Surgery for Parkinson's Disease
What is the current status of the subthalamotomy and pallidotomy in the treatment of Parkinson's disease? What are the leading centers for such research and treatment?
Ablative surgery of the globus pallidus (pallidotomy) was performed more often in the past. It was excellent for decreasing levodopa-induced dyskinesias, but surgical complications, including mild stroke or damage to brain tissues, sometimes occurred. Ablative surgery of the subthalamus (subthalamotomy) has not been performed in the United States.
Most surgery now done for advanced Parkinson's disease (PD) is deep brain stimulation (DBS) of the subthalamus. This procedure is highly effective for reducing all the motor symptoms of PD, and the dose of PD medications can often be lowered, which results in a reduction of dyskinesias. DBS is now the procedure of choice in most areas of the world. The results observed with this procedure have proven to be long-lasting and now have 10 years of follow-up. DBS has 2 distinct advantages: It does not destroy brain tissue and the amount of stimulation can be adjusted. There are many medical centers performing this surgery, such as Mt. Sinai and Columbia in New York City; Emory in Atlanta, Georgia; Rush-St.Luke's in Chicago, Illinois; University of Kansas Medical Center, and others.
What is the current status of the subthalamotomy and pallidotomy in the treatment of Parkinson's disease? What are the leading centers for such research and treatment?
Ablative surgery of the globus pallidus (pallidotomy) was performed more often in the past. It was excellent for decreasing levodopa-induced dyskinesias, but surgical complications, including mild stroke or damage to brain tissues, sometimes occurred. Ablative surgery of the subthalamus (subthalamotomy) has not been performed in the United States.
Most surgery now done for advanced Parkinson's disease (PD) is deep brain stimulation (DBS) of the subthalamus. This procedure is highly effective for reducing all the motor symptoms of PD, and the dose of PD medications can often be lowered, which results in a reduction of dyskinesias. DBS is now the procedure of choice in most areas of the world. The results observed with this procedure have proven to be long-lasting and now have 10 years of follow-up. DBS has 2 distinct advantages: It does not destroy brain tissue and the amount of stimulation can be adjusted. There are many medical centers performing this surgery, such as Mt. Sinai and Columbia in New York City; Emory in Atlanta, Georgia; Rush-St.Luke's in Chicago, Illinois; University of Kansas Medical Center, and others.
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