Neurosurgical procedures are now available and covered by insurers to treat some symptoms of Parkinson disease that no longer respond well to medication therapy alone.

Deep brain stimulation (DBS) is the most commonly chosen surgery. DBS involves placing a lead (thin wire), deep into the mid-brain. This lead is attached to a neurostimulator that is implanted in the chest wall. The neurostimulator is turned on and off by a magnetic device, much like a pacemaker for the heart. Deep brain stimulation is an effective treatment option for moderate to severe PD symptoms.

Other surgeries used to treat Parkinson's Disease include thalamotomy, pallidotomy, and subthalamotomy. Of these, pallidotomy and DBS have produced the best results to date in treating Parkinson's Disease. Patients who have surgery to help control Parkinson symptoms typically still require reduced doses of antiparkinson medication.

Pallidotomy is a technique in which a heated probe is inserted into the brain to precisely destroy a small area of brain cells in the region known as the globus pallidus. Pallidotomy can improve tremor, rigidity, bradykinesia, motor fluctuations, and in some cases, walking and balance.

There are advantages and disadvantages to pallidotomy and DBS:

Pallidotomy

• Permanently destroys a small area of brain cells
• Involves no implanted devices
• Should not be done bilaterally

Deep Brain Stimulation

• Does not destroy brain tissue
• Is reversible
• Can be done bilaterally
• Requires re-programming as symptoms change
• Involves the possibility of hardware malfunction

Both procedures involve a small risk for intracranial (within the skull) bleeding or strokes at the time of surgery. Neither procedure should be considered for a person with PD who also has dementia (marked confusion).

If you and the person in your care are considering surgery as a treatment to reduce Parkinson's Disease symptoms:

• Consult with a neurologist who has completed a fellowship in movement disorders. This individual should not be the same neurosurgeon who will perform the elective surgery. Do not be shy about asking for the doctor's credentials.
• Do your homework. Learn about DBS and look into the hospitals you are considering. (NPF has a patient education booklet devoted to DBS.) Choose a neurosurgery center with an interdisciplinary team of healthcare professionals with the training, technology, and expertise required.
• Be prepared to invest a lot of time, energy, and travel for pre-and postoperative appointments. A significant number of postoperative visits are necessary during the first six months after surgery.

Surgery is a serious step. Ask as many questions as you need before deciding to go ahead.

• Why does the person need the surgery?
• Will the surgery stop the problem or merely slow its progress?
• Are there other options?
• Can it be done on an outpatient basis (where the person is not admitted to the hospital)?
• What will happen if surgery is not done?
• Where will the surgery be done? When?
• Will the surgeon you spoke to do the surgery or will it be assigned to another doctor? (When going into surgery, put the surgeon's name on the release form to ensure that the named surgeon is the one who does the operation.)
• How many surgeries of this type has the doctor performed? (Generally, the more times the surgeon has performed an operation, the higher the success rate will be.)
• What is the doctor's success rate with this type of surgery?
• What are the anesthesiologist's qualifications?
• What can go wrong?
• How much will it cost, and is it covered by insurance or Medicare?
• What other specialists should be asked for a second opinion? (Medicaid and Medicare usually pay for second opinions. Doctors expect people to go for a second opinion when surgery is needed, and they should help you find one.)