Parkinson’s Disease

You are here

Surgery for Parkinson’s Disease

The primary goal of surgery is to reduce the motor symptoms and tremors of Parkinson’s disease, as well as the side effects that can come from some of the medications used to treat the disease, such as dyskinesia (too much involuntary movement after medication) or motor fluctuations (increasing randomness as to when and for how long the medications will work). Another goal of surgery is to increase the number of hours of “on” time (time spent in a better, less symptomatic state) each day.

Deep Brain Stimulation (DBS) is a minimally invasive surgical procedure to treat neurological symptoms of Parkinson’s disease, including tremors, rigidity, and movement control.

DBS uses a neurostimulation device, similar to a heart pacemaker, to deliver electrical pulses to a very precise location in the brain circuits that influence Parkinson’s disease symptoms. Abnormal activity in these circuits is what causes many of the movement problems in Parkinson’s disease; the electrical pulses from the DBS device blocks the activity of these circuits so the rest of the brain can function more normally. This can lead to improvement in many of the symptoms that had previously been helped by medication but that no longer respond adequately. Deep brain stimulation also usually reduces complications often seen with medication. Successful patients often can reduce substantially the amount of medication that they must take each day.

The procedure involves placing battery-operated neurotransmitters under the collarbone. The devices are connected to a wire under the skin that runs up the length of the neck into the scalp, where it is placed into the brain through a small hole in the skull. The tip of this wire sends the electrical impulses generated by the neurotransmitter into the precise spot in the brain that regulates activity of the key circuits in Parkinson’s disease.

The procedure can be done in one or two stages, which can be performed in a single day or on consecutive days.

  • The first stage, in which the electrode is placed in the brain under MRI guidance, is done while the patient is awake. The patient must be awake to provide feedback during surgery and to permit the surgeon to monitor brain activity to make sure the electrode is placed in the correct place. Other than a brief pinch for an injection of local anesthetic to numb the skin, there is generally no pain associated with this procedure. This first stage usually involves a single overnight hospital stay.
  • The second stage, in which the neurotransmitters are placed under the collarbone and connected to the end of the electrode just under the skin, is very similar to that of receiving a heart pacemaker. This second procedure is performed under general anesthesia since it does not require any patient feedback, and it usually requires another overnight stay.

 

As with all surgical procedures, DBS poses a small risk of bleeding and infection. There are also potential risks related to the device, such as breakage or movement of a wire. The major benefit of DBS, however, is that it does minimal damage to the surrounding brain tissue, as can happen with other surgeries. The implanted device can also be reprogrammed wirelessly and painlessly without additional surgery, so that the treatment is individualized to each patient. The therapy can also be reversed as technologies advance for improved treatments in the future.

The best candidates for DBS are patients who have tremors, stiffness, slowness, and other movement-related symptoms that had previously responded to medication but that are becoming more problematic despite increasing doses and/or numbers of medication. Those who suffer complications from medications — but still respond to them — are also excellent candidates. In these patients, deep brain stimulation usually reduces both the complications and the amount of medication needed.

Lesioning Surgery
An older alternative to DBS is lesioning surgery, in which a probe is placed into similar brain targets as DBS. Instead of leaving an electrode, the probe is heated to destroy a portion of the brain target. The idea is to eliminate the part of the brain that is firing abnormally in Parkinson’s disease. These procedures are usually only performed on one side of the brain, since patients can have increased complications from destroying the same target on both sides of the brain. The effects of lesioning can often wear off over time, and the surgery itself is permanent and cannot be reversed. For all of these reasons, lesioning is performed much less frequently in most centers today and is usually considered only in patients who for some reason are poor candidates for DBS or who have had DBS and cannot tolerate the device due to repeated infections or other unusual complications. The two major types lesioning for Parkinson’s disease include:

Pallidotomy: this brain surgery destroys a portion of the internal part of the globus pallidus region of the brain (GPi) and can be most effective at helping to control the adverse effects from medication, as well as some of the involuntary muscle twisting, contracting, and repetitive movements called dystonia. (Dystonia is a movement disorder that can arise from Parkinson’s disease or other conditions, or develop on its own. Read more about Dystonia.) It can help with the other movement symptoms of Parkinson’s disease as well, although it is usually difficult to reduce the amount of medication taken with this surgery.

Thalamotomy: this procedure destroys part of the thalamus region of the brain (Vim), which can help in reduce tremors. However, the surgery is usually not very effective for symptoms other than tremor; even when tremor is the primary symptom, other problems such as muscle stiffness and slowness can develop over time and those are usually not helped from this procedure. This surgery is most effective in patients who have mostly tremor and who do not have many other symptoms and also do not have speech or gait issues.

The Movement Disorder service of the Weill Cornell Brain and Spine Center is a leader in the diagnosis and treatment of Parkinson’s disease, and also conducts groundbreaking laboratory research and clinical trials to improve our understanding and treatment of this disorder. Led by pioneering researcher and neurosurgeon Michael Kaplitt, M.D., Ph.D., the Movement Disorder service provides state-of-the-art options for Parkinson’s treatment, including minimally invasive deep brain stimulation surgery.

Request an Appointment | Refer a Patient

Reviewed by Michael Kaplitt, MD, PhD
Last reviewed/last updated: April 2015