What are Surgical Options to Treat Parkinson's?

There is no type of surgery that can cure Parkinson's disease (PD). However, surgical methods may relieve symptoms of PD in some people. Surgical procedures for PD are typically considered after other treatments, like medicines, have been exhausted. Surgery generally only works to improve the motor symptoms of PD that have previously improved on levodopa therapy.^1,2

Initially, surgical procedures for people with PD aimed to destroy specific parts of the brain to relieve symptoms. These procedures include pallidotomy, thalamotomy, and subthalamotomy. However, these procedures have major risks, including the possibility of death.^1,2

Today, deep brain stimulation (DBS) is the most common surgery for PD. DBS has fewer risks and works by disrupting electrical signals in the brain rather than destroying tissue.^1,2

Pallidotomy

Pallidotomies are rarely performed today. However, the surgery may be considered for a person with advanced PD who has developed severe motor fluctuations like dyskinesia (uncontrolled, abnormal movements) from long-term levodopa treatment. Pallidotomy may also be performed for those with severe or disabling motor symptoms (like tremor, rigidity, or bradykinesia) that are no longer controlled with medicine.²

During a pallidotomy, the part of the brain called the globus pallidus is destroyed. In people with PD, there is an abundance of activity in the globus pallidus. Creating a scar in this portion of the brain reduces the activity, which may help relieve motor symptoms like tremor and rigidity. Before surgery, the globus pallidus is located using brain scans like magnetic resonance imaging (MRI).²

Deep Brain Stimulation

Deep brain stimulation is a procedure in which a device is implanted in the person to deliver electrical pulses to the brain to decrease motor symptoms of PD. The electrical pulses are targeted to the areas of the brain that control movement to block abnormal signals that produce symptoms like tremor. Areas of the brain that may be targeted include the thalamus, subthalamus, and the globus pallidus.²

DBS may be considered for people who have had PD for 4 or more years and:³

• Have significant times when their medicine is not working well
• Have dyskinesia

DBS can help relieve motor symptoms like:³

• Stiffness or rigidity
• Slowness (bradykinesia)
• Tremor

DBS does not work well to treat balance impairments, freezing when walking, or non-motor symptoms of PD. Because DBS can worsen cognition or memory problems, it is not recommended for people with dementia.³

Thalamotomy

Thalamotomies are rarely performed today. However, the surgery may be used to treat severe tremors on 1 side of the body that are not relieved by medicine.²

During a thalamotomy, the part of the brain called the thalamus is destroyed. Damaging the thalamus may relieve tremors. Surgery on the right side of the brain affects the left side of the body, and surgery on the left side of the body affects the right side of the body. A thalamotomy is performed on the contralateral side of the brain to where the person has the worst motor symptoms. To locate the thalamus, brain scans like MRI or computed tomography (CT) are used before surgery.²

Subthalamotomy

Subthalamotomies are rarely performed today. During a subthalamotomy, the small portion of the brain called the subthalamic nucleus is destroyed. This helps relieve motor symptoms of PD like tremor, rigidity, and bradykinesia.

In most cases, a subthalamotomy is performed only on 1 side of the brain. Risk of speech and cognitive problems are greatly increased when it is performed on both sides of the brain. To locate the subthalamus, brain scans like MRI or CT are used before surgery.^2,4