Surgical Management of Parkinson's Disease: Update and Review

Abstract

<jats:p> Although medical therapy is still the mainstay of treatment for Parkinson's disease, the development of surgical precision and decreased morbidity have made stereotatic lesioning and deep brain stimulation more popular. Neurosurgical ablations include pallidotomy, thalamotomy, and, more recently, subthalamotomy. Because of concern over the high risk of side-effects resulting from bilateral ablative procedure, alternative approaches have been explored. With improved deep brain stimulation (DBS) technology, DBS has been successfully applied in the internal globus pallidus, ventral intermediate nucleus and subthalamic nucleus for Parkinson's disease. </jats:p><jats:p> In addition, recent surgical approaches including biological neurorestorative technologies — surgical therapies with transplantation, gene therapy, and growth factor are all being discussed in this review. Although a great deal of work remains to be done for researchers, advances in surgical therapies for the treatment of Parkinson's disease are moving forward at an unprecedented pace, and, not surprisingly, would give PD patients more choices and hope. </jats:p>

Neuroprotective effect of combined therapy with hyperbaric oxygen and madopar on 6-hydroxydopamine-induced Parkinson’s disease in rats

“…The conventional therapy using levodopa and dopamine agonists for PD focuses primarily on relieving the motor symptoms, but this therapy does not prevent dopaminergic neuron degeneration [8,25]. Thus, there is a great demand for novel therapies that prevent neuronal death.…”

Intracranial Applications of Magnetic Resonance-guided Focused Ultrasound

“…Currently, only unilateral MRgFUS thalamotomy is being performed for ET. This is owing to the recognized risks of bilateral thalamotomy, including an up to 20-30 % risk of postoperative speech disturbances and ataxia [47][48][49][50]. The results of both phase I trials suggest that MRgFUS is safe, and can produce radiologic and clinical results similar to open thalamotomy.…”

Progression of motor symptoms in Parkinson’s disease

“…Surgical treatments have reportedly been effective in reducing symptoms and improving function. These include pallidotomy, thalamotomy, subthalamotomy, and high-frequency deep brain stimulation (DBS) via electrodes implanted in the globus pallidus, thalamus, or subthalamic nucleus [61,62] .…”