SURGICAL TREATMENT OF PARKINSON’S DISEASE

The first line of treatment of Parkinson’s disease is still medical. Most clinical studies as to the efficacy of pharmacological agents are based on the context of having mild, moderate and advanced disease. Thus, surgical treatment of PD has been reserved only for patients with both severe motor impairment from PD and motor complications in the form of fluctuations and dyskinesias.

In a review of literature of all researches done worldwide from 2001 to 2004, the following surgical interventions have been undertaken, namely:

1. Unilateral Pallidotomy

2. Pallidal Stimulation

3. Thalatomy

4. Thalamic Stimulation

5. Subthalatomy

6. Subthalamic Nucleus Stimulation (STN)

7. Human fetal mesencephalic transplantation

8. Fetal porcine cell transplantation

Of the above surgical procedures, unilateral pallidotomy and subthalamic nucleus stimulation (STN) have been found to be efficacious for symptomatic control of parkinsonism. However, only the former, i.e., unilateral pallidotomy, has been shown to be likely efficacious in the treatment of motor complications like dyskinesias and fluctuations. Thus, they are said to be clinically useful in the treatment of PD but with associated risk which are acceptable under specialized monitoring.

Pallidal stimulation has been observed to be likely efficacious for the symptomatic control of parkinsonism. It might possibly be useful for clinical practice but also with acceptable risk with specialized monitoring.

Human fetal mesencephalic transplantation has been observed to be non-efficacious in the symptomatic control of parkinsonism as well as in the treatment of motor complications. It also has an unacceptable risk of developing severely disabling dyskinesias predominantly affecting the legs which occurred generally 6 – 12 months after surgery thus requiring another surgical intervention.

The rest of the surgical procedures are still in the investigational stages and with insufficient data as to merit any clinical usefulness.

References:

Vitek JL, Bakay RAE, Freeman A, et al. Randomized trial of

pallidotomy versus medical therapy for Parkinson’s disease. Ann

Neurol 2003;53:558 –569.

Katayama Y, Kasai M, Oshima H, et al. Subthalamic nucleus

stimulation for Parkinson’s disease: benefits observed in levodopa intolerant

patients. J Neurosurg 2001;95:213–221

Olanow CW, Goetz CG, Kordower JH, et al. A double-blind

controlled trial of bilateral fetal nigral transplantation in Parkinson’s

disease. Ann Neurol 2003;54:403– 414.