Neurosurgical treatment modalities in Parkinson's disease

✍ Scribed by J.D. Speelman; D.A. Bosch

• Publisher: John Wiley and Sons
• Year: 2002
• Tongue: English
• Weight: 75 KB
• Volume: 17
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.10067

✦ Synopsis

Stereotactic neurosurgery for Parkinson's disease (PD) was introduced in 1948. Originally, the pallido(-anso)tomy and campotomy were the most frequently performed operations and lesions were induced either by electricity, chemicals, or freezing. From 1954 on, Hassler and Riechert 1 promoted the thalamus as the surgical target structure, and lesions were mainly performed with radiofrequency heating. The introduction of levodopa in 1967 caused a serious reduction in the number of operations, and only a few centres continued with surgery for PD. In the mid-1980s, a revival of stereotactic surgery took place due to shortcomings of pharmacotherapy, newly developed pathophysiological model of PD, and improvements in stereotactic techniques and equipment. 2 The present inclusion criteria for stereotactic neurosurgery are the following: (1) diagnosis of Parkinson's disease; (2) failure of pharmacotherapy, such as response fluctuations or persisting tremor, inability to tolerate adequate dosages of dopaminergic therapy, and adverse effects of medication, e.g., dyskinesias or psychiatric symptoms; (3) symptomatic improvement due to levodopa treatment (with exception of tremor); and (4) no surgical contraindications.