Parkinson’s disease is a complex condition that affects the nervous system. It can influence movement and cause a variety of symptoms, including tremors and issues with gait and balance. Currently, there is no cure, but surgical options may help relieve symptoms and improve quality of life.
Parkinson’s disease is a degenerative condition that
- tremors
- bradykinesia, which refers to slow or difficult movement
- stiffness
- difficulty with balance and coordination
Parkinson’s can also involve nonmotor symptoms, including:
- mood disorders, such as depression
- sleep disorders
- cognitive impairment
- hallucinations and delusions
Although there is currently no cure for the condition, many treatment options can ease symptoms and help maintain a person’s quality of life. However, if medication alone cannot manage an individual’s Parkinson’s symptoms, a doctor may consider surgical options.
This article explores surgical treatment options for Parkinson’s disease.
Deep brain stimulation (DBS) is the
Some evidence suggests people whose symptoms respond to levodopa, a common treatment for Parkinson’s disease, may see better results from DBS. Doctors may also consider DBS when medication does not control a person’s movement symptoms adequately or if the side effects of their medication interfere with their day-to-day life.
Procedure
The DBS procedure comprises two surgical stages. The first involves placing electrodes in the brain, using MRI and brain activity recordings for guidance. Before inserting these, the surgical team will numb the targeted area using medication. A person is awake during this procedure, and the neurosurgeon may require the patient to perform certain tasks, such as moving their arms or legs, to help guide them.
In the second stage, the surgeon places an impulse generator battery into the abdomen or under the collarbone. This device provides the electrical impulses to the electrodes in the brain — a person can activate the device using a controller. A doctor performs this procedure under general anesthesia, so patients are asleep throughout.
Benefits and risks
DBS can significantly improve motor symptoms such as stiffness, tremors, dyskinesia, and slowness.
Although these motor symptoms may not disappear entirely, improvements from the surgery may mean a person can lower their medication dose, reducing any side effects they may experience. However, many people still require medication after DBS to control their symptoms.
A 2021 study investigating the long-term benefits of DBS found significant improvements in motor symptoms and quality of life as well as lower required medication doses. These improvements can last up to 15 years after surgery. DBS may also prevent fluctuations of symptoms by treating them constantly throughout the day, while medications, such as levodopa, can wear off, meaning a person’s symptoms return between doses.
There are further benefits of DBS — unlike other surgeries, it does not damage parts of the brain. Additionally, the effects of the surgery are reversible by turning off or removing the electrodes.
Although DBS can significantly improve many Parkinson’s symptoms, it does not improve nonmotor symptoms, such as constipation, memory problems, depression and anxiety, swallowing issues, and balance. And while the technique is generally safe, as with any brain surgery, there is a small risk of infection, bleeds, strokes, or complications due to the anesthetic. These risks have a 1–3% chance of occurring.
Additionally, experts do not have a complete understanding of the cognitive effects a person may experience after DBS. These effects can vary from person to person — some people may experience speech problems such as slurring words or a strained voice. Other possible risks after DBS surgery are the development or worsening of swallowing difficulties and psychological issues such as apathy and depression.
Some people may experience an instant but temporary improvement in their symptoms, known as the “honeymoon phase.” This effect may last up to a few weeks before symptoms return to their normal levels. The full effects of DBS surgery usually take a few months to show. It may also take specialists several attempts to optimize the DBS device for the best results.
Thalamotomy is another possible surgical option for Parkinson’s disease. It is a
Procedure
During a thalamotomy, surgeons lesion a part of the brain called the thalamus. The surgery can help treat tremors but does not have a significant effect on other Parkinson’s symptoms.
A person is awake during this surgery. First, the surgeon uses a CT scan or MRI to locate the area for treatment. Then, during the surgery, they circulate liquid nitrogen into a probe that lesions the targeted part of the brain.
Surgery on one side of the brain affects the other side of the body. For this reason, thalamotomy tends to be an option for people who experience severe tremors on one side of the body that do not respond to medication.
Benefits and risks
While thalamotomy may help reduce tremors, doctors do not often use this procedure. This is because it does not help with other symptoms, is typically less effective, and carries greater risks than other options, such as DBS.
This surgery also poses similar risks as DBS, such as possible bleeds and infections. In cases where a doctor performs a thalamotomy on both sides of the brain, adverse effects, such as cognitive issues and swallowing problems, are far more likely.
Pallidotomy is similar to thalamotomy, but surgeons instead lesion a part of the brain called the globus pallidus internus, or pallidum.
Procedure
A surgeon will perform a pallidotomy in the same way as a thalamotomy, using liquid nitrogen to lesion a targeted part of the brain. Pallidotomy surgery treats tremors and other movement disorders such as muscle rigidity and slow movement.
Benefits and risks
Pallidotomy can help with certain symptoms of Parkinson’s, such as stiffness and involuntary movements, but like thalamotomy, doctors do not perform it often due to its potential risks and the availability of DBS.
It shares similar risks to a thalamotomy and is also nonreversible due to the damage of brain tissue. Recovery from both thalamotomy and pallidotomy tends to involve a few days in the hospital, with full recovery within 6–8 weeks.
Focused ultrasound (FUS) is a noninvasive procedure that uses focused beams of acoustic energy to damage targeted areas of brain tissue.
Procedure
A patient is awake during the procedure and wears a special helmet called a transducer. The specialist team will use MRI to help guide where the energy beams converge.
Benefits and side effects
FUS is a less invasive approach than others — doctors do not need to make incisions or holes in the skull, meaning there is a lower risk of infections and bleeds. The procedure is also incredibly precise, limiting damage to surrounding parts of the brain.
Currently, a doctor may only use FUS for the treatment of tremors due to Parkinson’s. Clinical trials are investigating the potential benefits of FUS in targeting other areas of the brain to help treat symptoms such as dyskinesias.
A person can usually return home the same day as the procedure, but they may experience some side effects such as numbness in the face or arms, poor balance, and speech and swallowing problems. However, these side effects tend to be temporary.
There are several medications to treat the symptoms of Parkinson’s, including:
- carbidopa or levodopa and dopamine agonists to increase dopamine levels
- anticholinergics and amantadine to treat motor symptoms
- medicines to treat depression, psychosis, and dementia
- medicines to control blood pressure
Other treatment options to help a person manage their condition include:
- speech therapy
- occupational therapy
- physical therapy, which may comprise exercises such as dance and
tai chi
Although there is currently no cure for Parkinson’s disease, surgical options may help bring relief to motor symptoms, increase quality of life, and allow people to lower their medication dosage. A person may wish to consult with their doctor on the possible benefits and risks of their treatment options to understand which technique is best for them.