Parkinson's Disease (PD) is a brain disorder that affects as many as 1 million Americans, according to the Parkinson's Disease Foundation. PD occurs when certain nerve cells in the brain are impaired or destroyed, altering the levels of dopamine in the brain. Dopamine, a chemical produced by nerve cells, is essential for the central nervous system and is responsible for creating smooth and coordinated movements in the body. A drop in dopamine levels creates the symptoms of PD, which include tremors, slow movements, trouble balancing and stiffness. For those who cannot get relief from their symptoms with medications, or whose medications cause too many side effects, there are several surgical treatments available.
Thalamotomy
Thalamotomy is a type of brain surgery that targets the thalamus, a group of nerves in the brain responsible for controlling movement. To perform this procedure a doctor uses a small heat probe to destroy the tissue of the thalamus. The lesion created interferes with the abnormal brain activity produced by these cells that resulted in tremors.
The American Academy of Neurology reports that performing a thalamotomy on one side of the brain can help relieve tremors, but that the procedure is not recommended for both sides of the brain because it can cause disabling side effects. Although this procedure can help to relieve tremors, according to the National Parkinson Foundation, it is no longer the surgical procedure of choice for most doctors.
Pallidotomy
A pallidotomy is a surgical treatment that involves destroying the tissue in the region of the brain known as the globus pallidus (GPi). When dopamine levels are low, the GPi region of the brain produces abnormal activity that results in movement difficulties. Destroying the tissue of the GPi region can help to restore normal movements. In fact, the We Move website reports that patients experience a 70 to 90 percent reduction in dyskinesia (repetitive spasmodic movements) and dystonia (prolonged muscle contraction) and a 25 to 50 percent reduction in tremors, stiffness, slow movements and gait problems.
Pallidotomy is typically performed on one side of the brain, which improves the movement issues on the opposite side of the body. It can be done on both sides of the brain; however, it also can interfere with cognition, speech and swallowing, so it is not usually recommended.
Deep Brain Stimulation
Deep brain stimulation (DBS) is currently the standard procedure performed, according to the Parkinson's Disease Foundation, which reports that more than 30,000 people have had DBS. DBS does not involve destroying any tissue in the brain, but rather the insertion of small electrodes that are controlled by an impulse generator. By delivering small electrical impulses to specific areas of the brain, DBS can help to "pace" those areas that are producing abnormal activity. Depending on the type and severity of the symptoms, DBS electrodes can target different areas of the brain, including the thalamus, the GPi or the subthalamic nucleus. DBS can be performed on both sides of the brain without further complications.
