PdCure.org

  Providing resources and ideas for therapies and medical developments for Parkinson's disease:

 

Surgical Treatments for Parkinson's Disease:

The following are surgical options available for Parkinson's patients. None are cures, nor do they halt the progression of the disease but they do address the symptoms and can supplement pharmaceutical therapies.

Deep Brain Stimulation (DBS):

This surgical procedure embeds wires deep into the brain to connect an electrical power source to provide impulses to activate two basal ganglia regions of the brain (thalamus, subthalamic nucleus or globus pallidus) to improve motor symptoms such as tremors and dyskinesia. Inserting and targeting of the wire electrodes is planed using an magnetic resonance imaging (MRI) scan along with recordings of regions of the brain thought to be causing the problems. The impulse generator (neurostimulator) and battery are surgically implanted (typically under the collar bone or in the abdomen) as well. A controller is available to the patient so that it can be turned on or off. This surgery is typically reserved for those with advanced progression of Parkinson's Disease whose symptoms cannot be adequately controlled with medications. Deep Brain Stimulation (DBS) treats the patient by interrupting problematic electrical brain signals from the targeted area of the brain that are causing Parkinson's symptoms such as tremors. A successful surgery is usually followed by a reduction of medication and the medication side-effects.

There are two DBS brain target options which are referred to as:
  • STN DBS: Subthalamic Nucleus Deep Brain Stimulation (more common - bilateral) more medication reduction, less‐frequent battery changes, improvements in rigidity
  • GPI DBS: Globus Pallidus Internus Deep Brain Stimulation - more‐robust dyskinesia suppression, easier programming, and greater flexibility in adjusting medications

Both regions are equally effective at tremor suppression. The GPI is the larger of the two brain regions (450mm3 vs 150mm3) requiring more power to stimulate but is an easier target for the surgeon, when installing lead wires, with a smaller chance of error. There can be unintended effects and behavioral changes when neighboring regions are accidentaly stimulated. For each target region there are two additional options, unilateral or bilateral.

Also see Subthalamic Nucleus Versus Globus Pallidus Internus Deep Brain Stimulation: Translating the Rematch Into Clinical Practice (2014)

DBS Vendors: Support Equipment Vendors:

Pallidotomy:

Pallidotomy surgery seeks to damage an overactive globus pallidus to lessen the symptoms of Parkinson's disease (tremor, bradykinesia, and balance problems).

Thalamotomy:

Pallidotomy surgery seeks to damage an overactive thalamus to control the brain signals causing tremors. It is not often recommended for Parkinson's as it only affects tremors.

Brain surgery drill guide

Pros:
  • Potential to alleviate Parkinson's symptoms and reduce medication, thus reducing the side-effects of the medication (typically LDOPA dyskinesia and hallucinations).

Cons:
  • Brain surgery has risk for infection, hemorrhaging, etc