2. Deep Brain Stimulation:
This procedure involves passage of needles through brain tissue to place electrodes into targeted structures of basal ganglia and subsequently to provide high frequency stimulation to these structures. This procedure not only controls tremors associated with Parkinson’s Disease but other symptoms also.
This procedure is similar to ablative procedures, however has added advantage of fewer side effects, it can be performed bilaterally and postoperative adjustments can be made to improve symptom control and to minimize side effects. Another advantage is that it is reversible hence leaving room for further effective treatments.
Disadvantages include risk of brain hemorrhage with needle passage. Mechanical failure of the device and battery failure are also cause of concern. This procedure can cause infection in about 5% of those who undergo this procedure. It has extremely diverse stimulation variables as part of its settings hence achieving ideal settings for symptom control is not only very difficult but also labor intensive. There are very few and far between centers that offer this service and it is not that cost effective either. The tremor recurs when the device is turned off and the treated patients develop tolerance to this treatment over a period of time so that they gradually need higher level of stimulation to control the same symptoms, which could be controlled with lower intensity stimulation initially.
III. Side Effects:
Possible side effects of the procedure include speech and balance problems along with sensory and motor impairments and headache.
3. Restorative Procedures:
These procedures include stem cell transplantation and fetal cell transplantation. These procedures facilitate reinnervation of dopaminergic brain neurons.
These have the advantage of being one time procedure without significant side effects and with permanent restoration of dopaminergic neurons and solution to the problem.
Accurate placement of the regenerative cells is a problem along with ethical issues about use of fetal cells for transplant. These procedures are still in their infancy and need further trials and collection of data to conduct these on large scale.
4. Always Remember:
Surgery will effectively control symptoms only in those patients who had good control of symptoms on levodopa. Surgical treatment is reserved only for those patients who have tried all the medical treatments previously without any relief or for those patients who have extreme fluctuations in their motor symptoms such as wearing off or dyskinesias. Surgery is offered to those who have symptoms unresponsive to medical treatment or longstanding medical treatment has resulted in unbearable complications and whose general medical status is good.Surgery controls the symptoms but does not arrest the progression of disease and most of the patients will still need medications (although in lesser quantity) for symptom control.
Most common surgical intervention used for symptomatic improvement of Parkinson’s disease is deep brain stimulation.