[Surgery for Parkinson's disease].
Surgery for Parkinson's Disease (PD) is being increasingly used. The main reason for this renewal in surgical treatment for PD is the "deep brain stimulation" (DBS) that replaced the previously used stereotactic lesions in most centers. DBS allows a focal specific electrical stimulation of basal ganglia target instead of an irreversible lesion. Mainly bilateral DBS of the nucleus subthalamicus is now an established surgical treatment for PD. But DBS of the Globus pallidus internus and of the thalamus should still be considered in selected patients. DBS is an efficient treatment for motor complication of PD that can no longer be controlled by drug treatment. Dyskinesia, bradykinesia, tremor and rigor can be improved by DBS and the medication can be reduced. It is still unclear, however, how the improvement in motor symptoms affects quality of life in the long term. Furthermore, patients with severe cognitive and psychiatric symptoms as well as patients with severe axial symptoms should not be operated since these symptoms may worsen after surgery.
Kaelin-Lang
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Zentrum für Bewegungsstörungen, Neurologische Klinik, Universitätsspital, Bern. alain.kaelin@dkf.unibe.ch
Stibal
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D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004558:Electric Stimulation; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D020531:Subthalamic Nucleus / Q000503:physiopathology; D013788:Thalamus / Q000503:physiopathology; D013997:Time Factors