk
- Mask-like face
Patients may experience dramatic improvement after pallidotomy. Studies show that this improvement may be maintained for at least five years after the procedure is completed. Pallidotomy is not commonly done anymore.
Deep Brain Stimulation (Neurostimulation)
Thalamotomy and pallidotomy are not done as often anymore because they can cause side effects and complications. Deep brain stimulation is the more common treatment now.
In this technique, a stimulating electrode lead is placed into the subthalamic nucleus (just below the thalamus) or internal globus pallidus (part of the basal ganglia) to reduce symptoms of advanced Parkinson's disease. Or, it can be placed into the thalamus to reduce tremor. A wire is snaked out and attached to a generator that is implanted in the patient’s chest. A small, handheld magnet can be passed over the generator switch to turn it on and off.
When the device is activated, it sends an electrical impulse to its destination and acts as a kind of "brain pacemaker." Complications with the device may require additional surgery. Other potential adverse events include:
- Slurred speech
- Tingling in head and hands
- Problems with balance
The generator requires replacement every 3-5 years. Advantages of deep brain stimulation are that it is:
- Less invasive than thalamotomy and pallidotomy
- Potentially reversible (rather than causing irreversible tissue damage)
The risk of infection or breakage of the electrical leads is higher, though, because of the implanted device.
Research is underway to study the effects of dopamine-producing tissue implanted into the part of the brain responsible for the symptoms of Parkinson’s disease. The sources of the tissue currently being tested are fetal brain tissue and fetal pig tissue. These procedures are somewhat controversial and require further testing.
American Association of Neurological Surgeons website. Available at: http://www.aans.org/ .
Conn HF, Rakel RE. Conn’s Current Therapy 2002. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Herzog J, Volkmann J, Krack P, et al. Two-year follow-up of subthalamic deep brain stimulation in Parkinson's disease. Mov Disord. 2003;18:1332-1337.
Kumar R, Lozano AM, Sime E, and Lang AE. Long-term follow-up of thalamic deep brain stimulation for essential and Parkinsonian tremor. Neurology. 2003;61:1601-1604.
National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ .
Parkinson's disease. Medtronic website. Available at: http://www.medtronic.com.
Parkinson’s Disease Foundation website. Available at: http://www.pdf.org/ .
Putzke JD, Wharen RE, Wszolek ZK, et al. Thalamic deep brain stimulation for tremor-predominant Parkinson's disease. Parkinsonism Relat Disord. 2003;10:81-88.
Last reviewed February 2009 by ]]> Rimas Lukas, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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