Deep brain stimulation & other surgical treatments
Deep brain stimulation (DBS)
As Parkinson’s progresses you may find that medication does not adequately control your symptoms. If this happens, your doctor may recommend deep brain stimulation (DBS).
DBS is a treatment option for people with Parkinson's whose motor (movement) symptoms no longer respond adequately to medication. DBS is also used for other movement disorders such as dystonia and essential tremor.
DBS therapy uses a small, pacemaker-like device to send electronic signals to a precise area in the brain that controls movement (either the subthalamic nucleus (STN) or the internal globus pallidus) via very thin wires. Stimulation of these areas appears to block the brain messages that cause disabling motor symptoms and so can provide greater symptom control. Each person has a programmer and once this has been programmed by a specialist, the programmer can be adjusted to give a level of stimulation that provides the best possible symptom control. For the right candidate, this can provide greater control over body movement and so improve quality of life but DBS is not suitable and will not work for everyone.
For more detailed information see:
Other surgical treatments
Over time, medication may no longer effectively control Parkinson’s symptoms. In some carefully selected cases, surgery may help. Neurosurgery (surgery of the brain) focuses on three target areas to treat Parkinson’s:
- the subthalamic nucleus (STN) – this seems to be the site that helps most symptoms so is more favoured
- the thalamus - for treating drug-resistant tremor
- the globus pallidum internus (GPi), a part of the globus pallidus - for treating stiffness, dyskinesia and akinesia, dystonia and pain
The choice of treatment and the target selected is based on a careful evaluation of each patient and his or her needs.
Neurosurgery is usually only considered for people with Parkinson’s whose symptoms are no longer adequately controlled by medication. It is generally not recommended for anyone with psychiatric problems, dementia, cerebrovascular disease, uncontrolled high blood pressure or for people over 75.
The first step when considering surgery is to discuss it with your doctor. He or she will then refer you to both a neurologist and a neurosurgeon who specialise in treating Parkinson’s. Each form of surgery carries its own risks and you should discuss these, and the likely benefits, with the experts.
Your neurosurgeon will answer your questions and explain what the surgery involves and what happens afterwards. You may also want to ask how many operations the surgeon has performed and the results that have been achieved.
This involves very carefully damaging a particular part of the brain. The damage is called a lesion. Computer imaging is used to locate the target site precisely. The lesion is made by inserting an electrode with its tip at the site and then passing an electric current through the tip.
There are currently three target areas for lesioning:
- Pallidotomy – This is the most common lesioning technique, in which a lesion is made in the GPi area of the brain. This is usually only carried out on one side of the brain; more rarely both sides are lesioned to control severe symptoms, but the risks are greater.
- Thalamotomy – A lesion is made in the thalamus, usually only on one side, as treating both sides is thought to be too risky.
- Subthalamotomy – A lesion is made in the STN area of the brain. This is less commonly used because it carries higher risks and the long-term effects are unclear.
Because lesioning is irreversible and cannot be modified without further surgery, it is not ideal and is unlikely to be a long-term treatment option.
Gamma knife surgery
This is a type of radiotherapy which involves directing gamma radiation through the skull at damaged brain tissue. The risks of this surgery are relatively high compared to other techniques and it is therefore not currently considered practical.
Other surgical techniques under research
For information on other techniques currently under research see Current research.
Last updated: October 2015