The surgical treatment of parkinsonism

Abstract

An unselected series of 60 patients with Parkinsonism have been treated by stereotaxic electrocoagulation cerebral lesions. Of these patients 53, or 88%, have had tremor and/or rigidity abolished or significantly reduced without complications in the treated limbs, and have been followed for up to five years. Six patients, despite successful treatment of limb tremor and/or rigidity, have persisting complications of the operations. In only one case have limb tremor and rigidity been unimproved. These results have been achieved by accurate siting of the lesion and by making it as small as would be compatible with maintained improvement. The method used has evolved progressively, and is unique, in allowing the creation of lesions in the globus pallidus, internal capsule, or thalamus with one electrode track at different depths. Such combined lesions are usually necessary to eliminate contralateral limb rigidity and tremor. As a result of our experience we believe that the selection of patients for operation should be governed by the degree of widespread manifestations of Parkinsonism pre-operatively. Where widespread manifestations are present, surgical lesions to treat limb tremor and rigidity cannot be large or inexactly placed, otherwise mental deterioration characterized particularly by akinesis will be accentuated. © 1960, British Medical Journal Publishing Group. All rights reserved.