ABLATIVE SURGERY AND DEEP BRAIN-STIMULATION FOR PARKINSONS-DISEASE

SURGICAL OPTIONS FOR Parkinson's disease (PD) are vapidly expanding an d include ablative procedures, deep brain stimulation, and cell transp lantation. The target nuclei for ablative surgery and deep brain stimu lation are the motor thalamus, the globus pallidus, and the subthalami c nucleus. Multiple factors have fed to the resurgence of interest in the surgical treatment of PD: 1) recognition that long-term medical th erapy for PD is often unsatisfactory, with patients eventually sufferi ng from drug-induced dyskinesias, motor fluctuations, and variable res ponses to medication; 2) greater understanding of the pathophysiology of PD, providing a better scientific rationale for some previously dev eloped procedures and suggesting new targets; and 3) use of improved t echniques, such as computed tomography- and magnetic resonance imaging -guided stereotaxy and single-unit microelectrode recording, making su rgical intervention in the basal ganglia more precise. We review the p resent status of ablative surgery and deep brain stimulation for PD, i ncluding theoretical aspects, surgical techniques, and clinical result s.