Surgical treatment of movement disorders.
A substantial body of evidence has accumulated regarding the efficacy and safety of neurosurgery for Parkinson's disease, essential tremor, and dystonia. Surgery for movement disorders (thalamotomy, pallidotomy, and subthalamic nucleotomy or subthalamotomy) was largely ablative (lesion-based). Given the safety and anatomy-preservation advantage, long-term electrical stimulation of these same targets (thalamus, globus pallidus, and subthalamic nucleus) is discussed as the treatment of choice. High-frequency deep brain stimulation procedures replicate the effects of ablative interventions, but do not require making a destructive brain lesion. This article outlines patient eligibility for surgery, targeting techniques, intraoperative findings, and potential complications and discusses the outcomes expected for each of the major interventions for which clinical trial data are available.
Espay
Alberto J
AJ
Department of Neurology, Movement Disorders Center, The Neuroscience Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525, USA.
Mandybur
George T
GT
Revilla
Fredy J
FJ
D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D009069:Movement Disorders / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D016896:Treatment Outcome