Surgery for Parkinson's Disease Symptoms

Friday, September 05, 2008

JC Jones MA RN

A jury in Kentucky awarded $5 million to the widow of a man who died following elective surgery for Parkinson's disease symptoms. While most of us are familiar with Parkinson's disease as a chronic illness manifesting in tremors, many people are unaware that there are surgical options available for treatment. Surgical treatment for Parkinson's disease symptoms actually predated medical treatment. At the beginning of the last century, ablation of the sensorimotor cortex was performed, and later, experimentation and exploration of the basal ganglia and extrapyramidal system were tried, but the mortality rate was unacceptably high. Levodopa was introduced in 1968, but hopes that this medication would be the definitive treatment were diminished as patients became refractory to the drug or developed side effects that were worse than the symptoms (dyskinesias, motor problems).

Normal movement is initiated by neurons in the cerebral cortex and modulated by nerve cells in the basal ganglia and thalamus. Too much output from the basal ganglia leads to decreased and slow motor activity seen in Parkinson's disease - rigidity, tremor, instability and moving slowly. Goals of surgery are to either reduce thalamic activity (ablation) to restore balance or increase neural activity of other brain targets. Neurologists and neurosurgeons treat this complex problem. Some of the methods in use today are:

• Pallidotomy: destruction of a small region of the brain. A type of ablation treatment with a high risk of dysarthria, dysphagia and dysphonia.
• Deep Brain Stimulation (DBS): electrodes are surgically implanted into the subthalamic nucleus (STN). Programming the stimulator is complex, requiring extensive follow-up and battery replacement. Patient selection criteria is stringent.
  
• Transplantation: still in experimental stage, researchers are investigating the use of stem cells. New cells taking over the function of old cells may be the only hope for a cure.
  

With careful patient selection, morbidity and mortality rates are relatively low - less than 8%. As with any medical procedure, even elective surgeries and especially those involving such a delicate and complex structure as the brain, there are risks. Make sure you and your loved ones understand the risks associated with any elective procedure before you agree to have it done, and seek a second opinion if you are uneasy or have further questions.

Thank you Nieve44/La Luz for use of photo My father has Parkinson's.

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