Title:Surgical Advances in Parkinson’s Disease
Volume: 22
Issue: 6
Author(s): Victor S. Hvingelby and Nicola Pavese*
Affiliation:
- Department of Clinical Medicine, Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
- Clinical
Ageing Research Unit, Newcastle Upon Tyne, Newcastle University, United Kingdom
Keywords:
Deep brain stimulation, MRgFUS, movement disorder, neuromodulation, neurosurgery, Parkinsons.
Abstract: While symptomatic pharmacological therapy remains the main therapeutic strategy for Parkinson’s
disease (PD), over the last two decades, surgical approaches have become more commonly
used to control levodopa-induced motor complications and dopamine-resistant and non-motor symptoms
of PD. In this paper, we discuss old and new surgical treatments for PD and the many technological
innovations in this field. We have initially reviewed the relevant surgical anatomy as well as the
pathological signaling considered to be the underlying cause of specific symptoms of PD. Subsequently,
early attempts at surgical symptom control will be briefly reviewed. As the most well-known surgical
intervention for PD is deep brain stimulation, this subject is discussed at length. As deciding on
whether a patient stands to benefit from DBS can be quite difficult, the different proposed paradigms
for precisely this are covered. Following this, the evidence regarding different targets, especially the
subthalamic nucleus and internal globus pallidus, is reviewed as well as the evidence for newer proposed
targets for specific symptoms. Due to the rapidly expanding nature of knowledge and technological
capabilities, some of these new and potential future capabilities are given consideration in
terms of their current and future use. Following this, we have reviewed newer treatment modalities,
especially magnetic resonance-guided focused ultrasound and other potential surgical therapies, such
as spinal cord stimulation for gait symptoms and others. As mentioned, the field of surgical alleviation
of symptoms of PD is undergoing a rapid expansion, and this review provides a general overview of
the current status and future directions in the field.
