Parkinson�s Disease � Surgical Treatment

Types of Surgery

The two surgical procedures employed in the treatment of Parkinson's disease are lesioning and deep brain stimulation

There are two surgical procedures - lesioning and deep brain stimulation - and three target locations in PD surgery: Thalamus, Globus pallidum internus, and Subthalamic Nucleus.

1. Lesion procedures destroy areas of brain that maybe responsible for the symptoms. In this procedure a radio-frequency energy is delivered to heat and ablate (destroy) a pea-sized region within the brain,where there is abnormal activity related to the movement problems.

In a surgical technique called pallidotomy, an electric probe is employed to destroy a hyperactive small portion of the brain called Globus pallidus that is believed to generate the symptoms of Parkinson's disease.

A thalamotomy on the other hand is the removal of the thalamus region of the brain which is responsible for involuntary movements. This type of surgery is a rarity and is usually employed as a last resort for patients whose disease is debilitating. However, the procedure does not help to alleviate other symptoms of Parkinson's disease.

2. Deep brain stimulation (DBS) is a novel alternative surgical technique and uses implanted electrodes to stimulate minute regions of the brain. These electrodes blocks the brain waves that creates uncontrollable movements creating the same effect as a lesion but without destroying the region of the brain.

The effect lasts as long as the stimulation continues, but ceases when it is shut off. This procedure must be continued lifelong. It is especially useful in patients that have severe symptoms such as tremor, involuntary movements (dyskinesia), and problems with gait.