Two older, and somewhat outdated, lesioning procedures that provide relief from Parkinson's symptoms are pallidotomy and thalamotomy. Pallidotomy can alleviate rigidity and bradykinesia symptoms, and thalamotomy helps to control tremors. Doctors rarely perform either procedure because both permanently destroy parts of the brain and have serious side effects. The damage could make it impossible to perform surgeries that may become available in the future, such as brain tissue transplants.
Deep brain stimulation (DBS) , a safer and more effective surgery, has replaced these methods. It is a preferred surgical option because it has the same, if not better results than pallidotomy and thalamotomy. DBS also leaves open the possibility of other therapies, should they become available in the future. As with any surgical procedure, there are risks and side effects. The main benefit of DBS surgery is to reduce motor fluctuations i.e. the ups and downs caused by a decreasing effectiveness of Sinemet.
The electrode is usually placed on one side of the brain. The DBS electrode implanted in the left side of the brain will control the symptoms on the right side of the body and vice versa. In some cases, patients will need to have stimulators on both sides of the brain.
During surgery, a device is implanted to provide an electrical impulse to a part of the brain involved in motor function. This is often the subthalamic nucleus, in a deep part of the brain called the thalamus. During the procedure, electrodes are inserted into the targeted brain region using MRI and neurophysiological mapping to ensure that they are implanted in the right place. The electrodes are connected to wires that lead to an impulse generator or IPG (similar to a pacemaker) that is placed under the collarbone and beneath the skin. Patients have a controller, which allows them to verify whether the DBS is 'on' or 'off'. They can use this device to check the battery and to turn the device 'on' or 'off'. An IPG battery lasts for about 3 to 5 years and is relatively easy to replace under local anesthesia.
Patients considering one or another surgical procedure should discuss the options first with their movement disorder specialists and then with their families and/or caregivers.
For more information on DBS, order from PDF our comprehensive booklet "Surgery for Parkinson's Disease", written by our medical advisor Dr. Blair Ford. To order your free copy, send a request by email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Or you can get information on the web by visiting these sites:– www.medtronic.com/UK/patients/neuro/brain_stimulation.html
– www.clevelandclinic.org/neuroscience/treat/movement/dbs.htm
– www.rewiredforlife.org
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