What surgical approaches are available for Parkinson's disease?

Some older surgical techniques for Parkinson's disease include pallidotomy and thalamotomy, which involves making a small stroke in the brain to suppress excessive activity. While they work well for a few years there is a tendency for symptoms to be back where they started in three to four years. Deep brain stimulation (DBS) involves placing an electrode in the brain to deliver continuous high-frequency electrical stimulation to various parts of the brain that control movement. The big advantage of deep brain stimulation is that it is programmable. Just as we increase medications to keep pace with the disease, we can, over time, increase the DBS settings and continue to maintain good symptom control. The other advantage is that surgery on both sides of the brain is a lot safer with DBS than with the old lesioning techniques. Transplantation and gene therapy with surgical techniques are experimental strategies that are not yet ready for prime time.