What are Surgical Options to Treat Parkinson’s?

Surgery is an option for some people with Parkinson’s disease (PD) to help treat the symptoms. There is no type of surgery that can cure PD; however, surgical techniques may relieve symptoms from PD in some patients. Surgical procedures for PD are typically considered after other treatments, like medication, 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 significant risks, including the possibility of death. Today, deep brain stimulation is the most common surgery for PD. Deep brain stimulation has fewer risks and works by disrupting electrical signals in the brain, rather than destroying tissue.1,2

Pallidotomy

Although rarely performed today, a pallidotomy may be considered for a person with advanced Parkinson’s who has developed severe motor fluctuations like dyskinesia (uncontrolled, abnormal movements) from long-term levodopa treatment, or it may be performed for those with a severe or disabling motor symptoms (like tremor, rigidity, or bradykinesia) that are no longer controlled with medication. A pallidotomy is a surgical procedure in which 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, and creating a scar in this portion of the brain reduces the activity and may help relieve motor symptoms such as tremor and rigidity. Prior to surgery, the exact location of the globus pallidus is located using brain scans like an MRI (magnetic resonance imaging).2

Deep Brain Stimulation

Deep brain stimulation (DBS) 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 Parkinson’s for four years or more and who have significant “off” periods, times when their medication isn’t working well, or those who have dyskinesia. DBS can help relieve motor symptoms of stiffness or rigidity, slowness (bradykinesia), and tremor. It 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

Thalamotomy is rarely performed today, but may be used to treat severe tremor on one side of the body that is not relieved by medication. During a thalamotomy, the part of the brain called the thalamus is destroyed. The thalamus is a small portion of the brain that is located using detailed brain scans like MRI or CT (computed tomography). Damaging the thalamus may relieve tremor. 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.2

Subthalamotomy

Subthalamotomies are rarely performed today. A subthalamotomy is a surgical procedure in which the small portion of the brain called the subthalamic nucleus is destroyed to relieve the motor symptoms of PD, such as tremor, rigidity, and bradykinesia. To locate the subthalamus, brain scans, like MRI or CT, are used prior to surgery. Usually, the subthalamotomy is performed only on one side of the brain, as risks are greatly increased when it is performed on both sides.2,4

Written by: Emily Downward | Last reviewed: March 2017
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