Patient Selection for Surgery for Parkinson’s Disease

Abstract

The cornerstone of therapy for Parkinson’s disease (PD) is dopamine replacement with levodopa. The early years of treatment with levodopa are most predictable in obtaining a satisfactory therapeutic response. However, chronic administration can lead to problematic side effects, chiefly motor fluctuations and dyskinesias, in the majority of patients [1,2]. There has been an enormous resurgence of interest in functional surgery in PD in recent years as evidenced by the growing number of reported clinical trials in this area. Better understanding of the pathophysiology of basal ganglia dysfunction underlying PD and advancements in neuroradiological, neurosurgical and neurophysiological techniques have contributed to this trend. PD surgery involves lesioning or deep brain stimulation (DBS) of specific nuclei of the basal ganglia and cell replacement, details of which will be covered in other chapters of this book. It is worth emphasizing that surgical therapy can complement medical treatment in the more advanced cases of PD and improve quality of life [3]. A randomized study showed that DBS of the subthalamic nucleus (STN) was more effective than medical management alone in patients under 75 years of age with severe motor complications [4].