Parkinson's disease surgery: Difference between revisions
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==Overview== | ==Overview== | ||
Deep brain stimulation: [[Deep brain stimulation]] in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. Thalamotomy and pallidotomy: Unilateral [[pallidotomy]] can reduce [[dyskinesia]], on and off fluctuations, [[tremor]], rigidity, [[bradykinesia]] and [[gait]] problems but it is not as effective as [[Deep brain stimulation|DBS]]. | |||
Subthalamotomy: unilateral subthalamotomy is useful in managing [[Parkinson's disease|PD]] symptoms. | |||
== Indications == | |||
* Surgery is not the first-line treatment option for patients with Parkinson's disease. Surgery is usually reserved for patients with drug complications or sever disease. | |||
==Surgery== | ==Surgery== | ||
[[Image:Parkinson surgery.jpg|thumb|200px|Illustration showing an electrode placed deep seated in the brain]] | [[Image:Parkinson surgery.jpg|thumb|200px|Illustration showing an electrode placed deep seated in the brain]] | ||
* Deep brain stimulation: [[Deep brain stimulation]] in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. [[Deep brain stimulation|DBS]] of [[subthalamic nucleus]] or [[globus pallidus]] interna have a better outcome in comparison to medication only. The most serious [[Complications|complication]] of this treatment is fatal [[intracerebral hemorrhage]].<ref name="pmid22516078">{{cite journal |vauthors=Fasano A, Daniele A, Albanese A |title=Treatment of motor and non-motor features of Parkinson's disease with deep brain stimulation |journal=Lancet Neurol |volume=11 |issue=5 |pages=429–42 |date=May 2012 |pmid=22516078 |doi=10.1016/S1474-4422(12)70049-2 |url=}}</ref><ref name="pmid19126811">{{cite journal |vauthors=Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD |title=Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial |journal=JAMA |volume=301 |issue=1 |pages=63–73 |date=January 2009 |pmid=19126811 |pmc=2814800 |doi=10.1001/jama.2008.929 |url=}}</ref><ref name="pmid16943402">{{cite journal |vauthors=Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J |title=A randomized trial of deep-brain stimulation for Parkinson's disease |journal=N. Engl. J. Med. |volume=355 |issue=9 |pages=896–908 |date=August 2006 |pmid=16943402 |doi=10.1056/NEJMoa060281 |url=}}</ref> | |||
* Thalamotomy and pallidotomy: Unilateral [[pallidotomy]] can reduce [[dyskinesia]], on and off fluctuations, [[tremor]], rigidity, [[bradykinesia]] and [[gait]] problems but it is not as effective as [[Deep brain stimulation|DBS]].<ref name="pmid14745054">{{cite journal |vauthors=Esselink RA, de Bie RM, de Haan RJ, Lenders MW, Nijssen PC, Staal MJ, Smeding HM, Schuurman PR, Bosch DA, Speelman JD |title=Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial |journal=Neurology |volume=62 |issue=2 |pages=201–7 |date=January 2004 |pmid=14745054 |doi= |url=}}</ref><ref name="pmid10599758">{{cite journal |vauthors=Hallett M, Litvan I |title=Evaluation of surgery for Parkinson's disease: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The Task Force on Surgery for Parkinson's Disease |journal=Neurology |volume=53 |issue=9 |pages=1910–21 |date=Decemb | |||
er 1999 |pmid=10599758 |doi= |url=}}</ref><ref name="pmid11071505">{{cite journal |vauthors=Lai EC, Jankovic J, Krauss JK, Ondo WG, Grossman RG |title=Long-term efficacy of posteroventral pallidotomy in the treatment of Parkinson's disease |journal=Neurology |volume=55 |issue=8 |pages=1218–22 |date=October 2000 |pmid=11071505 |doi= |url=}}</ref><ref name="pmid12730989">{{cite journal |vauthors=Vitek JL, Bakay RA, Freeman A, Evatt M, Green J, McDonald W, Haber M, Barnhart H, Wahlay N, Triche S, Mewes K, Chockkan V, Zhang JY, DeLong MR |title=Randomized trial of pallidotomy versus medical therapy for Parkinson's disease |journal=Ann. Neurol. |volume=53 |issue=5 |pages=558–69 |date=May 2003 |pmid=12730989 |doi=10.1002/ana.10517 |url=}}</ref> bilateral [[pallidotomy]] can cause permanent pseudobulbar speech and [[swallowing]] problems.<ref name="pmid10599758">{{cite journal |vauthors=Hallett M, Litvan I |title=Evaluation of surgery for Parkinson's disease: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The Task Force on Surgery for Parkinson's Disease |journal=Neurology |volume=53 |issue=9 |pages=1910–21 |date=Decemb | |||
er 1999 |pmid=10599758 |doi= |url=}}</ref> | |||
* Subthalamotomy: unilateral subthalamotomy is useful in managing [[Parkinson's disease|PD]] symptoms.<ref name="pmid19684228">{{cite journal |vauthors=Tarsy D |title=Does subthalamotomy have a place in the treatment of Parkinson's disease? |journal=J. Neurol. Neurosurg. Psychiatry |volume=80 |issue=9 |pages=939–40 |date=September 2009 |pmid=19684228 |doi=10.1136/jnnp.2008.163949 |url=}}</ref> the [[Side effects|side effect]] of this surgery is that it can cause [[contralateral]] [[dyskinesia]] which may resolve after 4 to 12 weeks.<ref name="pmid19204026">{{cite journal |vauthors=Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA |title=Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months |journal=J. Neurol. Neurosurg. Psychiatry |volume=80 |issue=9 |pages=979–85 |date=September 2009 |pmid=19204026 |doi=10.1136/jnnp.2008.154948 |url=}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 19:16, 28 November 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Deep brain stimulation: Deep brain stimulation in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. Thalamotomy and pallidotomy: Unilateral pallidotomy can reduce dyskinesia, on and off fluctuations, tremor, rigidity, bradykinesia and gait problems but it is not as effective as DBS.
