Surgical treatments for Parkinson's disease.
OBJECTIVE
This article reviews surgical treatments for Parkinson's disease, emphasizing aspects pertinent to family physicians: rationale for and description of surgeries, patient selection issues, and outcome expectations.


METHODS
No published series describes long-term follow up of a randomized controlled study of any surgery for Parkinson's disease. Some reports, however, describe thorough but brief follow up of functioning in small numbers of patients following surgery. MEDLINE articles were identified using Parkinson's disease, surgery, pallidotomy, thalamotomy, stimulation, grafting, and transplantation as search words. Articles chosen for this paper described patients with systematic follow up using accepted validated rating scales.


RESULTS
Reported series show impressive improvements to patients undergoing lesioning, stimulation, and grafting surgery for Parkinson's disease. These patients are typically severely disabled but highly selected, and follow up is brief. Stereotactic lesioning (pallidotomy and thalamotomy), deep brain stimulation (thalamic, and elsewhere) and grafting (striatal) can be performed safely, but results vary greatly among centres.


CONCLUSIONS
Certain Parkinson's disease patients might benefit from surgery. Ideal candidates for pallidotomy experience motor fluctuations with disabling levodopa-induced dyskinesias. Tremors resistant to antiparkinsonian medications sometimes respond to thalamotomy or thalamic stimulation. Other parkinsonian syndromes, dementias, and difficulties with gait and balance respond poorly to unilateral pallidotomy. Bilateral deep brain stimulation procedures could benefit "midline" dysfunction.
Uitti
R J
RJ
Mayo Clinic, Jacksonville, Fla, USA. uitti.ryan@mayo.edu
D016380:Brain Tissue Transplantation; D002421:Caudate Nucleus / Q000637:transplantation; D004558:Electric Stimulation; D004599:Electric Stimulation Therapy; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000601:surgery*; D018579:Patient Selection; D011699:Putamen / Q000637:transplantation; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery; D013997:Time Factors