Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Abstract

Surgical treatment for Parkinson's disease (PD) has evolved from ablative procedures, within a variety of brain regions, to implantation of electrodes into specific targets of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred to ablative procedures by many experts owing to its reversibility, programmability, and the ability to be safely performed bilaterally. Several randomized clinical studies have demonstrated the effectiveness of DBS surgery for control of PD symptoms. Many brain targets, including the subthalamic nucleus and the globus pallidus internus, have emerged as potentially effective, with each target being closely associated with important pros and cons. Selection of appropriate PD candidates through a methodical interdisciplinary screening is considered a prerequisite for a successful surgical outcome. Despite recent growth in DBS knowledge, there is currently no consensus on the ideal surgical technique, the best surgical approach, and the most appropriate surgical target. DBS is now targeted towards treating specific PD-related symptoms in a given individual, and not simply addressing the disease with one pre-defined approach. In this review we will discuss the historical aspects of surgical treatments, the selection of an appropriate DBS candidate, the current surgical techniques, and recently introduced DBS-related technologies. We will address important pre-and postoperative issues related to DBS. We will also discuss the lessons learned from the randomized clinical studies for DBS and the shifting paradigm to tailor to a more patient-centered and symptom-specific approach.

Effect of Subthalamic Nuclei Electrical Stimulation in the Treatment of Parkinson’s Disease

“…The key to guarantee the curative effect of STN-DBS surgery is the right case selection, accurate target positioning, and electrodes implantation, as well as complications reducing [7]. The patients that were clearly diagnosed with Parkinson's disease with drug efficacy reducing are suitable for STN-DBS surgery in the premise of no surgery taboo, so the preoperative evaluation, especially levodopa drugs impact test is necessary.…”

Gastrointestinal Dysfunctions in Parkinson’s Disease: Symptoms and Treatments

“…However, since nausea and vomiting are often side effects of various medications, they can limit the use of the latter and, as a result, preempt the benefit of such medications on motors symptoms [31]. Moreover, deep brain stimulation (DBS), which is widely used to treat motor symptoms, has been shown to have a potential impact on the manifestation of GI symptoms [113, 114]. According to some studies, constipation and deglutition are significantly improved after surgery in the subthalamic nucleus [115–117].…”

Treatment and Physiology in Parkinson’s Disease and Dystonia: Using Transcranial Magnetic Stimulation to Uncover the Mechanisms of Action

“…STN and GPi, are two preferred targets for stimulation, and they both have shown equivalent benefits [51]. STN activity in PD are characterized by augmented synchrony of neuronal firing, loss of specificity of the receptive fields, and increased firing rates with bursting activity.…”