Experts say two types of brain surgery can have immediate results for Parkinson’s disease patients. However, they say oral medications should be tried first.
A woman lies awake on an operating table, her outstretched arm shaking uncontrollably. A team of four doctors surround her, and after a few seconds, her shaking stops.
That moment was the first time in seven years that the 67-year-old patient from India experienced relief from tremors that were so severe, they kept her from sleeping at night.
A video of the surgery has circulated around the world.
To some it may seem like a miracle. But thanks to modern medicine, it’s one of many options now available to those living with Parkinson’s disease.
“This surgery is the ‘real deal.’ In this video, the neurosurgical team is creating a small lesion in the part of the brain that controls tremor and, as expected, it results in immediate improvement in the tremor,” Dr. Nader Pouratian, chief of functional neurosurgery at the University of California, Los Angeles (UCLA), told Healthline.
“Although the surgery appears [to be] science fiction, the concept of lesioning the brain and achieving tremor control, like that shown in the video, is decades old,” Pouratian added.
“It is a relatively safe procedure. For patients that are severely disabled by the tremor, such that it interferes with their quality of life and function, these surgeries are extremely valuable and the risk-benefit ratio is very favorable.”
About 1 million Americans live with Parkinson’s disease. That’s more than the combined number of people with multiple sclerosis, Lou Gehrig’s disease, and muscular dystrophy.
Parkinson’s is a neurodegenerative disorder, and the diversity of the disease means no two people experience Parkinson’s exactly the same way.
Common symptoms that may develop slowly over many years include tremors, slowness of movement, problems with balance and gait, and rigidity of limbs.
Risk factor genes for the disease differ between patients, but there are some commonalities.
“What Parkinson’s disease patients have in common is an abnormal accumulation of a misfolded protein called alpha-synuclein in the cells of the brain. This accumulation of this protein tends to affect a group of cells in the brainstem called the substantia nigra early in the course of the disease,” Dr. Kelly Mills, an assistant professor of neurology at Johns Hopkins Medicine in Maryland, told Healthline.
“One function of these cells is to produce a chemical called dopamine that is used in several other parts of the brain, including the network that controls movement initiation and speed,” Mills explained.
“When the alpha-synuclein aggregates in these cells, they malfunction and cannot produce adequate amounts of dopamine to allow normal movement control. As this protein accumulation affects other parts of the brain, other symptoms arise beyond the movement symptoms of tremor, slowness, and stiffness.”
People living with Parkinson’s may also experience symptoms such as loss of smell, cognitive impairments, gastrointestinal problems, and blood pressure issues.
For some, tremors can significantly impact quality of life. These people don’t always respond to treatment options such as oral medication.
Pouratian says when oral medication fails to help with tremors, surgeries like that seen in the video are a good option.
“Medications can be very effective, but when they are not, one can and should consider surgery if tremors are debilitating. In general, one can expect at least 50 percent improvement, but often up to 90 percent improvement in tremors,” he said.
For people with Parkinson’s, there are two types of brain surgeries available.
The first, as shown in the video, involves lesioning the brain.
“Lesioning, or burning, can be done with an open procedure as shown here or with focused ultrasound treatment,” Pouratian said.
The lesion stops the abnormal functioning of the part of the brain that is causing tremors and allows that part of the brain network to “reset” and perform more normal movements without tremors.
In the United States, treatment is more often done with deep brain stimulation. In this procedure, an electrode placed in the brain emits electrical impulses. This disrupts the abnormal functioning of movement control and can immediately stop a tremor.
“Because it depends on stimulation, it does not require lesioning the brain, making it reversible and modulatable. This has become preferable because if a lesion causes a complication, it is irreversible, whereas with a stimulator, we can just turn it off,” Pouratian said.
Using similar techniques, other symptoms of Parkinson’s such as slowness of movement, stiffness, excessive movement, and writhing or twisting movements can also be improved.
Experts, however, say medication should always be the first line of treatment.
As for whether those with Parkinson’s should consider this kind of surgery, Mills said it’s dependent on a number of factors, unique to each person.
“Whether or not it is worth the risk of surgery in any one individual depends on the degree of disability the tremor is causing, the likelihood of it easily being treated with a less invasive method such as oral medications, and other medical issues that would impact the surgical candidacy of that patient. When done in an experienced center, the procedure is relatively safe but because there are always risks, the potential for risk must be weighed against the potential for benefit in any one individual,” he said.