Subthalamotomy: unilateral subthalamotomy is useful in managing PD symptoms.
Indications
- Surgery is not the first-line treatment option for patients with Parkinson's disease. Surgery is usually reserved for patients with drug complications or sever disease.
Surgery
- Deep brain stimulation: Deep brain stimulation in the most common surgical treatment of Parkinson disease and is shown to be effective in improving motor function in these patient especially when it’s done bilaterally. DBS of subthalamic nucleus or globus pallidus interna have a better outcome in comparison to medication only. The most serious complication of this treatment is fatal intracerebral hemorrhage.[1][2][3]
- Thalamotomy and pallidotomy: Unilateral pallidotomy can reduce dyskinesia, on and off fluctuations, tremor, rigidity, bradykinesia and gait problems but it is not as effective as DBS.[4][5][6][7] bilateral pallidotomy can cause permanent pseudobulbar speech and swallowing problems.[5]
- Subthalamotomy: unilateral subthalamotomy is useful in managing PD symptoms.[8] the side effect of this surgery is that it can cause contralateral dyskinesia which may resolve after 4 to 12 weeks.[9]
References
- ↑ Fasano A, Daniele A, Albanese A (May 2012). "Treatment of motor and non-motor features of Parkinson's disease with deep brain stimulation". Lancet Neurol. 11 (5): 429–42. doi:10.1016/S1474-4422(12)70049-2. PMID 22516078.
- ↑ Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, Rothlind J, Sagher O, Reda D, Moy CS, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein J, Stoner G, Heemskerk J, Huang GD (January 2009). "Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial". JAMA. 301 (1): 63–73. doi:10.1001/jama.2008.929. PMC 2814800. PMID 19126811.
- ↑ Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J (August 2006). "A randomized trial of deep-brain stimulation for Parkinson's disease". N. Engl. J. Med. 355 (9): 896–908. doi:10.1056/NEJMoa060281. PMID 16943402.
- ↑ Esselink RA, de Bie RM, de Haan RJ, Lenders MW, Nijssen PC, Staal MJ, Smeding HM, Schuurman PR, Bosch DA, Speelman JD (January 2004). "Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial". Neurology. 62 (2): 201–7. PMID 14745054.
- ↑ 5.0 5.1 Hallett M, Litvan I (Decemb
er 1999). "Evaluation of surgery for Parkinson's disease: a report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. The Task Force on Surgery for Parkinson's Disease". Neurology. 53 (9): 1910–21. PMID 10599758. line feed character in
|date=at position 7 (help); Check date values in:|date=(help) - ↑ Lai EC, Jankovic J, Krauss JK, Ondo WG, Grossman RG (October 2000). "Long-term efficacy of posteroventral pallidotomy in the treatment of Parkinson's disease". Neurology. 55 (8): 1218–22. PMID 11071505.
- ↑ Vitek JL, Bakay RA, Freeman A, Evatt M, Green J, McDonald W, Haber M, Barnhart H, Wahlay N, Triche S, Mewes K, Chockkan V, Zhang JY, DeLong MR (May 2003). "Randomized trial of pallidotomy versus medical therapy for Parkinson's disease". Ann. Neurol. 53 (5): 558–69. doi:10.1002/ana.10517. PMID 12730989.
- ↑ Tarsy D (September 2009). "Does subthalamotomy have a place in the treatment of Parkinson's disease?". J. Neurol. Neurosurg. Psychiatry. 80 (9): 939–40. doi:10.1136/jnnp.2008.163949. PMID 19684228.
- ↑ Alvarez L, Macias R, Pavón N, López G, Rodríguez-Oroz MC, Rodríguez R, Alvarez M, Pedroso I, Teijeiro J, Fernández R, Casabona E, Salazar S, Maragoto C, Carballo M, García I, Guridi J, Juncos JL, DeLong MR, Obeso JA (September 2009). "Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months". J. Neurol. Neurosurg. Psychiatry. 80 (9): 979–85. doi:10.1136/jnnp.2008.154948. PMID 19204026.