Parkinson's disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Deep brain stimulation: Deep brain stimulation in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. Thalamotomy and pallidotomy: Unilateral pallidotomy can reduce dyskinesia, on and off fluctuations, tremor, rigidity, bradykinesia and gait problems but it is not as effective as DBS.
Subthalamotomy: unilateral subthalamotomy is useful in managing PD symptoms.
Indications
- Surgery is not the first-line treatment option for patients with Parkinson's disease. Surgery is usually reserved for patients with drug complications or sever disease.
Surgery
- Deep brain stimulation: Deep brain stimulation in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. DBS of subthalamic nucleus or globus pallidus interna have a better outcome in comparison to medication only. The most serious complication of this treatment is fatal intracerebral hemorrhage.[1][2][3]
- Thalamotomy and pallidotomy: Unilateral pallidotomy can reduce dyskinesia, on and off fluctuations, tremor, rigidity, bradykinesia and gait problems but it is not as effective as DBS.[4][5][6][7] bilateral pallidotomy can cause permanent pseudobulbar speech and swallowing problems.[5]
- Subthalamotomy: unilateral subthalamotomy is useful in managing PD symptoms.[8] the side effect of this surgery is that it can cause contralateral dyskinesia which may resolve after 4 to 12 weeks.[9]
References
- ↑ Fasano A, Daniele A, Albanese A (May 2012). "Treatment of motor and non-motor features of Parkinson's disease with deep brain stimulation". Lancet Neurol. 11 (5): 429–42. doi:10.1016/S1474-4422(12)70049-2. PMID 22516078.
- ↑ Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD (January 2009). "Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial". JAMA. 301 (1): 63–73. doi:10.1001/jama.2008.929. PMC 2814800. PMID 19126811.
- ↑ Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J (August 2006). "A randomized trial of deep-brain stimulation for Parkinson's disease". N. Engl. J. Med. 355 (9): 896–908. doi:10.1056/NEJMoa060281. PMID 16943402.
- ↑ Esselink RA, de Bie RM, de Haan RJ, Lenders MW, Nijssen PC, Staal MJ, Smeding HM, Schuurman PR, Bosch DA, Speelman JD (January 2004). "Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial". Neurology. 62 (2): 201–7. PMID 14745054.
- ↑ 5.0 5.1 Hallett M, Litvan I (Decemb
er 1999). "Evaluation of surgery for Parkinson's disease: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The Task Force on Surgery for Parkinson's Disease". Neurology. 53 (9): 1910–21. PMID 10599758. line feed character in
|date=at position 7 (help); Check date values in:|date=(help) - ↑ Lai EC, Jankovic J, Krauss JK, Ondo WG, Grossman RG (October 2000). "Long-term efficacy of posteroventral pallidotomy in the treatment of Parkinson's disease". Neurology. 55 (8): 1218–22. PMID 11071505.
- ↑ Vitek JL, Bakay RA, Freeman A, Evatt M, Green J, McDonald W, Haber M, Barnhart H, Wahlay N, Triche S, Mewes K, Chockkan V, Zhang JY, DeLong MR (May 2003). "Randomized trial of pallidotomy versus medical therapy for Parkinson's disease". Ann. Neurol. 53 (5): 558–69. doi:10.1002/ana.10517. PMID 12730989.
- ↑ Tarsy D (September 2009). "Does subthalamotomy have a place in the treatment of Parkinson's disease?". J. Neurol. Neurosurg. Psychiatry. 80 (9): 939–40. doi:10.1136/jnnp.2008.163949. PMID 19684228.
- ↑ Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA (September 2009). "Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months". J. Neurol. Neurosurg. Psychiatry. 80 (9): 979–85. doi:10.1136/jnnp.2008.154948. PMID 19204026.