The Surgical Treatment of Parkinson’s Disease

Abstract

Surgical treatment of Parkinson's disease (PD) can provide gratifying symptomatic improvements for many individuals who suffer from persistent disabling symptoms despite the best available medical management. Current surgical therapies include ablative techniques (thalamotomy and pallidotomy), augmentative techniques (nondestructive) (deep brain stimulation), and restorative techniques (tissue transplantation and gene therapy). Ablative procedures can provide substantial clinical benefit, but the current trend is toward deep brain stimulation, which can provide similar symptomatic improvement in a nondestructive manner. Restorative techniques, such as tissue transplantation and gene therapy, are exciting but have significant obstacles to overcome before their promise can be realized. Until the underlying pathological defect of PD can be identified and treated, surgical intervention is likely to remain important in the symptomatic treatment of this disabling disease.

Nerve growth factor prevents 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced cell death via the Akt pathway by suppressing caspase-3-like activity using PC12 cells: Relevance to therapeutical application for parkinson's disease

“…As a result of genetic analysis, parkin (Kitada et al, 1998) and α‐synuclein (Polymeropoulos et al, 1997) as genes responsible for PD were discovered. Therapeutic approaches to these diseases currently being studied include the gene delivery method (Lesch, 1999; Follett, 2000) and the transplantation method (Piccini et al, 1999; Follett, 2000), to maintain cell numbers. It is important to the development of therapeutic methods that the pathway of cell survival via PI3‐K and Akt is used, because this pathway contributes to cell survival and may maintain cell numbers even in the progressive chronic phase of disease in vivo.…”

Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease<subtitle>A Randomized Controlled Trial</subtitle>

“…The attractiveness of deep brain stimulation is related in part to the fact that stimulation is adjustable and reversible 4. However, recent reports highlighting unexpected behavioral effects of stimulation suggest that deep brain stimulation, while improving motor function, may have other less desirable consequences 5,6.…”

New uses for botulinum toxin

“…These stereotactic lesions might produce therapeutic effects per se [15][16][17]. However, assuming that the method is efficacious, careful cost analyses would be necessary to ascertain whether it might replace other techniques used for the control of disabling tremors and dyskinesias, such as apomorphine pumps and deep brain stimulators.…”