ROLE OF SURGICAL-TREATMENT

Clinically adapted procedures: Surgery for Parkinson's disease has pro gressed greatly over the last few years. Resting tremor can be well co ntrolled with chronic stimulation of the thalamus. Palliodotomy or chr onic stiumlation of the pallidium are effective against dopa-induced d yskinesia. Current experimentatins involve chronic simulation of the s ub-thalamic locus or intrastriatal grafts using dopaminergic neurons a nd have proven remarkably effective in cases with akinesia. Second lin e therapy: Careful clinical management required before any of these pr ocedures can be entertained. Possible candidates include patients who are resistant or who no longer respond to well-conducted medical treat ment. In addition, surgery tan only be indicated after a long-duration dopatherapy with at a minimum dose of 1000 mg/day.