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What are all the surgical treatments available for PD?

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I would like to know all the options in surgical treatment for PD.

Is Radiosurgery used at all?

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There are currently several techniques used for DBS in PD. The most common and most preferred is DBS of the GPi or STN. There are several randomized studies which will be published soon, but both sites seem to be effective. DBS of the thalamus has fallen out of favor as it only addresses tremor (it however is done for PD tremor occassionally).

 

Lesions can take several forms, but are falling out of favor because DBS is reversible and can be performed bilaterally without the same level of speech and swallowing problems.

 

Possible lesions-

 

Thalamotomy- for tremor- performed in the thalamus

Pallidtotomy or subthalamotomy- for all motor symptoms of PD that are levodopa responsive- done in the globus pallidus or subthalamic nucleus.

 

Radiosurgery with Gamma Knife and other techniques has fallen out of favor because it is hard to control lesion size and there can be resultant complications (see Archives of Neurology 2001).

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