Parkinson's disease surgery: Difference between revisions
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[[Image:Parkinson surgery.jpg|thumb|200px|Illustration showing an electrode placed deep seated in the brain]]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. | [[Image:Parkinson surgery.jpg|thumb|200px|Illustration showing an electrode placed deep seated in the brain]]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. | ||
* 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> | * 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: | * 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]].(66_67_68_69) bilateral [[pallidotomy]] can cause permanent pseudobulbar speech and [[swallowing]] problems.(67) | ||
* Subthalamotomy: | * Subthalamotomy: | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
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.
- 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.(66_67_68_69) bilateral pallidotomy can cause permanent pseudobulbar speech and swallowing problems.(67)
- Subthalamotomy:
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.