Supporting People Living With Parkinson Disease in Central and South Texas
Similar to available pharmacological treatments, no currently available surgical treatment has been proven to either slow the disease or "rejuvenate" the sick and dying nerve cells affected by PD. Today's PD surgeries offer symptomatic benefits.
Because of the level of risk inherent in any brain surgery, it is usually an option only for patients with advanced or quickly debilitating Parkinson's disease or those with severe medication-induced side effects, such as debilitating dyskinesia or other quality-of-life impacts. The decision about undergoing surgery should be made in consultation with physicians and caregivers involved in a patient's treatment regimen. Identifying an experienced surgical team is essential.
Deep Brain Stimulation
Today, the most commonly discussed surgical treatment is deep brain stimulation (DBS), a procedure that seeks to reduce "on/off" fluctuations as well as dyskinesia. While we do not understand how DBS works, it seems to counteract the abnormal neuronal functioning that occurs in PD. DBS is increasingly attractive for many Parkinson's patients, particularly as more surgeons become proficient with the technique.
DBS is not well suited for all patients. Generally, patients with typical PD who have had a good response to levodopa, but who are experiencing medication-related motor side effects such as dyskinesia might be good candidates. DBS is usually not recommended for patients with dementia.
In DBS, a very thin electrode (about the diameter of a piece of spaghetti) is implanted into the brain, targeting motor circuits that are not functioning properly. Small electrical pulses from a device similar to a cardiac pacemaker are then used to stimulate a small brain region and block the signals that cause some Parkinson's symptoms. DBS electrodes are usually placed in regions of the brain called the globus pallidus (GPi) or subthalamic nucleus (STN) to improve motor function. The stimulator can be adjusted as necessary to optimize effects.
Generally, DBS does not improve symptoms that do not respond to levodopa. DBS may improve motor function in PD patients, and may also allow reductions in the amount of medication a PD patient requires, although this is not always the case. DBS also reduces motor fluctuations and “off” time. While DBS can produce major improvements in many of the motor symptoms of PD, its effectiveness varies from patient to patient. Realistic expectations and an acceptance of the risks and benefits associated with surgery are essential attributes in the DBS decision process.
Other Surgical Approaches
Because deep brain stimulation has become the surgical method of choice where available, other surgeries such as pallidotomy and thalamotomy are used less often. Both of these approaches permanently damage small regions of the brain to reduce symptoms. These procedures are not reversible.