Advances in surgery for movement disorders

Abstract

Movement disorder surgery has evolved throughout history as our knowledge of motor circuits and ways in which to manipulate them have expanded. Today, the positive impact on patient quality of life for a growing number of movement disorders such as Parkinson's disease is now well accepted and confirmed through several decades of randomized, controlled trials. Nevertheless, residual motor symptoms after movement disorder surgery such as deep brain stimulation and lack of a definitive cure for these conditions demand that advances continue to push the boundaries of the field and maximize its therapeutic potential. Similarly, advances in related fields - wireless technology, artificial intelligence, stem cell and gene therapy, neuroimaging, nanoscience, and minimally invasive surgery - mean that movement disorder surgery stands at a crossroads to benefit from unique combinations of all these developments. In this minireview, we outline some of these developments as well as evidence supporting topics of recent discussion and controversy in our field. Moving forward, expectations remain high that these improvements will come to encompass an even broader range of patients who might benefit from this therapy and decrease the burden of disease associated with these conditions. © 2016 International Parkinson and Movement Disorder Society.

Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

“…Technical advances in the field have emerged during recent years, where directional current steering and closed‐loop devices are promising . However, these techniques also have limitations and their efficacy still depends on correct localization of the target.…”

Past, present, and future of Parkinson's disease: A special essay on the 200th Anniversary of the Shaking Palsy

“…In 1992, Laitinen and colleagues published a seminal paper on the reexamination of pallidotomy in the treatment of PD, which he had learned from Leksell 3 decades earlier . The rediscovery and reintroduction of pallidotomy rekindled interest in surgery for PD fostered by a few studies in the MPTP monkey model (ie, Bergman, Wichman, and DeLong in Baltimore, United States; Aziz and Crossman in Manchester, United Kingdom; Guridi and Obeso, Spain; and Benazzouzz and Gross, France), showing that lesion or high‐frequency stimulation of the STN could reverse parkinsonism . This coincided with the development and application of DBS in the Vim of the thalamus to treat tremor, which allowed Grenoble's group in France to pioneer the STN for DBS in the early 1990s…”

N-3 (Omega-3) Fatty Acids: Effects on Brain Dopamine Systems and Potential Role in the Etiology and Treatment of Neuropsychiatric Disorders

“…Current treatments for PD include pharmacological management, primarily with drugs that mimic or augment dopaminergic neurotransmission [83]. Surgical treatment, deep-brain stimulation, and physical therapy are also used; however, there is no cure, and all current treatments eventually become ineffective at managing symptoms [100, 101]. Therefore, understanding the foundations of PD, including the effects of diet on the etiology and treatment of PD, may prove crucial to developing treatments to minimize suffering of PD patients.…”