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Surgical intervention was relatively common for the treatment of Parkinson's disease before the introduction of levodopa. It then fell out of practice but is now being re-evaluated as new surgical techniques become available.

Surgery may be recommended as a treatment for:

• Young-Onset Parkinson's Disease patients for whom drugs do not adequately control the symptoms and who have no evidence of cognitive impairment or other medical problems
• Patients of any age with advanced stage Parkinson's disease who are no longer responsive to medication and who suffer from disabling tremors or associated Parkinson's disease symptoms such as motor fluctuations or dyskinesia
• Parkinson's disease patients of any age who have a significantly impaired quality of life

Surgery for Parkinson's disease is often done under local anesthesia. Surgery is not curative and is intended only to relieve symptoms of Parkinson's disease. Since the symptoms which may warrant surgery are associated with advanced Parkinson's disease, surgical intervention is not considered to be an option for early Parkinson's disease.

Currently, there are four types of surgical procedures that may be considered for Parkinson's disease patients:

• Pallidotomy
• Thalamotomy
• Deep Brain Stimulation (DBS)
• Fetal Tissue Transplantation

If your doctor recommends surgery for Parkinson's disease, it is important to confirm coverage for these procedures with your health insurance carrier before undergoing surgery.

Pallidotomy

Pallidotomy involves the destruction of part of the globus pallidus (GPi) area of the brain which controls movement. A wire probe is inserted into the GPi and the precise target location is identified by MRI. The probe is heated by radio-waves to a temperature that destroys the tissue around it. Since the reduction and loss of dopamine cause overactivity in the GPi, destruction of part of the tissue restores the balance needed for controlled movement.

Pallidotomy is performed to treat:

• Peak-dose dyskinesias (uncontrolled movements that occur when levodopa is at its highest concentration in the blood)
• "Wearing-off" dystonia (muscle spasms at the lowest concentration of levodopa as the medication wears off)
• Bradykinesia and tremor are sometimes targeted but the surgery is not as effective for these symptoms

Pallidotomy can be performed in one of two ways:

• Unilateral pallidotomy - a portion of the tissue on only one side of the brain is destroyed (ablated) which improves motor control on the opposite side of the body and has a moderate effect on dyskinesia on the same side as the ablation.

• Bilateral pallidotomy - tissue is ablated (destroyed) on both sides of the brain.

At this point, results of unilateral pallidotomy are more promising than for bilateral pallidotomy. There is evidence that after pallidotomy, some patients can tolerate a higher dose of levodopa. Pallidotomy is most effective in patients under the age of 70 but may be performed on older patients as well.

There are complications in approximately 10-20% of patients undergoing the pallidotomy procedure. There is a risk that the probe can strike a blood vessel causing a stroke. There is also the risk of damaging other parts of the brain.

Thalamotomy