What kinds of procedures are used to treat Parkinson's?

The two types of procedures used to treat Parkinson's are deep brain stimulation (DBS) and ablative procedures.

Ablative procedures, such as thalamotomy and pallidotomy use cold or heat to destroy tissue in a part of the brain that is abnormally overactive in Parkinson's patients. Surgery performed on one side of the brain affects the other side of the body.

With deep brain stimulation (DBS), a thin electrode is implanted in the brain and attached to a battery-operated neurostimulator, which acts much like a heart pacemaker. It sends impulses to correct abnormal brain activity.

Brain surgery may be considered when drugs fails to control symptoms of Parkinson's disease or cause severe or disabling side effects. Surgery is not a cure for Parkinson's disease. Drugs are usually still needed after surgery. But surgery can reduce the number and amount of drugs needed to control symptoms. This reduces the side effects caused by drugs while at the same time controlling symptoms.

Surgery choices

• Deep brain stimulation affects movement by using electrical impulses to stimulate a target area in the brain. The electrical impulses are generated by wire electrodes surgically placed in the brain. Deep brain stimulation may be used in addition to therapy with levodopa or other drugs when drugs alone do not control symptoms adequately. This technique is the preferred surgical method of treating most cases of advanced Parkinson's disease. It does not destroy brain tissue and has fewer risks than older, more destructive surgical methods, such as pallidotomy and thalamotomy.
• Pallidotomy involves the precise destruction of a very small area in the deep part of the brain (the globus pallidus) that causes symptoms.
• Thalamotomy involves the precise destruction of very small area in the deep part of the brain (the thalamus) that causes symptoms.

Neurotransplantation is an experimental procedure being studied for the treatment of Parkinson's disease. It involves implanting cells that produce dopamine into the brain. Information about the effectiveness of neurotransplantation is limited. And it is not a proven treatment or a realistic option for most people at this time.

What to think about - A neurologist with special training in Parkinson's disease is most often the best kind of doctor to make a decision about surgery. If you might benefit from surgery or deep brain stimulation, your neurologist can refer you to a brain surgeon with experience doing these operations.

People who have extremely advanced Parkinson's or who have other serious conditions (such as heart or lung disease, cancer or kidney failure) are not usually good candidates for surgery. Surgery is usually not considered for people who have dementia or psychiatric disorders.