Ablative Brain Surgery - Uses - Parkinson's Disease

Parkinson's Disease

Parkinson's disease (PD) is diagnosed in the area of the basal ganglia, as it is a progressive degenerative disease. Pathologically, it is characterized by the loss of dopaminergic cells of the substantia nigra, pars compacta (SNc). Surgical ablation has been used to treat Parkinson's disease. In the 1990s, the pallidum was a common surgical target. Unilateral pallidotomy improves tremor and dyskinesia on one side of the body (opposite the side of the brain surgery), but bilateral pallidotomy was found to cause irreversible deterioration in speech and cognition. There are two other potential rapidly evolving surgical approaches to Parkinson's disease such as deep brain stimulation (DBS) and restorative therapies. The thalamus is another potential target for treating a tremor; in some countries, so is the subthalamic nucleus, although not in the United States due to its severe side effects. Stimulation of portions of the Thalamus or lesioning has been used for various psychiatric and neurological conditions, and when practiced for movement disorders the target is in the motor nuclei of the thalamus. Deep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. Generally, deep brain stimulation surgery (DBS) is considered preferable to ablation because it has the same effect and is adjustable and reversible. Thalamotomy is another surgical option in the treatment of Parkinson's disease. However, rigidity is not fully controlled after successful thalamotomy, it is replaced by hypotonia. Furthermore, significant complications can occur, for example, left ventral-lateral thalamotomy in a right-handed patient results in verbal deterioration while right thalamotomy causes visual-spatial defects. However, for patients for whom DBS is not feasible, ablation of the subthalamic nucleus has been shown to be safe and effective. DBS is not suitable for certain patients. Patients who suffer from immunodeficiencies are an example of a situation in which DBS is not a suitable procedure. However, a major reason as to why DBS is not often performed is the cost. Because of its high cost, DBS cannot be performed in regions of the world that are not wealthy. In the case of such circumstances, a permanent lesion in the subthalamic nucleus (STN) is created as it is a more favourable surgical procedure. The surgical procedure is going to be done on the non-dominant side of the brain; a lesion might be favored to evade numerous pacemaker replacements. More so, patients who gain relief from stimulation devoid of any side effects and need a pacemaker change may have a lesion performed on them in the same position. The stimulation parameters act as a guide for the preferred size of the lesion. In order to identify the part of the brain that is to be destroyed, new techniques such as micro electrode mapping have been developed. The advent of deep brain stimulation (DBS) has been an important advance in the treatment of Parkinson’s disease (PD). DBS may be employed in the management of medication-refractory tremor or treatment-related motor complications, and may benefit between 4.5% and 20% of patients at some stage of their disease course. DBS at high frequency often has behavioral effects that are similar to those of lesioning.In Australia, patients with PD are reviewed by specialised DBS teams who assess the likely benefits and risks associated with DBS for each individual. The aim of these guidelines is to assist neurologists and general physicians identify patients who may benefit from referral to a DBS team. Common indications for referral are motor fluctuations and/or dyskinesias that are not adequately controlled with optimised medical therapy, medication-refractory tremor, and intolerance to medical therapy. Early referral for consideration of DBS is recommended as soon as optimised medical therapy fails to offer satisfactory motor control.

Read more about this topic:  Ablative Brain Surgery, Uses

Other articles related to "parkinson, disease":

Parkinson - Places
... Parkinson, Queensland, a suburb of Brisbane, Australia. ...
Stephen Parkinson
... Stephen Parkinson (1 August 1823, Keighley – 2 January 1889) was a British mathematician ... Parkinson went up to St John's College, Cambridge as a sizar in 1841 and graduated as Senior Wrangler in 1845, beating William Thomson ... Parkinson was the author of two mathematical textbooks, Elementary Treatise on Mechanics (1855) and A Treatise on Optics (1859) ...
Sepan - Side Effects
... which are characterized as Drug-Induced Parkinson's disease and is the second leading cause of Parkinson's ... that has an active role in contributing to the development of drug-induced Parkinson's ... It is also of note that an estimated 17 of 100 new Parkinson's cases are linked to administration of either cinnarizine or Flunarizine, making cinnarizine and ...
Angela Owen-Taylor
... She is the first councillor elected for Parkinson Ward ... The Parkinson Ward stretches along the southern boundary of Brisbane City and includes Heathwood, Larapinta, Pallara, Algester, Doolandella, Parkinson, Willawong and parts of Calamvale and Forest Lake ...
Mists Of Krynn - The DL Modules - DL3 Dragons of Hope
... was written by Tracy Hickman, with a cover by Keith Parkinson, and illustration by Parkinson and Larry Elmore, and was published by TSR in 1984 as a. 2 detailed area maps and features art by Keith Parkinson ...

Famous quotes containing the words disease and/or parkinson:

    What is the disease which manifests itself in an inability to leave a party—any party at all—until it is all over and the lights are being put out?... I suppose that part of this mania for staying is due to a fear that, if I go, something good will happen and I’ll miss it. Somebody might do card tricks, or shoot somebody else.
    Robert Benchley (1889–1945)

    In politics people give you what they think you deserve and deny you what they think you want.
    —Cecil Parkinson (b. 1932)