Neurosurgery for Parkinson's disease

Medical therapy for Parkinson's disease (PD) often becomes inadequate over several years. Disability increases despite maximal medical management and many patients develop motor fluctuations and dyskinesia. In addition, medic ations provide good control of tremor in only 50% of cases. In appropriatel y selected cases, surgical therapies for PD provide benefit for medically r efractory symptoms. Recent advances have provided a greater array of surgic al options. Unilateral thalamotomy and thalamic stimulation are considered safe and effective procedures to treat contralateral tremor. Pallidotomy an d pallidal stimulation primarily reduce contralateral dyskinesia, with less er effects on bradykinesia and rigidity. Studies indicate that subthalamic nucleus (STN) stimulation improves "off" period function, decreases "off" t ime, and lessens dyskinesia, Fetal cell transplantation remains experimenta l, and studies are underway to evaluate the safety and efficacy of porcine fetal cell and human retinal pigment epithelial cell transplantation. This chapter reviews the history of surgical procedures for PD, describes curren t procedures, and offers a look into the future of neurosurgical options fo r PD.