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Movement Disorders

April, 1999

1. Does surgery cure Parkinson's disease?

   Answer: No. Surgery alleviates or helps improve some symptoms only. <

2. Do I need to take Parkinson medications after surgery?

   Answer: Yes. After surgery you may take less, same, or more medications depending on your symptoms.

3. Is surgery for Parkinson's disease dangerous?

   Answer: Every surgery in the brain can be potentially dangerous and surgery for Parkinson's disease is no

4. Does surgery for Parkinson's disease provide permanent improvement?
   Answer: Preliminary studies demonstrate that postoperative improvement lasts several years in most patients. However, one should not forget that some symptoms may return or other symptoms appear after surgery as a result of progression of the disease.

5. Can surgery be performed for both sides?

   Answer:Yes, but the risks are greater. This is especially true for pallidotomy or thalamotomy performed on both sides although many patients do well. In theory, deep brain stimulation should be safer to perform on both sides because of its potential reversibility.

6. Can surgery be repeated if symptoms reappear?

   Answer: Yes. This is however determined individually based on the location and size of the old lesion, the nature of symptom recurrence, and the general medical condition.

7. Which surgery is better: pallidotomy, thalamotomy, or DBS?

   Answer: This is not clear. If tremor is the major problem, then thalamotomy or DBS offer the best chance for tremor control; however, pallidotomy can also be effective. If control of other symptoms such as rigidity, dyskinesia, or walking is needed, then pallidotomy or DBS can be effective. The effect of DBS varies with the location of the implanted electrode. Compared to pallidotomy and thalamotomy, DBS is a potentially reversible procedure; however it carries a slightly higher risk of infection and the inconvenience of interference with some magnetic and high frequency fields. For these and other reasons, patients should discuss with their physicians what surgery would best fit their needs.

8. Are there other "laser" surgeries available for Parkinson's disease?

   Answer:If you mean surgery without using a knife then the answer is yes. The surgery does not use laser but utilizes focused radiation directed to the desired structure in the brain. The disadvantage of the procedure is that it relies solely on anatomical information without physiological confirmation. The advantage is that it does not require actual cutting in the head. The results of the radiation treatment are encouraging but are still considered preliminary.
   

9. When should patients with Parkinson's disease referred for surgery?

   Answer: When medications stop controlling symptoms because of severe fluctuations in the response, lack of effectiveness, or development of side effects.
   

10. Which patients are usually excluded from pallidotomy?

    Answer:Patients with severe depression, advanced dementia, unstable medical condition, and patients who have symptoms similar to Parkinson's disease but who carry other diagnosis such as Parkinson plus or multi-system atrophy.