Parkinson’s Disease – Surgical Options

Surgery is mainly used to treat patients whose Parkinson’s symptoms cannot be managed by different classes of medications. While surgical treatment can help people control movement-related symptoms, they cannot be completely cured. In some cases, even after the surgery, treated patient has to take life-long medication to manage the condition. Since different PD fighters have different symptoms and severity levels, not every person with Parkinson’s is a good candidate for surgery. As per an estimate, only about 10% of Parkinson’s patients are suitable candidates for this Parkinson’s treatment approach.

Currently, the most used surgical treatment for Parkinson’s is Deep Brain Stimulation. Other less popular surgical methods for Parkinson’s include Thalamotomy, Pallidotomy, and Subthalamotomy. These surgeries are carried out on structures within the brain such as the Thalamus, the Globus Pallidus and the Subthalamic Nucleus that are responsible for the modification of movements.

1. Deep Brain Stimulation

In Deep Brain Stimulation (DBS) method, a medical device called a Neurostimulator is inserted into a targeted area of patient’s brain that control movement.  The device delivers electrical stimulation in the areas of the brain and blocks the abnormal nerve signals that cause tremor, speech changes, and medication-induced Dyskinesias. The benefits of the surgery last for at least five years, however, it does not cure or slow the PD progression. Like any other brain surgery, DBS involves a minor risk of stroke, infection, brain bleeding or seizures.

2. Thalamotomy

In this kind of brain surgery, the thalamus, a tiny area of the brain that controls some involuntary movements, is destroyed. In order to identify the precise location of the thalamus, detailed CT scans or MRI of the brain is suggested before surgery. If a person has the tremor in his right hand, then his left side of the brain will be treated or vice versa. Performing the procedure on the both side of the brain increases the risk of speech and cognitive problems post-surgery. The patient remains awake during the surgery.

3. Pallidotomy

It is found that a part of the brain, called the Globus Pallidus, is overactive among people suffering from PD. This results in a decrease in the activity of a brain area that is responsible for movement controls. Though Pallidotomy, the surgeon destroys the Globus Pallidus and hence helps relieve symptoms of tremor and muscle rigidity. The procedure is suggested for PD fighters who have developed severe motor fluctuations that can no longer be controlled by medication. If a person has the tremor in his right hand, then his left side of the brain will be treated or vice versa. Just like Thalamotomy, the patient remains awake during Pallidotomy.

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4. Subthalamotomy

In subthalamotomy, the subthalamus, a tiny area of the brain that controls some involuntary body movements, is destroyed. During the surgery, an extremely cold substance, liquid nitrogen, is circulated to destroy the subthalamus. If a person has the tremor in his right hand, then his left side of the brain will be treated or vice versa. Performing the procedure on the both side of the brain increases the risk of speech and cognitive problems post-surgery. The procedure requires a 2-day hospitalization and 6-week recovery period. Just like Thalamotomy and Pallidotomy, the patient remains awake during this surgery as well.

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