Monday, November 3, 2008

Kinds of Surgery for Parkinson's Disease

Frequently, people come to the clinic to inquire about surgery. Sometimes they've seen a program on the news, more often a family member suggested they look into it, and perhaps they looked it up on the internet. There are some professionally produced educational materials circulating, and some people have friends who have had procedures done and been pleased with the results, and passed on the educational materials they reviewed before surgery.

What people commonly don't realize is the complexity of the answers they have come seeking. There are a number of surgeries performed for PD, and it helps to draw some distinctions. In broad categories, there are surgeries in which brain cells are destroyed ("ablation" or "lesion" surgery), and surgeries in which an electrode is implanted and connected to a device similar to a pacemaker, often called the pulse generator (IPG, "implantable pulse generator"). Often, the IPG is casually called the "battery." Stimulators can be implanted in any number of ways at a variety of locations, but one method is FDA approved for PD, and it usually goes by the name "Deep Brain Stimulation," abbreviated DBS.

There are other, experimental surgeries as well, such as laying grids of electrodes over the surface of the brain, injecting gene therapies, transplant surgeries, or implanted pumps with nerve growth factors, but none of these appears particularly close to becoming a major clinical breakthrough.

With the rise of DBS surgery, very few lesion surgeries are now performed in the United States, although there may still be times, such as in infections, where they are the best choice.

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