The Surgical Treatment of Parkinson's Disease

Abstract

Parkinson‘s disease (PD) is a debilitating disorder characterized by degeneration of the nigrostriatal pathway resulting in decreased caudoputaminal dopamine (DA) levels. Nigrostriatal pathway degeneration and reduced DA stores may lead to increased rigidity, gait and speech disturbances, bradykinesia and resting tremors. Currently there is no cure for PD. but early treatment consists of Levodopa (L-dopa) therapy. With long-term L-dopa use, there is development of the ‘on-off phenomenon‘ and dyskinesias. In the majority of PD cases, L-dopa adequately controls the motor symptoms inherent to PD. but a small percentage of the Parkinsonian population is medically-incalcitrant to this therapy. Many clinical trials are currently being conducted world-wide to investigate the efficacy of surgery to treat this disease. These surgical therapies include ablative procedures, chronic deep brain stimulation, as well as the transplantation of dopaminergic cells. Neurosurgical treatment of PD is not a new concept, being attempted as early as the 1930‘s, but these procedures were plagued with many side effects that led to their abandonment. Currently, a resurgence in these techniques has evolved due to our increased understanding of basal ganglia anatomy and physiology along with recent advances in medical technology. This review will briefly discuss the benefits and short-comings of these surgical paradigms as well as the rationale behind their application.