Surgical treatment of Parkinson's disease

Stereotaxtic surgery is an effective therapeutic maneuver in the management of advanced Parkinson's disease (PD). Thalamotomy is an effective measure to control tremor but other PD symptoms are not changed. Bilateral operatio ns are associated with a risk of severe speech impairment. Deep brain stimu lation (DBS) of the thalamus is as effective as thalamotomy and is associat ed with fewer side effects. Pallidotomy is effective in reducing contralate ral dyskinesias and the cardinal symptoms of PD. Bilateral pallidotomy ofte n results in cognitive dysfunction. Deep brain stimulation of the pallidum replicates the positive effects of pallidotomy and appears to be safer than ablative lesions. Subthalamic DBS is currently under investigation. This p rocedure may control all PD symptoms, and the dose of levodopa can often be dramatically reduced. Neurotransplantation is a promising surgical approac h to PD. However, further investigation is needed to optimize this approach . (C) 1999 Elsevier Science BV. All rights reserved.