When is surgery indicated in the treatment of Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Surgery is reserved for patients with disabling motor fluctuations and dyskinesia or disabling tremor that cannot be adequately controlled with medications. Key points to consider are as follows:

  • Ablative surgery such as thalamotomy, pallidotomy, and subthalamotomy have largely been replaced by DBS

  • Thalamic DBS is offered to the minority of patients with Parkinson disease who have predominant and disabling tremor (more commonly, this procedure is performed on patients with disabling essential tremor)

  • Bilateral STN DBS (or globus pallidus interna [GPi] DBS) is offered to patients with advanced Parkinson disease with disabling motor fluctuations and/or dyskinesia or disabling tremor that cannot be adequately controlled by medications; outcomes have been shown to be similar after STN and GPi DBS

  • Before surgery, the patient should be informed that these procedures do not cure Parkinson disease and that progression is expected


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